Children and Adolescents and Digital Media

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.

Lifestyle Interventions in Pediatric Primary Care

Pediatric clinicians should offer guidance on age-appropriate nutrition, physical activity, sleep and screen time for families of children and adolescents with obesity. They should build rapport with families, ask permission before discussing obesity-related health concerns, use preferred terminology, and recommend whole family change. Using principles of shared decision-making, pediatric clinicians and families should set individualized goals for lifestyle changes, prioritizing reducing sugar-sweetened beverage intake, increasing physical activity, and reducing screen time. Families of children and adolescents with obesity should be connected to the highest level of support accessible to and desired by the family, including intensive health behavior and lifestyle treatment programs.

Domestication of Information and Communication Technologies into Family Systems: A Conceptual Framework Evaluating Family Health

As the world undergoes its fourth industrial revolution, digital media are becoming more prevalent in both rural and urban communities. This shift has had a profound impact on our daily lives, transforming the way we live, work, and communicate. Although technology now plays a crucial role in our daily routine, it can lead to interference in human relationships, a phenomenon referred to as technoference. This interference has significant consequences, particularly in parent-child relationships, as it can adversely affect children's emotional and behavioral development and the mental health and overall functioning of parents. Thus, for children to grow up healthy and for families to be harmoniously balanced, all the family subsystems need to be aligned in a healthy manner. This study conceptualizes how family health is affected when technological devices are brought as a subsystem into a family system. The researchers developed a conceptual multidimensional framework based on several interrelated theoretical concepts, and this framework is presented in three sequential frames for better comprehension, to identify how the interference, in particular, impacts the various dimensions of a healthy family system and contributes to dysfunctional family functioning and mental health issues in both parents and children.

Relationships between screen time and childhood attention deficit hyperactivity disorder: a Mendelian randomization study

Background

In previous observational studies and meta-analyses, childhood attention deficit hyperactivity disorder (ADHD) is found to have a significant association with screen time. However, the causal associations between them remain unclear.

Method

This study performed a bidirectional two-sample Mendelian randomization (MR) analysis to confirm the causality between screen time and childhood ADHD. Large-scale genome-wide association studies (GWAS) datasets derived from the Psychiatric Genomics Consortium (PGC) and the UK Biobank were used to identify single nucleotide polymorphisms (SNPs) associated with exposure and outcome. Four categories of datasets were selected to represent screen time. The SNPs that are significantly associated with exposure data (P < 5e-08) and have a strong correlation with the exposure in the F-statistic (F > 10) were selected as instrumental variables. This study also used the PhenoScanner V2 database and the LDlink webtool to exclude confounding factors, and the MR-PRESSO method (p < 0.05) was employed to eliminate outliers with bias. Five commonly used methods were employed to assess the interaction and the Inverse Variance Weighted (IVW) method was utilized as the primary basis for determining the MR estimates in this study.

Results

The MR analysis revealed that the length of mobile phone use (OR, 1.848; 95% CI, 1.3360-2.5558; p=2.07e-4) and the time spent watching television (OR, 2.104; 95% CI, 1.3958-3.1703; p=3.8e-4) increased the risk of childhood ADHD. Although the causal relationships were exclusively identified through the IVW and weighted median methods, the results retained their statistical significance following correction. In the reverse analysis, no evidence was found to support an effect of childhood ADHD on screen time. The sensitivity analysis conducted on the significant findings revealed no evidence of horizontal pleiotropy or heterogeneity.

Conclusion

This study provides some evidence for the causality of screen time and childhood ADHD. Given the limitations of our study, further research is required to comprehensively investigate this relationship.

Dose-Response Associations of Internet Use Time and Internet Addiction With Depressive Symptoms Among Chinese Children and Adolescents: Cross-Sectional Study

Background

Children's lives are increasingly mediated by digital technologies, yet evidence regarding the associations between internet use and depression is far from comprehensive and remains unclear.

Objective

This study aimed to investigate the dose-response association between internet use, including use time and addiction behaviors, and depressive symptoms among children and adolescents in Zhejiang Province.

Methods

Data were collected from a school-based health survey China Common Disease and Risk Factor Surveillance Among Students, encompassing 21,336 students in Zhejiang Province. The daily internet use time, internet addiction (IA) behaviors, and depressive symptoms were assessed with questionnaires. Logistic regression models were used to explore the associations of internet use time and IA behaviors with depressive symptoms among children and adolescents. Restricted cubic spline curves were used to determine the dose-response associations.

Results

A total of 6225 (29.2%) students had depressive symptoms. Compared to those reporting no internet use, boys using the internet for >2 hours/day (odds ratio [OR] 1.53, 95% CI 1.34-1.74) and girls using internet for 1.1-2 hours/day (OR 1.22, 95% CI 1.06-1.39) and >2 hours/day (OR 1.70, 95% CI 1.50-1.93) were at higher risks of depressive symptoms. A significant J-shaped association was identified between internet use time and depressive symptoms among children and adolescents, especially in boys and primary school students (nonlinear P values were .006, .003, and <.001, respectively). Increased IA behaviors were associated with a higher odd of depressive symptoms (1 IA behavior: OR 2.01, 95% CI 1.83-2.21; 2 IA behaviors: 2.91, 95% CI 2.57-3.29; and ≥3 IA behaviors: 4.72, 95% CI 4.26-5.22). A positive nonlinear association between the number of IA behaviors and depressive symptoms was found in total population, girls, and primary school students (nonlinear P values were .02, .002, .007, respectively).

Conclusions

Findings suggested that excessive internet use time and IA behaviors were significantly associated with an increased risk of depressive symptoms, highlighting the importance of interventions to regulate and educate about adequate internet use during childhood and adolescence.

Nigerian adolescents' exposure to fast food marketing via Instagram

OBJECTIVES

To explore the promotion of fast food to lower-income adolescents on Instagram with the specific aims of (i) identifying the marketing strategies used by fast food brands on Instagram to promote fast food to Nigerian adolescents and (ii) examining the influence of these strategies on user engagement.

DESIGN

A content analysis of posts from a 90-day period of the Instagram accounts of five fast-food brands in Nigeria was conducted. Overall, 576 posts were analysed, using a codebook developed based on the relevant literature, to identify adolescent-targeted strategies. User engagement was measured by number of likes each post received.

RESULTS

The observed brands frequently utilised adolescent-targeted marketing strategies, with the most popular strategies being emotional appeal, 'teen language' and product appeal. The results of Mann-Whitney U tests revealed significant associations between the use of these promotional strategies and user engagement. Adolescent-aimed strategies like product appeal and competitions resulted in higher user engagement with fast food promotional content.

CONCLUSION

Fast food companies heavily target lower income adolescents through the use of Instagram. This raises health concerns related to the consumption of unhealthy food that arises from regular advertising in that demographic. Further, this exposure increases ad interactions that could cause adolescents to view fast foods more positively. Overall, findings indicate the need for actions aiming to limit and reduce the effect of adolescents' exposure to fast food marketing on social media, to target the features of social media platforms which affords users the ability to interact with fast food advertisements.

Socio-demographic and other factors contributing to excessive leisure screen time in preadolescent children

OBJECTIVES

Excessive screen use in early school age is associated with worsened health habits and negative child development in later age. We aimed to assess the time spent on modern and traditional screen-based devices and examine its associations with socio-demographic characteristics.

METHODS

This population-based cross-sectional observation study was conducted in Czechia, Slovakia and Finland between April and June 2021. Participants (N = 1,915) were parents/caregivers of children attending elementary school grades 1 to 3, selected by stratified random sampling. Children's daily leisure screen time (LST) based on parental reports was the main outcome. Descriptive statistics, mean comparison and linear regression analysis were used for the analysis.

RESULTS

The average daily LST was found to be as high as 3.5 hours and significantly associated with most socio-demographic variables. Eighty percent of children exceeded the threshold of two hours of LST per day, which was formerly introduced by the American Academy of Pediatrics. The most important predictor of LST in children was having their screen-based device(s) for their exclusive personal use (EPU). Linear regression with all predictors assessed together confirmed the significant effect of the screen-based devices' EPU, the child's sex and grade, the child's birth order and the parent's education, even when controlled for media parenting practices.

