The effectiveness of a parental guide for prevention of problematic video gaming in children: A public health randomized controlled intervention study

The impact of screen use on sleep health across the lifespan: A National Sleep Foundation consensus statement

OBJECTIVE

To achieve consensus on whether screen-based digital media (1) in general, (2) via prebedtime content, and (3) via prebedtime light impairs sleep health in (a) childhood, (b) adolescence, and (c) adulthood. Furthermore, to address whether employing behavioral strategies and interventions may reduce the potential negative effects of screens on sleep health.

METHODS

The National Sleep Foundation convened a 16-person multidisciplinary expert panel ("Panel"). Panelists met virtually 5 times throughout 2023, during which they followed a modified Delphi RAND/UCLA Appropriateness Method to reach consensus.

RESULTS

The Panel conducted a literature review starting with 2209 articles, narrowed down to 522 relevant empirical articles and 52 relevant review articles. The search was refined to include 35 experimental/intervention studies that examined whether there was a causal link between screen-based digital media and sleep. In addition, panelists reviewed 5 recent relevant systematic review articles. After reviewing the summarized current literature, panelists voted on 10 candidate statements about whether screen use impairs sleep health. The Panel met virtually to discuss the results of the first round of votes, which was then followed by a second round of voting, ultimately achieving consensus on 5 out of the 10 statements.

CONCLUSIONS

The Panel achieved consensus that (1) in general, screen use impairs sleep health among children and adolescents, (2) the content of screen use before sleep impairs sleep health of children and adolescents, and (3) behavioral strategies and interventions may attenuate the negative effects of screen use on sleep health.

Treatment effects of therapeutic interventions for gaming disorder: A systematic review and meta-analysis

The prevalence of gaming disorder is assumed to be between 2%-5%. The treatment effect of different therapeutic interventions of gaming disorder has not been studied extensively. This systematic review and meta-analysis sought to identify all intervention studies on gaming disorder with a control group, determine the effect of the interventions, and examine moderators. Studies applying a therapeutic intervention and using an appropriate comparison group were identified by searching electronic databases, previous reviews, and reference lists. Data on type of treatment, name of outcome measurement, symptom level and other study characteristics were extracted and analyzed using meta-analysis and meta-regression. A total of 38 studies and 76 effect sizes, originating from 9524 participants were included. RoB2 and ROBINS-I risk of bias tools were used to assess within-study risk of bias. Correlational hierarchical models with robust variance estimation were fitted to effect size data and yielded a moderate summary estimate. Egger's sandwich test, funnel plot inspections, and other tests were conducted to assess risk of bias between studies. Results indicate that there may be an overall effect of therapeutic interventions for gaming disorder, but confidence in these findings is compromised by small-study effects, possible publication bias, a limited study pool, and a lack of standardization. The field needs more higher quality studies before the evidence-base can support reliable meta-analytic estimates.

Gaming disorder: A summary of its characteristics and aetiology

The emergence, development, and maintenance of gaming disorder (GD) is the result of an interplay between gaming-related factors, individual factors, and environmental factors. None of these alone are sufficient to cause a disordered state, but it is the interactive co-occurrence of all these factors, which in some cases leads to GD. The goal of the present paper is to discuss in detail these three factors based on relevant and recent findings of the literature. Among gaming-related factors, we discuss online vs. offline videogames, the role of game genres, structural characteristics, game design elements, as well as some important monetization techniques. Among individual factors demographic risk factors, personality traits, motivational factors, comorbid psychopathology, genetic predisposition, and neurobiological processes are considered. Finally, among environmental factors we discuss family factors, early life experiences, the role of peers and school-related factors, as well as the broader context of culture including the popularity of esports.

Parenting in the Prevention of Internet Gaming Addiction

Game addiction, smartphone addiction, and Internet disorder in children and adolescents have become the subject of parental concern in recent years. Parenting interventions are the most appropriate choice for parents to reduce excessive use of problematic games, and this review has not been carried out by other researchers before. The purpose of this review was to describe the preventive management of parenting in children and adolescents who are at risk for game addiction, smartphone addiction, and Internet disorders. This paper reviews findings, trends, and new developments in the field concerned (n = 5 studies). The current research was conducted based on a literature search with Preferred Reporting Items for Systematic Reviews and Meta-analyses, and articles were searched with five databases: ProQuest, Ebscohost, Springer Link, PubMed, and Scopus. Furthermore, the keywords used are MeSH determination based on PICOS framework using keywords of Game Disorder OR Smartphone Addictions OR Internet Disorder, parenting, as well as prevention without a time limit for publishing articles. In conclusion, parenting programs are a preventive method that needs to be understood and developed in order to provide significant results in long-term management of game addiction, smartphone addiction, and Internet disorders.