CONCLUSIONS

Given the widespread availability of smartphones for exclusive personal use among young children, the regulation of EPU and the reinforcement of effective media parenting practices, particularly in families with lower education and income, are critical public health strategies to mitigate the negative impact of excessive screen time on child development and overall well-being.

Adverse Childhood Experiences and Excessive Recreational Screen Time Among Adolescents in the United Kingdom: A National Longitudinal Study

PURPOSE

This study aimed to investigate the associations between adverse childhood experiences (ACEs) and excessive recreational screen time.

METHODS

Using data from the UK Millennium Cohort Study, we examined the associations of prospectively collected individual ACEs, ACE scores, and poverty with excessive recreational screen time (>4 hours) across different media types. We ran further analyses to investigate sex differences in the associations of ACEs with excessive screen time. The robustness of these associations were tested by controlling for sociodemographic factors.

RESULTS

Among the included 11,439 adolescents (49.9% boys), those who experienced three or more ACEs were more likely to partake in excessive screen time compared to those with no ACEs after adjusting for covariates. This included recreational internet time at age 14, television time at age 14, electronic game time at ages 14 and 17, and social networking time at ages 14 and 17. We found similar associations between individual ACEs and excessive screen time. For example, parental mental health problems were associated with excessive recreational internet time (odds ratio [OR]: 1.28; 95% confidence interval [CI]: 1.15, 1.42), excessive television time (OR: 1.14; 95% CI: 1.01, 1.28), and excessive electronic game time (OR: 1.34; 95% CI: 1.16, 1.56) at age 14. Boys showed stronger associations between certain ACEs and excessive screen time compared to girls.

DISCUSSION

ACEs and poverty are associated with adolescents' later excessive recreational screen time, including excessive time spent on television watching, electronic games, and social networking.

Intergenerational care and rural childhood obesity in the digital era: Based on screen exposure perspective

Background

Rural Chinese children are experiencing increasing obesity rates, yet studies often neglect the impact of IT and screen media growth on obesity risks in the context of intergenerational care, leading to incomplete strategies for the digital era.

Methods

By comprehensively utilizing the data on rural children aged 6-17 from the China Family Panel Studies (CFPS) and the China Health and Nutrition Survey (CHNS), this study aims to test the logical chain and specific mechanisms regarding "intergenerational care - screen exposure - rural childhood obesity". We employ the Propensity Score Matching (PSM) and Generalized Propensity Score Matching (GPSM) methods to respectively address the self-selection biases associated with inter-generational care and children's screen exposure behaviors.

Results

1) Intergenerational care significantly increases screen exposure among rural children. 2) Gender bias increases the risk of screen exposure for rural boys under intergenerational care. 3) Children with higher screen exposure levels are more affected by intergenerational care, which further undermines parental supervision. 4) Children's screen exposure leads to increased sedentary time and higher probability of purchasing unhealthy foods, thereby exacerbating obesity. This process is facilitated by enhancing preferences for snacks, fast food, and beverages, and weakening preferences for physical activity. 5) GPSM analysis indicates that children's screen exposure has an inverted "U"-shaped impact on unhealthy dietary preferences and a "U"-shaped impact on activity preferences. It results in a nonlinear positive impact of screen exposure on obesity. This study reveals a positive association between screen exposure and obesity, offering new insights into how intergenerational care in the digital era may elevate obesity prevalence through excessive screen time for rural children.

Effects of Modifiable Activity-Related Health Behaviors on the Sleep-Pain Relationship in Adolescents

Poor sleep and chronic pain are commonly related in adolescents. Only 5% of adolescents meet recommendations for physical activity and screen time, both of which impact the experience of sleep and pain disturbances. Research is needed to better understand the sleep-pain relationship in adolescents and to identify potential protective factors, such as activity-related health behaviors. This study examined sleep, behaviors that influence activity (i.e., physical activity, screen time), and their interaction as predictors of pain in a sleep-disordered sample of 105 adolescents aged 12-18 presenting for polysomnography. A hierarchical multiple linear regression was conducted to examine these relationships. Consistent with hypotheses, worse insomnia predicted worse pain. However, other activity-related health behaviors did not influence this relationship, ps > .05. Findings suggest that sleep should be the focus of treatment for adolescents with primary sleep disorders to prevent the onset or exacerbation of pain.

Exploring the relationship between media use and depressive symptoms among gender diverse youth: findings of the Mental Health Days Study

BACKGROUND

Over the past decades, media use has become a key aspect of young people's daily lives, significantly shaping their social interactions, learning processes, and recreational pursuits. At the same time, healthcare professionals and researchers are increasingly concerned about the impact of media use on young people's mental health. This concern is particularly relevant for gender diverse youth who may have distinct experiences with media that could impact their mental health uniquely compared to their peers, such as increased exposure to cyberbullying and negative content regarding their gender identity. This study aims to explore the associations between media use and depressive symptoms among youth and examine if gender moderates this association.

METHODS

This study utilized a cross-sectional design involving a school-based sample of 8158 participants (Mage = 14.05 years, SD = 2.45, Ndiverse = 144) from Austria. Participants completed a survey assessing their media use and depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9). Media use was measured by asking participants to report their daily usage in hours and minutes across various categories, including smartphone use, streaming services, social networks, and other media types. Multiple regression analyses were conducted to examine relationships between different forms of media use and depressive symptoms. Moderation analyses were performed using the PROCESS macro for SPSS to explore the role of gender.

RESULTS

For gender diverse youth, multiple regression analysis identified streaming services (β = 0.265, p = .005) and social networks (β = 0.189, p = .037) as significant predictors of depressive symptoms in gender diverse youth. Moderation analyses conducted with the entire sample showed that gender moderates the relationship between depressive symptoms and smartphone use (B = - 0.008, p = .014), with the effect being the most negative for gender diverse individuals.

CONCLUSION

The findings underscore the complex relationship between media use and depressive symptoms among gender diverse youth, emphasizing the moderating role of gender. These results underline the need for gender-sensitive approaches in media literacy and mental health interventions. Stakeholders should be aware of risks and benefits of different media types to foster healthy media engagement.

Social Media Escapism in Poland: Adaptation of a Measure and its Relationship With Thought Suppression and Mental Health

Research indicates that social media use can lead to addiction, fear of missing out, higher stress levels, anxiety, and experiencing symptoms typical of depression. The purpose of the present study was to conduct a Polish adaptation of the Social Media Escapism Scale and to assess its associations with fear of missing out, Facebook addiction, thought suppression, and the experience of stress, anxiety, and symptoms typical of depression. Two studies were conducted, the first adaptive and the second testing associations. The first study included 383 participants aged 18 to 63 (M = 23.51; SD = 5.7). To adapt the scale, the following were used: the Bergen Facebook Addiction Scale, the fear of missing out Scale, and the demographic questionnaire. The second study included 417 participants aged 18 to 60 (M = 26.33; SD = 9.7). The study tested relationships using the same three scales used in the first study, and also Depression, Anxiety, Stress Scale, and the White Bear Suppression Scale. The Polish version of the Social Media Escapism Scale revealed a univariate structure with strong internal consistency (α = .91). The adapted scale was associated with fear of missing out and Facebook addiction. In study 2, the structural equation modeling analyses revealed that fear of missing out, Facebook addiction and escapism were positively related to thought suppression and the experience of anxiety, stress, and depression symptoms. In addition, thought suppression partially mediated the relationship between harmful media use and anxiety, stress, and depression. Furthermore, the findings reveal a positive correlation between escapism and several psychological constructs, including fear of missing out, Facebook addiction, as well as aspects of depression and suppression, thereby lending support to the convergent validity of the adapted measure under investigation. The results can be used in psychological intervention and developing support and treatment programs for social network addiction.

Daily smartphone use predicts parent depressive symptoms, but parents' perceptions of responsiveness to their child moderate this effect

Introduction

Smartphone use during caregiving has become increasingly common, especially around infants and very young children, and this use around young children has been linked with lower quality and quantity of parent-child interaction, with potential implications for child behavior, and parent-child attachment. To understand drivers and consequences of parent phone use, we were interested in the daily associations between parent phone use and depressed mood, as well as the potential for parent perceptions of their responsiveness toward their infant to alter the association between parent phone use and mood.