Effects of Self-Management Training on Smartphone Dependence in Low to Moderate Adolescent Males’ Users

While taking advantage of the educational benefits of smartphones, students also apply this device in inappropriate ways that cause certain disciplinary and educational problems. This study examines the effect of self-management training on smartphone dependence among male high school students. Methods: In this quasi-experimental study, data were collected using the Cell Phone Addiction Scale (Koo, 2009), which was completed by the trial and control groups before and after the educational intervention. After assessing their normal distribution, the data were analysed using the Chi-square test, the independent and paired t-tests, Mann–Whitney's U-test, and the Wilcoxon test at a significance level of p < .05. Results: The results showed significant post-intervention reductions in the mean score of smartphone dependence (35.10) and its three domains, including withdrawal/tolerance (14.80), life dysfunction (8.70), and compulsion/persistence (11.60), in the trial group compared to the controls (44.80, 16.2, 12.10, and 16.50) and also in the mean score of certain applications of smartphones (p < .05). Discussion and conclusions: Despite the existing limitations, the results confirmed the efficacy of self-management training in reducing smartphone dependence in the students. The implementation of this programme is recommended for reducing dependence and promoting the proper use of this device.

Relationship between sense of coherence and health-related behaviours in adolescents and young adults: a systematic review

Background

The sense of coherence is developed through the learning process and contributes to the positioning of individuals in the health-disease continuum, facilitating successful and adaptive personal outcomes. Health-related behaviours represent a health determinant of utmost importance for public health and the development of adolescent and youth health promotion policies, as they are related to the main risk factors and problems of morbidity and mortality in our society. Previous studies have analysed the relationship between sense of coherence and only some individual health outcomes such as oral health, the relationship of sense of coherence with smoking and alcohol consumption, concluding that salutogenic factors are related to quality of life and preventive behaviours. The aim of this systematic review was to describe the relationship of sense of coherence with different health-related behaviours investigated so far in the adolescent and youth population.

Methods

A systematic review was carried out in databases (PubMed, CINAHL, Scopus and PsycInfo) and in the bibliographies of the retrieved articles, without limitation of time or language. Associations between sense of coherence and health-related behaviours have been assessed.

Results

A total of 1214 investigations were reviewed and 21 of them were included in this systematic review. The relationship between sense of coherence and eight health-related behaviours were identified (alcohol use, physical activity, tobacco use, eating habits, rest periods, use of illegal substances, behaviours related to oral health and time spent in games on the computer).

Conclusions

Our results increase the available evidence and support the solid relationship of the sense of coherence with health behaviours both as a protective factor against risk behaviours and for its positive association with preventive and health promoting behaviours of adolescents, young adults and university students.

Increased Gaming During COVID-19 Predicts Physical Inactivity Among Youth in Norway—A Two-Wave Longitudinal Cohort Study

Background

A concern for the COVID-19 measures and the potential long-term consequences the measures may have on physical inactivity and gaming among youth.

Objectives

Examine the stability and change in internet and offline gaming and the association with physical inactivity among adolescents in Norway during the pandemic.

Methods

A total of 2940 youth (58% girls) aged 12–19 years participated in an online longitudinal two-wave survey during the first Norwegian national lockdown in April 2020 (t1) and in December 2020 (t2). Gaming behavior and physical activity status were assessed at both time points. Age, gender, and socioeconomic status were included as covariates.

Results

Among boys, 41% reported gaming a lot more and 35% a little more at t1 compared to before the national lockdown. The corresponding numbers for girls were 14 and 23%, respectively. In fully adjusted analysis, a pattern of increased gaming at t1 followed by an additional increase in gaming reported at t2 was associated with physical inactivity at t1 (OR = 2.10, p < 0.01) and t2 (OR = 2.45, p < 0.001). Participants gaming more at t1 followed by a reduction at t2 had higher odds of inactivity at t1 (OR = 1.88, p < 0.01). Youth reporting no gaming at t1 had lower odds for inactivity at this time point (OR = 0.67, p < 0.05).