Methods

In the present study, we explored associations between day-to-day changes in parent smartphone use (objectively-measured via passive sensing) around their infant, depressed mood, and parent perceptions of their responsiveness to their infants among a sample of 264 parents across eight days. We utilized multilevel modeling to examine these within-person daily associations.

Results

Objectively-measured parent smartphone use during time around their infant was significantly associated with depressed mood on a daily basis. Interestingly, this was not true on days when parents perceived themselves to be more responsive to their infant.

Discussion

These results suggest that parent judgements and perceptions of their parenting behavior may impact the potential link between parent phone use and parent mood. This is the first study utilizing intensive daily data to examine how parent perceptions may alter the felt effects of phone use on their parenting. Future work examining potential impacts of smartphone use on parenting should consider the effects of both actual use and perceptions about that use.

Effects of outdoor activity time, screen time, and family socioeconomic status on physical health of preschool children

Objective

Experienced 3 years of pandemic-induced home life, in the post-epidemic period, preschoolers in China are falling short of the World Health Organization's standards for screen time and outdoor activities. This notably impacts their physical well-being. The study aims to probe the associations between screen time, outdoor activities, and the physical health of preschoolers, offering insights to shape interventions targeting myopia and obesity prevention in children.

Methods

A cross-sectional study was conducted in Guangdong Province, involving a representative sample of 23,992 preschoolers and their caregivers recruited through proportional stratified cluster sampling. Data collection utilized the Chinese Early Human Capability Index (CHeHCI, eHCi), a questionnaire on children's media use in daily family life, and Body Mass Index (BMI). Linear regression and binary logistic regression models were employed to analyze the impact of screen time and outdoor activity duration on the physical health of preschoolers.

Results

In the high family socioeconomic status (SES) group, children had significantly less screen time compared to those in the medium and low SES groups. Outdoor activity time varied significantly based on SES, with higher SES linked to extended outdoor engagement. Additionally, children's eHCi health dimension score exhibited significant SES-related differences, showcasing higher scores for children in higher SES groups. In terms of gender differences, boys dedicated significantly more time to outdoor activities than girls, yet boys had a notably higher overweight rate. Furthermore, girls demonstrated better health outcomes based on eHCi health scores. A significant association emerged between overweight and screen time in children with high SES, indicating that prolonged screen time was linked to a higher likelihood of overweight based on BMI. Additionally, a substantial negative correlation was observed between children's eHCi health dimension score and screen time. Furthermore, children's outdoor activity time exhibited a significant positive correlation with eHCi health dimension score. Regression analysis revealed that screen time could significantly negatively predict children's physical health score, while outdoor activity time could significantly positively predict children's eHCi physical health score.

Conclusion

The current study highlights that family SES, age, and gender play pivotal roles in influencing preschoolers' screen time and outdoor activity duration, with family SES being particularly influential. Higher family SES correlates with reduced screen time, increased outdoor activity, and elevated health levels among children. Importantly, children's screen time negatively predicts their health status, while outdoor time positively predicts their health status.

Parental views on their children's smartphone use during personal and relational activities

Given the negative outcomes associated with smartphone use during personal and relational activities (SUPRA), parents strive to regulate its use among their children. However, media parenting recommendations lack knowledge of parental views on SUPRA and their relative occurrence in youths. This study aimed to (i) estimate SUPRA frequency among children and adolescents, (ii) assess parental dislike (PD) of SUPRA, and (iii) identify predictors of PD of SUPRA. An online survey was completed by 826 parents (49% mothers, age 25-74, Median = 43 years), capturing PD of SUPRA, estimated frequency of SUPRA in their children (49% female, age 6-18, Median = 10 years), parenting styles (warmth and control), parental attitudes toward screen media, and sociodemographic characteristics. The rate of frequent SUPRA was significantly higher in adolescents (2.7-48.1%) compared to children (2.1-27.2%) with odds ratios ranging from 0.67 to 3.04, depending on the activity type. PD of SUPRA was high in parents of children (M = 4.04, SD = 0.66) and adolescents (M = 3.93, SD = 0.71). Linear regression identified being a mother, having higher levels of control and warmth, and less positive attitudes toward screen media as significant predictors of SUPRA dislike. Our study was the first to report the estimated occurrence and parental dislike of smartphone use (SU) during various personal and relational activities, enabling their direct comparison. Experts warn against SU while studying and at bedtime, which frequently occurred in 4-5% of children and 10-12% of adolescents. More attention should be paid to SU during relational (peer/family) activities due to its relatively high occurrence and parental dissatisfaction.

Children's screen time and psychosocial symptoms at 5 years of age - the role of parental factors

BACKGROUND AND OBJECTIVES

Electronic media (e-media) has become a universal part of young children's daily lives. Previous studies have found an association between increased screen time and children's psychosocial symptoms. We investigated whether parents' psychological distress and parenting style dimensions explain the association between children's screen time and psychosocial symptoms. Moreover, we investigated whether parents' mental well-being and parenting style dimensions moderate this association.

METHODS

We used data from the Finnish CHILD-SLEEP birth cohort study. Parents and the child were assessed when the child was 5 years old (N = 671). The measure of screen time included program viewing from TV and other devices. Child's psychosocial problems and parents' depression, stress and parenting style dimensions were assessed by self-reports.

RESULTS

A high level of screen time in children was associated with attention and concentration difficulties, hyperactivity and impulsivity symptoms as well as internalizing and externalizing symptoms among 5-year-olds. For the most part, the associations remained significant despite controlling for parents' mental health, parenting style dimensions and multiple background factors, especially associations relating to attention and concentration difficulties and hyperactivity symptoms were robust. Maternal stress and depression moderated the association between children's screen time and psychosocial symptoms, indicating a more pronounced association among stressed or depressed mothers.

CONCLUSION

There is an independent association between children's screen time and psychosocial symptoms which is especially pronounced among those children whose mothers had poorer mental well-being. In clinical practice, the length of screen time should be inquired already at a young age and parents should be offered guidance to reduce the possible ill effects of excessive screen time, as well as help with their own mental health problems.

Association of Smoking Media Literacy with Vietnamese and South Korean Adolescents' Susceptibility to Smoking

Studies on how smoking media literacy (SML) is associated with susceptibility to smoking among adolescents in South Korea and Vietnam are scarce. Thus, we examined the association of SML with susceptibility to smoking among adolescents in these countries to initiate a collaborative global health program. In total, 460 adolescents (Vietnam: 277, South Korea: 183) aged 15-18 completed an online cross-sectional survey. SML was measured using the 15-item SML scale. Susceptibility to smoking was measured by three questions on future smoking and if offered a cigarette by a friend. A multiple logistic regression model explored the association of SML with susceptibility to smoking. The study revealed that higher SML was significantly associated with lower susceptibility to smoking among Vietnamese, but not South Korean adolescents. Further studies to identify pathways between other factors associated with SML and susceptibility to smoking are needed to develop culture-specific intervention strategies for smoking prevention.

Sociodemographic Characteristics and Digital Behaviors Associated with the Use of Fitness and Diet Apps Among Adolescents

BACKGROUND

Numerous health apps focusing on fitness, nutrition, and physical activity are available, yet many adolescents have never used them. The purpose of this study was to assess the prevalence of the use of fitness and diet apps and related socio-demographic factors and digital behaviors among high school students. Study Design: A cross-sectional study.

METHODS

High school students were recruited from 4 out of 21 public high schools in Belgrade, Serbia. Participants filled out an anonymous questionnaire about socio-demographic characteristics and digital behaviors, along with the e-health literacy scale (eHEALS). Adjusted logistic regression was applied for data analysis using SPSS 20.

RESULTS

Of the 702 students who completed the questionnaire, 670 used smartphones (95.4%; average age 16.5±1.2 years). The prevalence of fitness and diet app use among girls was 29.7% and 9.6%, as well as 17.3% and 3.6% among boys, respectively. Having higher family income, having better e-health literacy, browsing websites about fitness and diet, and using diet apps but not watching YouTube were associated with the use of fitness apps among girls. Being younger and browsing fitness websites and YouTube were associated with the use of fitness apps among boys. Being younger, browsing websites about diet, and using fitness apps were associated with the use of diet apps among girls.

CONCLUSION

Based on the findings, girls used fitness and diet apps more often than boys. Practical demonstrations on how to utilize certain health apps could be an additional opportunity to support positive health behaviors among adolescents.

Association of smartphones use, ocular symptoms and binocular dysfunctions in adolescents: a hospital-based cross-sectional study

PURPOSE

Given the current scenario of increased smartphone use in youth, this study aims to evaluate the proportion of ocular symptoms and binocular dysfunction and their association with smartphone use in adolescents through a hospital-based cross-sectional study.

METHODS

The participants were asked to fill out questionnaires related to smartphone use and symptoms of eyestrain experienced (Balik et al. and Kucer). They were asked about the following seven symptoms: blurring of vision, redness, visual disturbance, secretion, inflammation, lacrimation, and dryness. Each symptom out of the 7, was scored on a scale of 0-1 and was used to calculate an Ocular Symptom Score (OSS) by summing the scores of each symptom.Depending upon the duration of smartphone usage, the participants were classified into four groups: <2 hours/day, 2-4 hours/day, 4-6 hours/day, and >6 hours/day. Binocular functions were assessed using near point of convergence (NPC), near point of accommodation (NPA), Accommodative convergence/Accommodation (AC/A) ratio, dissociated heterophoria, and binocular accommodative facility (BAF).

RESULTS

A total of 123 smartphone user adolescents, aged 10-19 years were included in this study. The mean age of the study population was 16.58 + 2.8 years, out of which 52.03% were males. Prevalence of ocular symptoms was higher in groups with greater duration of smartphone use (2 to 4, 4 to 6, and >6 hours/day as compared to <2 hours/day: 90.48%, 94.74%, 100% vs. 75% respectively). The mean of NPC was 8.51, it was highest in subjects using smartphones for >6 hours. (p-value = .001). The mean AC/A ratio was 2.83 + 1.03: 1. A low AC/A ratio was associated with a longer duration of smartphone usage (p-value = .0001). The mean of BAF was 7.4 + 3.18 cycles/min, only 30 (24.4%) participants had BAF beyond the normal range (<5 cycles/min). The mean of BAF was lowest in the group with >6 hours/day of smartphone use (p-value < .0001). No significant change was found in NPA and dissociated heterophoria with the duration of smartphone usage.

CONCLUSION

Higher duration of smartphone use (>2 hours/day) is associated with various ocular symptoms and binocular dysfunction. However, additional research is necessary to authenticate the results of the study.

Internet Use as a Moderator of the Relationship Between Personal Resources and Stress in Older Adults: Cross-Sectional Study

BACKGROUND

Internet use has dramatically increased worldwide, with over two-thirds of the world's population using it, including the older adult population. Technical resources such as internet use have been shown to influence psychological processes such as stress positively. Following the Conservation of Resources theory by Hobfoll, stress experience largely depends on individuals' personal resources and the changes in these resources. While personal resource loss has been shown to lead to stress, we know little regarding the role that technical resources may play on the relationship between personal resources and stress.

OBJECTIVE

This study aims to investigate the moderating effect of technical resources (internet use) on the relationship between personal resources and stress in younger and older adults.

METHODS

A total of 275 younger adults (aged 18 to 30 years) and 224 older adults (aged ≥65 years) indicated their levels of stress; change in personal resources (ie, cognitive, social, and self-efficacy resource loss and gain); and internet use. Variance analyses, multiple regression, and moderation analyses were performed to investigate the correlates of stress.

RESULTS

Results showed that older adults, despite experiencing higher levels of resource loss (questionnaire scores: 1.82 vs 1.54; P<.001) and less resource gain (questionnaire scores: 1.82 vs 2.31; P<.001), were less stressed than younger adults (questionnaire scores: 1.99 vs 2.47; P<.001). We observed that the relationship among resource loss, resource gain, and stress in older adults was moderated by their level of internet use (β=.09; P=.05). Specifically, older adults who used the internet more frequently were less stressed when they experienced high levels of both loss and gain compared to their counterparts who used internet the less in the same conditions. Furthermore, older adults with low resource gain and high resource loss expressed less stress when they used the internet more often compared to those with low internet use.

CONCLUSIONS

These findings highlight the importance of internet use in mitigating stress among older adults experiencing resource loss and gain, emphasizing the potential of digital interventions to promote mental health in this population.

The Association of Social Media Use and Eating Behaviour of Belgian Adolescent Girls Diagnosed with Anorexia Nervosa-A Qualitative Approach

BACKGROUND

Social media have become integral in adolescents' lives, presenting both opportunities and risks, especially concerning psychiatric issues like eating disorders, prevalent in this vulnerable age group.

METHODS

This qualitative study employed semi-structured interviews with seven adolescent girls (aged 15-17) diagnosed with eating disorders. Interviews covered seven predefined topics, recorded and transcribed for thematic analysis.

RESULTS

Participants identified four key themes: exposure to selective content, biased interpretation, behavioural adaptation, and evolving perspectives during recovery. They highlighted social media's role in exacerbating body dissatisfaction and altering behaviours related to eating disorders.

CONCLUSIONS

This research underscores the critical need for awareness and guidance in adolescents' social media use to mitigate negative impacts, emphasizing the potential link between exposure to specific content and cognitive-behavioural changes in those with eating disorders. Further investigation is warranted to deepen our comprehension of these dynamics.

Impact of Elevated Screen Time on School-Age Adolescents During the COVID-19 Pandemic: An Analytical Study

INTRODUCTION

The rise in digital technology use, especially during the COVID-19 pandemic, has heightened concerns about extended "screen time" (ST) among adolescents. Excessive screen use is linked to negative physical and cognitive effects, yet digital media also offers educational and social advantages. Cultivating healthy digital habits is crucial as technology continues to evolve.

METHODOLOGY

This cross-sectional study was conducted between July and August 2022 among school-going adolescents and a total of 221 participants were assessed through questionnaires, employing statistical analysis.

RESULTS

In the current study, all participants fell within the 16-18 year age group, with 114 (51.6%) being male and 107 (48.4%) female. The majority 209 (94.5%) identified as Hindu, while the rest were from Muslim and Christian communities. Most participants, both male and female, resided in urban areas, 140 (63.3%) were pursuing Class 12, and 73 (33.1%) were pursuing Class 11. Mobile phones were the most commonly owned devices, followed by desktops or laptops and tablets. Males generally spend more time on these devices than females. Notably, 168 (76.01%) adolescents exceeded the recommended 2-hour daily screen time limit set by the American Academy of Pediatrics (AAP), with 92 (80.7%) males more likely to do so than 76 (71%) females. The study found a significant link between increased screen time, reduced physical activity, and academic performance, while no association was observed for behavioral risk factors.

CONCLUSION

There is increased digital device use among youth, with many exceeding recommended screen time limits, particularly males. This was significantly linked to reduced physical activity and academic decline, highlighting the need for further research and balanced digital use.

The relationship between video games and social-emotional delay in Chinese rural preschoolers: A comparison of five types of media video games and social-emotional delay

BACKGROUND

Recent studies have revealed a negative relationship between children's digital media use and social-emotional development. However, few studies distinguish between different digital devices and the different functions they provide that may lead to different outcomes.

METHODS

This study explored the relationship between young children's time spent on various digital devices and their social-emotional delay based on a survey of 1182 preschoolers (3 to 6 years old) in rural China. Children's social-emotional delay was assessed through a validated screening tool (ASQ-SE II).

RESULTS

Children's time spent on television, computers, tablets, or smartphones was not associated with their social-emotional delay. However, their risk of social-emotional delay increased as their time spent on game consoles increased. This relationship was reflected in five of the seven behavioural areas of children's social-emotional development (i.e., self-regulation, compliance, affect, social communications, and interactions with people). Moreover, it did not vary between children with different socioeconomic statuses.

CONCLUSIONS

This study suggests a possible relationship between children's social-emotional delay and video games, which might need to be paid more attention to than other media types.

Social media use, knowledge, attitudes, and risky sexual behavior of HIV transmission: A survey among boarding school adolescent students in Indonesia

Background

Social media has many positive and negative influences on individuals, especially for adolescents related to HIV. However, little is known about how social media impacts HIV-related outcomes among adolescents in boarding schools.

Objective

This study aims to investigate the social media use, knowledge, attitudes, and sexual behavior at risk of HIV transmission and their relationship with the demographic characteristics of adolescent students at boarding schools.