Conclusions

Increased gaming among many youths and a relationship with physical inactivity was observed during the first phase of the COVID-19 pandemic. To counteract the negative long-term impacts of COVID-19 restrictions, public health initiatives should emphasize the facilitation of physical activity in youth and develop effective strategies to prevent problematic gaming.

Association between Adverse Childhood Experiences and Time Spent Playing Video Games in Adolescents: Results from A-CHILD Study

Background: Excessive time spent playing video games is associated with adverse health outcomes in adolescents. Although poor child–parent relationship and social relations with peers are considered as possible predictors, little is known as to whether adverse childhood experiences (ACEs) are associated with time spent playing video games. The aim is to examine the association between ACEs and time spent playing video games in adolescents. Methods: We used pooled data from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study in 2016 and 2018, which is a population-based cross-sectional study in Adachi City, Tokyo, Japan (N = 6799, 4th, 6th, and 8th-grade students). Adolescents answered questionnaires examining the time spent playing video games, per day, on weekdays (“less than 1 h”, “less than 3 h”, and “more than 3 h”) and ACEs (eight types). Results: The results of the ordinal logistic regression analysis showed a positive association between ACE total score and time spent playing video games after adjusting for covariates (1 ACE: OR = 1.28, 95% CI = 1.10–1.48; 2 ACEs: OR = 1.25, 95% CI = 1.06–1.48; 3 + ACEs: OR = 1.44, 95% CI = 1.14–1.82, p for trend < 0.001). Regarding each type of ACE, the experiences of single parenthood, parental history of psychiatric disorders, and peer isolation were independently positively associated with time spent playing video games. Conclusions: Health policy to address ACEs might be important to shorten the time spent playing video games.

Development and Verification of an Internet Game Literacy Scale

BACKGROUND

Education on internet games for parents and internet game literacy are needed to prevent problematic internet game playing in Korea. We created an 18-item Internet Game Literacy Scale (IGLS). It is a valuable tool for assessing the positive and negative aspects of internet game play. We aimed to determine the validity of the IGLS and the cut-off for the tendency for internet gameplay.

METHODS

An online research company gathered data from 300 participants. Factor analysis, including Cronbach's α and consistency coefficient, exploratory factor analysis, and confirmatory factor analysis were conducted to verify the 18 items of the IGLS. Additionally, a K-means cluster analysis was performed to determine the cut-off values for positive and negative IGLS scores.

RESULTS

The 18 items of the IGLS were proven to be reliable, as evidenced by a high Cronbach's alpha (α = 0.892). The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.903, and Bartlett's test of sphericity was good (χ² = 1,623.314, P < 0.001). All 18 items were segregated into two factors, with nine items each. The eigenvalue of all 18 items was significant at > 0.4. In the analysis of the validity of the 18-item IGLS with confirmatory factor analysis (CFA) (maximum likelihood estimation, with an oblique method), the fit indices of the standard three-factor model reached acceptable standards. The cut-off point of the total score between the low positive and average positive groups was 23, and the cut-off point of the total score between the average positive and high positive groups was 30. The cut-off point of the total score between the low negative and the average negative groups was 24. The cut-off point of the total score between the average negative group and the high negative group was 32.

CONCLUSION

The study assessed the reliability and validity of the IGLS and suggested a cut-off for low, average, and high Internet game literacy degree with 300 Korean adults aged 21-49 years. The current results suggest that the IGLS has good internal consistency and a proper cut-off for positive and negative internet game literacy degrees.

Interventions to control children's screen use and their effect on sleep: A systematic review and meta-analysis