Methods

This study was school-based and used a cross-sectional design. The questionnaires were used to assess social network site usage, knowledge, attitudes, and risky behavior. Cluster random sampling involved students (n = 214) from three boarding schools in Cirebon City, West Java, Indonesia, in 2022. Chi-square tests and Cramer's V were used to explore correlations between social and demographic factors.

Results

A considerable number of adolescent students exhibited high social media addiction (58.4%), with the majority possessing limited knowledge of HIV transmission (54.7%). Additionally, nearly half displayed a negative attitude towards preventing HIV transmission (47.2%), while only a small fraction engaged in risky behavior (2.8%). Bivariate analysis revealed that social media use was moderately associated with the type of social media application (φc = 0.246, p <0.05). Knowledge of HIV transmission exhibited a moderate correlation with age (φc = 0.331, p <0.05), education level (φc = 0.240, p <0.001), and exposure to information (φc = 0.269, p <0.001). Similarly, attitudes toward HIV prevention demonstrated moderate associations with age (φc = 0.341, p = 0.001), education level (φc = 0.317, p <0.001), and exposure to information (φc = 0.266, p <0.001). Furthermore, risky sexual behavior exhibited a strong association with exposure to pornographic content (φc = 0.730, p <0.001).

Conclusion

The study found a high prevalence of social media usage among adolescents, coupled with low knowledge about HIV, negative attitudes, and risky behavior. Significant relationships were observed between social media use, knowledge, attitudes, and risky sexual behavior related to HIV transmission and demographic characteristics. This study emphasizes the vital role of nurses and healthcare professionals in implementing targeted educational interventions in boarding schools to address gaps in HIV risk knowledge influenced by social media, ultimately improving strategies for adolescents' sexual health.

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.

Associations between media parenting practices and early adolescent screen use

BACKGROUND

To assess the prevalence of various media parenting practices and identify their associations with early adolescent screen time and problematic social media, video game, and mobile phone use.

METHODS

Cross-sectional data from Year 3 of the Adolescent Brain Cognitive Development (ABCD) Study (2019-2022) that included 10,048 adolescents (12-13 years, 48.3% female, 45.6% racial/ethnic minorities) in the US were analyzed using multiple linear regression analyses adjusting for potential confounders.

RESULTS

Parent screen use, family mealtime screen use, and bedroom screen use were associated with greater adolescent screen time and problematic social media, video game, and mobile phone use. Parental use of screens to control behavior (e.g., as a reward or punishment) was associated with higher screen time and greater problematic video game use. Parental monitoring of screens was associated with lower screen time and less problematic social media and mobile phone use. Parental limit setting of screens was associated with lower screen time and less problematic social media, video game, and mobile phone use.

DISCUSSION

Parent screen use, mealtime screen use, and bedroom screen use were associated with higher adolescent problematic screen use and could be limited in a family media use plan. Parental monitoring and limiting of screen time are associated with less problematic screen use.

IMPACT STATEMENT

Although the American Academy of Pediatrics provides guidance for screen use for children 5-18 years, there is a paucity of evidence-based guidance for media parenting practices, specifically for early adolescents. In a diverse sample of 10,048 early adolescents across the US, we found cross-sectional associations between parent, mealtime, and bedroom screen use and higher adolescent problematic screen use. Parental monitoring and limiting of adolescent screen time were cross-sectionally associated with less problematic screen use in our analytic sample and may be incorporated into a family media use plan.

The impact of social media use on psychiatric symptoms and well-being of children and adolescents in the Post-COVID-19 era: a four-year longitudinal study

This longitudinal study examined the long-term effects of the COVID-19 pandemic on social media use and its impact on psychiatric symptoms and well-being of 3,697 Israeli children and adolescents aged 8 to 14. Data were collected from October 2019 to June 2023, covering four school years and five measurement points prior to, throughout and post- COVID-19. Social media usage, psychiatric symptoms (depression, anxiety, somatization, and general distress), as well as subjective well-being (positive and negative emotions, and life satisfaction) were assessed. The analysis also probed the extent to which social support and extracurricular activities moderated the associations between social media use and mental health outcomes. The results of the growth mixed-effects models indicated a significant increase in social media use and psychiatric symptoms, and a significant decrease in subjective well-being over time. Greater social media use was related to more psychiatric symptoms and negative emotions, but also to more positive emotions and life satisfaction. Social support buffered the negative effects of excessive social media use on mental health, whereas extracurricular activities increased positive emotions, but also psychiatric symptoms related to social media use. These findings highlight the need for targeted interventions to regulate social media usage, given its lasting consequences on the mental health of children and adolescents in the wake of the COVID-19 pandemic.

Crowdsourcing Opinions and Awareness of Upper Extremity Transplantation in the United States

Introduction As of 2008, the United States had 41,000 people living with upper extremity amputation. This number is projected to reach 300,000 by 2050. Human upper extremity transplantation (HUET) may become a more common treatment option with the potential to significantly improve the quality of life for certain amputees. Awareness and opinions regarding HUET among Americans, particularly in Veterans/Service Members (VSM) affiliates, are largely unknown. Materials and methods We administered a survey on Amazon Mechanical Turk (MTurk) workers. Eligible participants were US citizens aged ≥18 years; MTurk worker selection targeted workers who self-reported being a VSM. We used descriptive statistics to summarize study findings and Fisher's exact and Wilcoxon's rank-sum tests for between-group comparisons. Results The survey was completed by 764 individuals, 604 (79.1%) of whom reported being aware of HUET. Among those familiar versus unfamiliar, a significantly higher proportion were aged ≤35 years (n=385, 64.0% vs. n=86, 53.7%; p=0.017), employed (n=523, 86.6% vs. n=114, 71.3%; p<0.001), and aware of their religion's stance on organ/tissue donation (n=341, 54.5% vs. n=62, 38.8%; p<0.001). Amputees and/or respondents related to an amputee were more likely to be aware of HUET than individuals who were amputation naive (n=211, 90.6% vs. n=393, 74.0%, respectively; p<0.001), as were individuals with a personal or familial military affiliation (n=286, 85.4% with vs. n=318, 74.1% with no affiliation; p<0.001). The most reported HUET information sources were digital media (n=157, 31.2%) and internet (n=137, 27.2%). Conclusions Our survey of MTurk workers found greater awareness of HUET among individuals with a VSM or amputee connection. Our additional findings that the internet and academic sources, such as journals or reputable medical publications, were respondents' preferred sources of HUET information emphasize the importance of vascularized composite allotransplantation (VCA) centers' involvement in creating accurate and accessible content to help educate the public about this treatment.

Associations between social network addiction, anxiety symptoms, and risk of metabolic syndrome in Peruvian adolescents-a cross-sectional study

Background

The link between physical and mental health and screen time in adolescents has been the subject of scientific scrutiny in recent years. However, there are few studies that have evaluated the association between social network addiction (SNA) and metabolic risk in this population.

Objective

This study determined the association between SNA and anxiety symptoms with the risk of metabolic syndrome (MetS) in adolescents.

Methods

A cross-sectional study was conducted in Peruvian adolescents aged 12 to 18 years, who completed a Social Network Addiction Questionnaire and the Generalized Anxiety Disorder 2-item scale (GAD-2), between September and November 2022. A total of 903 participants were included in the study using a non-probability convenience sample. Sociodemographic and anthropometric data were also collected. Binary logistic regression was used to explore the association between SNA and anxiety symptoms with MetS in a cross-sectional analysis.

Results

Males were more likely to have MetS than females (OR = 1.133, p = 0.028). Participants who were 16 years of age or older and those with excess body weight were 2.166, p = 0.013 and 19.414, p < 0.001 times more likely to have MetS, respectively. Additionally, SNA (OR = 1.517, p = 0.016) and the presence of anxiety symptoms (OR = 2.596, p < 0.001) were associated with MetS.

Conclusion

Our findings suggest associations between SNA, anxiety symptoms, and MetS among youth. However, more studies are needed to better understand this association and to deepen the possible clinical and public health implications.

Shared Reading of the Families With the Children With Chronic Disease

The aim of the study is to evaluate shared reading of families of children with chronic diseases. The mothers of children aged 2 to 6 years with chronic health problems who applied to the pediatric outpatient clinic between January and May 2022 were the study group, and the mothers of children with an acute health problem were the control group. The sociodemographic information form and "Child-Parent Shared Reading Activities Scale" were applied. At the end of the interview, 3 questions about shared reading were asked. A total of 187 children were enrolled in the study: 92 and 95 in the chronic disease group and control group, respectively. 57.6% of mothers of chronically ill children reported that the parents almost never did shared reading with their child. It was found that all mothers knew the importance of reading, but they could not support especially in the risky chronic disease group.

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

LAY ABSTRACT

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

Health practices, behaviours and quality of life of low-income preschoolers: A community-based cross-sectional comparison study in Singapore

Introduction

Children from low-income (LI) families often suffer from poor health, with sub-optimal health practices. This cross-sectional study examined the differences in health habits and health-related quality of life (HRQoL) of LI preschool children compared to non-low-income preschool peers (PPG).

Method

Using data from the social-health Circle of Care-Health Development Screening Programme (CoC-HDSP) in Singapore, 118 LI children and 304 PPG children aged 18 months to 6 years old and their families were recruited from 13 government-funded preschools. Health practices examined included screen time habits, sleep, nutrition, dental health and the children's HRQoL using PedsQL 4.0 Generic Core Scales.

Results

Majority of the children were aged 4-6 years in kindergarten 1 and 2. There were more Malay children in the LI than the PPG (61.9% versus [vs] 29.3%, P<0.001). Low-income children were more likely to have lower-educated parents (P<0.001). The completed vaccination rate in the LI group was lower than those in PPG (84.7% vs 98.0%, P<0.001). More in the LI group utilised emergency services for acute illnesses (P<0.05). Fewer LI children had ever visited a dentist (47.4% vs 75.4%, P<0.001), and more LI children consumed sweetened drinks daily (33.3% vs 8.6%, P<0.001). The LI group reported poorer-quality sleep (48.3% vs 27.2%, P<0.001), though both groups exceeded the daily recommended screen viewing duration. The LI group scored higher in the social (mean 92.4±12.2 vs 84.3±15.3, P<0.001) and emotional (mean 85.2±15.1 vs 76.6±17.3, P<0.001) domains of the PedsQL 4.0 when compared to PPG.

Conclusion

Low-income children have poorer health practices, receive less preventive paediatric care, and utilise more emergency services for acute illnesses. These findings are important for developing interventions that work towards improving the health of LI children.

Substituting Book Reading for Screen Time Benefits Preschoolers' Sleep Health: Results from the Ulm SPATZ Health Study

Purpose

Healthy sleep is essential for the physical, cognitive, and social development of children. Several studies have reported the increase in digital media use in preschool children and its association with impaired sleep. However, there is relatively little evidence on the effects of book reading as a potentially safe alternative. The objective of this study, therefore, was to investigate whether sleep in children could benefit from book reading, and whether the negative effects of media use on sleep can be mitigated by substituting book reading for screen time.

Participants and Methods

We used longitudinal data from three consecutive waves of the SPATZ Health study, including children at the ages of 4 (n=581), 5 (n=508), and 6 (n=426) years. All data were collected by self-administered questionnaires. Parent-reported child sleep was assessed by the Children's Sleep Habits Questionnaire.

Results

Across the three waves, screen-based media use increased and was associated with lower sleep quality. In contrast, the time spent with book reading decreased; however, book reading appeared to be beneficial for children's sleep. Substitution models revealed that the theoretical substitution of an equal amount of book reading for 50% of the time spent with screen-based media benefits several domains of preschoolers' sleep health, including parasomnias, sleep anxiety, daytime sleepiness, and sleep onset delay.

Conclusion

Besides implications for population-wide and individual prevention, book reading may also be incorporated as a useful intervention to improve sleep quality in children who are already affected by sleep problems. Given that book reading is perceived as a safe alternative, the presented evidence may suffice to support recommendations in this direction.

Social media use by young people with language disorders: a scoping review

PURPOSE

Social media are widely used by young people (YP), but how YP with language disorders use social media for social interaction remains insufficiently studied. This article provides an overview of the research on social media use by YP with language disorders.

MATERIALS AND METHODS

A scoping review was conducted, guided by a five-stage framework. Ten databases were searched (CENTRAL, CINAHL, ERIC, LLBA, Medline, PsychINFO, Scopus, speechBITE, Web of Science, ProQuest Dissertations & Theses Global). Chaining searches of papers identified for inclusion were conducted.

RESULTS

After screening 199 unique papers, 44 were included. Findings revealed that YP with language disorders use social media less compared to typically developing peers; their profile of communication difficulties may impact the types of social media with which they engage. Although intervention studies are limited, the results offer encouraging findings regarding the positive impact of support for use of social media. Barriers and facilitators for social media use are identified.

CONCLUSIONS

YP with language disorders use social media for social purposes. However, co-designed research into what YP with language disorders perceive their social media needs to be is urgently needed. How to support YP with language disorders to use social media is subject to future investigation.

Problematic situations related to social media use and competencies to prevent them: results of a Delphi study

A three-round Delphi method was used to study the problematic situations that adolescents may encounter when using the social media, and the competencies needed to address these situations. A panel of Finnish experts (N = 22) provided an open-ended list of problematic situations and competencies in 2020-2021. These were then evaluated and ranked according to their significance. The experts provided an information-rich list of both problematic situations and competencies. Finally, 16 problematic situations and 19 competencies were ranked in order of importance by the experts. The most important problematic situations were direct and indirect cyberbullying and sexual harassment. The most important competencies were the ability to act responsibly, knowing what kinds of activity are prohibited, and knowing whom to contact on exposure to cyberbullying or harassment. The findings can be used in developing policies, recommendations, and solutions aimed at counteracting the harmful effects of social media on wellbeing during adolescence.

COVID-19-Related distress, body image, and eating behaviors: a cross-sectional explanatory model

BACKGROUND

The COVID-19 pandemic has been associated with increased body dissatisfaction and disordered eating behaviors in adolescents. To better understand these associations, this study tested an explanatory model in which appearance-focused social media use, internalization of social media pressure, and mindfulness abilities mediated the relationship between COVID-related distress and body dissatisfaction, which in turn was associated with dietary restraint and binge eating episodes.

METHODS

Adolescents (N = 493, Mage= 16.7; 47.5% girls) recruited within high schools completed online measures. We conducted model testing through path analysis in MPlus, using modification indices to derive a well-fitting model.

RESULTS

The initially hypothesized model was a poor fit for the data. The final well-adjusted model confirmed several significant paths and supported the parallel mediational roles of social media (specifically, the use of appearance-focused social media and internalization of social media pressure) along with mindfulness, on the relationship between COVID-19-related distress and body satisfaction. Model adjustments involved adding three paths, resulting in two additional significant indirect effects, and suppressing one path.

CONCLUSIONS

Findings suggest that mindfulness, media use and the internalization of social media pressure are potential key processes explaining body dissatisfaction and eating disorders among adolescents who experienced higher levels of COVID-related distress.

Comparing the impact of three-dimensional digital visualization technology versus traditional microscopy on microsurgeons in microsurgery: a prospective self-controlled study

BACKGROUND

Emerging three-dimensional digital visualization technology (DVT) provides more advantages than traditional microscopy in microsurgery; however, its impact on microsurgeons' visual and nervous systems and delicate microsurgery is still unclear, which hinders the wider implementation of DVT in digital visualization for microsurgery.

METHODS AND MATERIAL

Forty-two microsurgeons from the Zhongshan Ophthalmic Center were enrolled in this prospective self-controlled study. Each microsurgeon consecutively performed 30 min conjunctival sutures using a three-dimensional digital display and a microscope, respectively. Visual function, autonomic nerve activity, and subjective symptoms were evaluated before and immediately after the operation. Visual functions, including accommodative lag, accommodative amplitude, near point of convergence and contrast sensitivity function (CSF), were measured by an expert optometrist. Heart rate variability was recorded by a wearable device for monitoring autonomic nervous activity. Subjective symptoms were evaluated by questionnaires. Microsurgical performance was assessed by the video-based Objective Structured Assessment of Technical Skill (OSATS) tool.

RESULTS

Accommodative lag decreased from 0.63 (0.18) diopters (D) to 0.55 (0.16) D ( P =0.014), area under the log contrast sensitivity function increased from 1.49 (0.15) to 1.52 (0.14) ( P =0.037), and heart rate variability decreased from 36.00 (13.54) milliseconds (ms) to 32.26 (12.35) ms ( P =0.004) after using the DVT, but the changes showed no differences compared to traditional microscopy ( P >0.05). No statistical significance was observed for global OSATS scores between the two rounds of operations [mean difference, 0.05 (95% CI: -1.17 to 1.08) points; P =0.95]. Subjective symptoms were quite mild after using both techniques.

CONCLUSIONS

The impact of DVT-based procedures on microsurgeons includes enhanced accommodation and sympathetic activity, but the changes and surgical performance are not significantly different from those of microscopy-based microsurgery. Our findings indicate that short-term use of DVT is reliable for microsurgery and the long-term effect of using DVT deserve more consideration.

Sleep and Technology in Early Childhood

Research suggests that technology use is associated with poorer sleep outcomes among children less than 6 years of age. These associations are evident regardless of the type of technology studied, although evening exposure may have the greatest impact compared with technology use during other parts of the day. More work is needed, particularly given that technology use is relatively high among young children. Clinicians should assess patients' technology exposure, including before bedtime, to assess whether sleep issues stem from children's technology use. Moreover, clinicians should educate caregivers about the association between technology use and sleep problems among young children.

TV Viewing From Young Adulthood to Middle Age and Cardiovascular Disease Risk

INTRODUCTION

Few studies have longitudinally examined TV viewing trajectories and cardiovascular disease risk factors. The objective of this study was to determine the association between level and annualized changes in young adult TV viewing and the incidence of cardiovascular disease risk factors from young adulthood to middle age.

METHODS

In 2023, prospective community-based cohort data of 4,318 Coronary Artery Risk Development in Young Adults study participants (1990-1991 to 2015-2016) were analyzed. Individualized daily TV viewing trajectories for each participant were developed using linear mixed models.

RESULTS

Every additional hour of TV viewing at age 23 years was associated with higher odds of incident hypertension (AOR=1.16; 95% CI=1.11, 1.22), diabetes (AOR=1.19; 95% CI=1.11, 1.28), high triglycerides (AOR=1.17; 95% CI=1.08, 1.26), dyslipidemia (AOR=1.10; 95% CI=1.03, 1.16), and obesity (AOR=1.12; 95% CI=1.06, 1.17). In addition, each hourly increase in daily TV viewing was associated with higher annual odds of incident hypertension (AOR=1.26; 95% CI=1.16, 1.37), low high-density lipoprotein cholesterol (AOR=1.15; 95% CI=1.03, 1.30), high triglycerides (AOR=1.32; 95% CI=1.15, 1.51), dyslipidemia (AOR=1.22; 95% CI=1.11, 1.34), and obesity (AOR=1.17; 95% CI=1.07, 1.27) over the follow-up period.

CONCLUSIONS

In this prospective cohort study, higher TV viewing in young adulthood and annual increases in TV viewing were associated with incident hypertension, high triglycerides, and obesity. Young adulthood as well as behaviors across midlife may be important time periods to promote healthful TV viewing behavior patterns.

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.

The Role of the Pediatrician in the Promotion of Healthy, Active Living

Few children and adolescents meet federal nutrition or physical activity recommendations, and many experience poor or inadequate sleep and negative health effects from screen use and social media. These lifestyle factors exacerbate physical and mental health risks for children and adolescents. This clinical report provides guidance to help pediatricians address the nutritional, physical activity, sleep, media and screen use, and social-emotional factors that affect child and adolescent health and wellness. The recommendations in this clinical report aim to promote health and wellness practices for infants, children, and adolescents across several domains of influence, including the individual, interpersonal, institutional, community, and public policy levels.

A longitudinal study of the relationship between children's exposure to screen media and vocabulary development

AIM

This study addresses the scarcity of longitudinal research on the influence of screen media on children. It aims to explore the longitudinal relationship between children's vocabulary development and their exposure to screen media.

METHODS

The study, initiated in 2017, included 72 children (37 boys) in Östergötland, Sweden, at three key developmental stages: preverbal (9.7 months), early verbal (25.5 months) and preliterate (5.4 years). Parents completed online surveys at each time point, reporting their child's screen time. At 10 months and 2 years, age-appropriate vocabulary assessments were conducted online. At age 5, children's vocabulary was laboratory assessed.

RESULTS

Correlational analysis revealed a negative relationship between language scores and screen media use across all time points. Furthermore, a cross-lagged panel model demonstrated that screen media use showed significant continuity over time, with screen use at age 2 predicting language development at ages 2 and 5.

CONCLUSION

This longitudinal study, spanned from 9 months to 5 years of age, established a predictive negative association between children's exposure to screen media and their vocabulary development. These findings underscore the need to consider the impact of screen media on early childhood development and may inform guidelines for screen media use in young children.

Algorithmic and sensor-based research on Chinese children's and adolescents' screen use behavior and light environment

Background

Myopia poses a global health concern and is influenced by both genetic and environmental factors. The incidence of myopia tends to increase during infectious outbreaks, such as the COVID-19 pandemic. This study examined the screen-time behaviors among Chinese children and adolescents and investigated the efficacy of artificial intelligence (AI)-based alerts in modifying screen-time practices.

Methods

A cross-sectional analysis was performed using data from 6,716 children and adolescents with AI-enhanced tablets that monitored and recorded their behavior and environmental light during screen time.

Results

The median daily screen time of all participants was 58.82 min. Among all age groups, elementary-school students had the longest median daily screen time, which was 87.25 min and exceeded 4 h per week. Children younger than 2 years engaged with tablets for a median of 41.84 min per day. Learning accounted for 54.88% of participants' screen time, and 51.03% (3,390/6,643) of the participants used tablets for 1 h at an average distance <50 cm. The distance and posture alarms were triggered 807,355 and 509,199 times, respectively. In the study, 70.65% of the participants used the tablet under an illuminance of <300 lux during the day and 61.11% under an illuminance of <100 lux at night. The ambient light of 85.19% of the participants exceeded 4,000 K color temperature during night. Most incorrect viewing habits (65.49% in viewing distance; 86.48% in viewing posture) were rectified swiftly following AI notifications (all p < 0.05).

Conclusion

Young children are increasingly using digital screens, with school-age children and adolescents showing longer screen time than preschoolers. The study highlighted inadequate lighting conditions during screen use. AI alerts proved effective in prompting users to correct their screen-related behavior promptly.

Social Media Use and Alcohol Sipping in Early Adolescents: A Prospective Cohort Study

BACKGROUND

Social media can influence alcohol initiation behaviors such as sipping, which can lead to future adverse alcohol-related outcomes. Few studies have examined the role of problematic social media use, characterized by addiction, mood modification, tolerance, withdrawal, conflict, and relapse, especially in early adolescence.

OBJECTIVE

To examine the prospective association between social media use and sipping alcohol in a nationwide sample of early adolescents, and the extent to which problematic social media use mediates the association.

METHODS

We analyzed prospective data from the Adolescent Brain Cognitive Development Study (N = 7514; ages 9-10 years at baseline; 2016-2018) to estimate associations between social media time (Year 1) and alcohol sipping (Year 3) using modified Poisson regression, adjusting for confounders and testing problematic social media use (Year 2) as a mediator.

RESULTS

Social media time (Year 1) was prospectively associated with 1.31 (95% confidence interval 1.20-1.43) times higher risk of new-onset sipping (Year 3). The association between social media time and new-onset alcohol sipping was partially mediated by problematic social media use at Year 2 (25.0% reduction in the association between the former two factors after adding problematic social media use, p = 0.002).

CONCLUSIONS

Time spent on social media was associated with a higher risk of alcohol sipping in a diverse national sample of early adolescents, and the association was partially mediated by problematic social media use. Media literacy education and family media use plans could advise early adolescents about exposure to alcohol content on social media and warning signs for problematic use.

Evaluation of Screen Time in Children Under Five Years Old

INTRODUCTION

Due to the rapid advancement of technology, there has been a noteworthy increase in the diversity and abundance of activities involving children. The most effective methods to enhance and facilitate children's media interactions are to minimize, reduce, use with caution, and establish healthy patterns. We aimed to evaluate media exposure of children below five years of age.

MATERIAL AND METHODS

This is a prospective, observational, cross-sectional study that was conducted between December 2017 and September 2019 in Eskişehir, Türkiye. To assess the frequency of electronic device usage among children under the age of five, including televisions, laptops, tablets, and mobile phones, as well as its impact on their sleep patterns and physical measurements, and to evaluate families' understanding of the terms "screen time" and "back screen time," we developed a questionnaire.

RESULTS

We analyzed a total of 731 questionnaires: 334 (45.7%) were girls, 397 (54.3%) were boys, and the mean age was 33.55±16.37 months. Upon examining the technical equipment accessible to the children in our study, we found that 98.6% possessed a television, 96.9% owned a mobile phone, 54% had a laptop, 49.5% had a tablet, and 34.1% possessed a gaming console. The study revealed the following proportions of electronic devices in children's rooms: 13% televisions, 11.9% tablets, 7.4% laptops, and 7% mobile phones. There has been a substantial increase in the amount of time they spend watching television and playing computer games among children who have at least one sibling. There was a statistically significant disparity between the television viewing periods and the body mass index of children older than two years old. Additionally, we have seen a significant disparity in the presence of media devices in children's bedrooms and the subsequent impact on their sleep duration and patterns throughout both nighttime and daytime. Around 65.8% of parents did not know of the concept of screen time, while 88.4% of parents did not know of the concept of back screen time.

DISCUSSION

Parental compliance with the current guidelines for screen time is insufficient, among parents with children under the age of five, even though exposure to screens begins in the first months of life. Our analysis highlighted the necessity for parents to establish and enforce a unified and logical media usage policy for all children residing in the household. It is crucial to allocate sufficient time during the routine healthcare visit to discuss these recommendations.

The relationships between screen exposure, parent-child interactions and comprehension in 8-month-old infants: The mediating role of shared viewing and parent-child conversation

OBJECTIVE

To explore the relationships between screen exposure, parent-child interactions and comprehension in 8-month-old infants, and to examine whether shared viewing and parent-child conversation during screen exposure may play mediating role in that relationships.

METHODS

The sample included 437 infants aged 8 months from the Children's Health Department of Guiyang Maternal and Child Health Hospital during January 2022 to February 2023. The use of electronic screen devices was assessed using a screen exposure questionnaire. The Brigance Parent-child interactions Scale was used to assess parent-child interactions and the Putonghua Communicative Development Inventory (PCDI) scale was used to assess infants' word comprehension.

RESULTS

48.7% of infants were found to be using screens 1-2 days per week. There was a significant difference (p < 0.05) in the PCDI-comprehension scores of screen-exposed infants compared to non-screen-exposed infants. Shared viewing and parent-child conversation during screen exposure were positively associated with parent-child interactions (p < 0.05). Mediation analysis revealed that parent-child conversation fully mediated between screen exposure and PCDI-comprehension, but partially mediated between parent-child interactions and PCDI-comprehension.

CONCLUSIONS

Shared viewing and parent-child conversation during screen exposure may mediate between screen exposure and comprehension development. Shared viewing, parent-child conversation and parent-child interactions may be protective factors for screen exposure in comprehension development. Suggests that parents should accompany and communicate with their children when they use electronic screen devices to reduce the negative impact of screen exposure on children's comprehension.

An umbrella review of the benefits and risks associated with youths' interactions with electronic screens

The influence of electronic screens on the health of children and adolescents and their education is not well understood. In this prospectively registered umbrella review (PROSPERO identifier CRD42017076051 ), we harmonized effects from 102 meta-analyses (2,451 primary studies; 1,937,501 participants) of screen time and outcomes. In total, 43 effects from 32 meta-analyses met our criteria for statistical certainty. Meta-analyses of associations between screen use and outcomes showed small-to-moderate effects (range: r = -0.14 to 0.33). In education, results were mixed; for example, screen use was negatively associated with literacy (r = -0.14, 95% confidence interval (CI) = -0.20 to -0.09, P ≤ 0.001, k = 38, N = 18,318), but this effect was positive when parents watched with their children (r = 0.15, 95% CI = 0.02 to 0.28, P = 0.028, k = 12, N = 6,083). In health, we found evidence for several small negative associations; for example, social media was associated with depression (r = 0.12, 95% CI = 0.05 to 0.19, P ≤ 0.001, k = 12, N = 93,740). Limitations of our review include the limited number of studies for each outcome, medium-to-high risk of bias in 95 out of 102 included meta-analyses and high heterogeneity (17 out of 22 in education and 20 out of 21 in health with I2 > 50%). We recommend that caregivers and policymakers carefully weigh the evidence for potential harms and benefits of specific types of screen use.

Mediation of Parental Aggravation in the Association Between ADHD Severity and Electronic Media Use: A National Survey of Children's Health Study

OBJECTIVE

To determine whether the association between ADHD severity and electronic media use was mediated by parental aggravation.

METHODS

This was a retrospective analysis from the 2016 to 2017 National Survey of Children's Health (NSCH) involving children ages of 3 to 17 years with parent-reported ADHD (n = 5,930). Path analyses were used to model the relationships between ADHD severity with parental aggravation (PA) as a mediator, and electronic device (ED) and television (TV) use as outcomes, controlling for covariates.

RESULTS

Parental aggravation mediated the relationship between ADHD severity and ED use and TV use (indirect effects: β = .02, p < .001; β = .01, p = .004). When stratified by age, the mediation effect between ADHD and ED use remained significant for adolescents and school-age children, and mediation between ADHD and TV use remained significant only for adolescents.

CONCLUSION

These findings suggest a need to develop targeted interventions to address PA and manage excessive electronic media use in children with moderate/severe ADHD.

Association between excessive screen time and school-level proportion of no family rules among elementary school children in Japan: a multilevel analysis

BACKGROUND

Excessive screen time (ST) in children is a global concern. We assessed the association between individual- and school-level factors and excessive ST in Japanese children using a multilevel analysis.

METHODS

A school-based cross-sectional study was conducted in Toyama, Japan in 2018. From 110 elementary schools in Toyama Prefecture, 13,413 children in the 4th-6th grades (boys, 50.9%; mean, 10.5 years old) participated. We assessed lifestyle, recreational ST (not for study use), psychological status, and school and family environment including family rules. We defined ≥3 hours ST as excessive. We calculated the school-level proportions of no family rules and divided them into four categories (<20%, 20% to <30%, 30% to <40%, and ≥40%). A modified multilevel Poisson regression analysis was performed.

RESULTS

In total, 12,611 children were included in the analysis (94.0%). The average school-level proportion of those with no family rules was 32.1% (SD = 9.6). The prevalence of excessive ST was 29.9% (34.9% in boys; 24.8% in girls). The regression analysis showed that excessive ST was significantly associated with both individual-level factors, such as boys (adjusted prevalence ratio (aPR); 1.39), older grades (aPR; 1.18 for 5th grades and 1.28 for 6th grades), late wakeup (aPR; 1.13), physical inactivity (aPR; 1.18 for not so much and 1.31 for rarely), late bedtime (aPR; 1.43 for 10 to 11 p.m. and 1.76 for ≥11 p.m.), frequent irritability (aPR; 1.24 for sometimes and 1.46 for often), feelings of school avoidance (aPR; 1.17 for sometimes and 1.22 for often), infrequent child-parental interaction (aPR; 1.16 for rare and 1.21 for none), no family rules (aPR; 1.56), smartphone ownership (aPR; 1.18), and the school-level proportion of no family rules (aPR; 1.20 for 20% to <30%, 1.29 for 30% to <40%, and 1.43 for ≥40%, setting <20% as reference).

CONCLUSION

Besides individual factors, a higher school-level proportion of no family rules seemed influential on excessive ST. Increasing the number of households with family rules and addressing individual factors, could be deterrents against excessive ST in children.

Media's Effect on Athletes' Mental Health

This article explores the athlete's relationship with both traditional and social (digital) media and describes athletes' media obligations and the pressures of media attention. It explains the difference in the representation of diverse groups, and the potential positive and negative outcomes of the media on an athlete's mental health. The article will review the emergence of social media, its limitless reach, and ways in which it diverges from traditional media coverage of athletic performance. Finally, the article concludes with a discussion of ways that athletes' multidsciplinary medical teams may become advocates for healthy and supportive interactions between athletes and media.