Prolonged viewing of screen-based media is associated with poor sleep in children. Previous systematic reviews have analysed the effectiveness of interventions that aim to limit children's screen use; however, none have evaluated its effect on sleep. The aim of this systematic review was to evaluate the effect of interventions that incorporate strategies to control children's screen use on screen use and sleep. The databases Pubmed, Embase, Eric, Scopus and PsycInfo were searched during October 2017 and updated in February 2019 for experimental studies with a control that assessed interventions to control screen use in children aged 2-14 years and reported both screen use and sleep outcomes. From 3,872 initial records, 11 studies (six randomized control [RCT], four cluster RCT and one cluster, quasi-experimental) were eligible for inclusion. A total of 4,656 children aged 2-13 years were included in the studies. The mean reduction in screen time was 0.56 hr (33 min)/day (95% confidence interval [CI], 0.92, 0.20) and the mean sleep duration increased by 0.19 hr (11 min)/day (95% CI, 0.05, 0.33). Bedtime was advanced by 0.16 hr (10 min) on weekdays and by 1.0 hr at the weekend. Subgroup analyses indicated stronger intervention effects for interventions of shorter duration (<3 months), which specifically targeted screen use or sleep, and those with direct participant contact. In conclusion, small improvements in screen time and sleep duration can be achieved in children. It is not possible to determine if a reduction in screen time directly improves sleep, due to the limited number of studies, the presence of co-interventions, issues with studies' methodological quality and heterogeneity.

Early-Life Interpersonal and Affective Risk Factors for Pathological Gaming

Internet gaming is among the most popular entertainment options, worldwide; however, a considerable proportion of gamers show symptoms of pathological gaming. Internet gaming disorder (IGD) has been proposed to describe a behavioral addiction, which shares many similarities, both physical and psychological, with substance use disorder. Environmental factors, such as interpersonal and relationship dynamics during childhood and adolescence, have been suggested to modulate the onset and trajectories of IGD. However, studies exploring the contributions of dysfunctional family environments to the development of IGD remain limited. This minireview aims to offer an overview of the current knowledge regarding the impacts of early-life interpersonal and relationship dynamics on the development of IGD and to provide a snapshot of the current state of the literature in this field. Specifically, it underlines the modulatory role of early-life relational factors such as a) family function, b) parent-child relationships, c) childhood maltreatment, and d) bullying and cyberbullying on the development of IGD. Consistent with this evidence, therapeutic interventions that aim to "restructure" the emotional ties and familiar dynamics that are known to be associated with dysfunctional behaviors and feelings, and likely promote pathological gaming, are recognized as the most successful clinical therapeutic approaches for IGD.

Motivational Climate Is Associated with Use of Video Games and Violence in Schoolchildren: A Structural Equation Model According to Healthy Behaviors

The aim of this cross-sectional study was to develop an explanatory model of motivational climate, problematic use of videogames, violent behaviour and victimisation in schoolchildren. The sample included 734 children aged between 10 and 12 years of age from the province of Granada (Spain). A multi-group structural equation model was used, with an excellent fit (CFI = 0.964; NFI = 0.954; IFI = 0.964; RMSEA = 0.048). The results showed a positive relationship between the problematic use of video games, victimisation and violent behaviors, associating negatively with the task climate. Likewise, the task-oriented motivational climate was indirectly related to victimisation situations and violent behavior, while the ego climate did so positively with special emphasis on children who did not perform physical activity. As a main conclusion it is shown that adherence to the practice of physical activity, and particularly within a task-oriented motivational climate, can act as a protective factor against the problematic use of video games.

Behavioral Addictions: Excessive Gambling, Gaming, Internet, and Smartphone Use Among Children and Adolescents

The introduction of behavioral addictions is a relatively new concept in psychiatry. It was not until 2010 that the term behavioral addictions was added to the official classification of psychiatric diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Gambling, typically thought to be an adult behavior, has become commonplace among adolescents. Although technological advances have made accessing information and communication easier, excessive use of the Internet and smartphones can result in multiple mental and physical health issues. Gambling disorders, gaming disorders, Internet use disorder, and excessive smartphone use often begin during childhood and adolescence.

Effects of a prevention intervention concerning screens, and video games in middle-school students: Influences on beliefs and use

BACKGROUND AND AIMS

The aim of this study was to evaluate the effects of a prevention intervention on French adolescents' Internet and video games use and on their beliefs concerning gaming and Internet Gaming Disorder (IGD), in order to adjust prevention programs further.

METHODS

The study comprised a prevention intervention group (PIG) and a control group assessed at three times - baseline, post-test, and 4-month follow-up. At baseline, a total of 434 junior high adolescents from five secondary schools were assessed (M_age = 13.2 years; SD = 0.5). The main outcome measures were adolescents' gaming and Internet use (amount of time spent during the week and the weekend), the number of adolescents with IGD, and beliefs about gaming and IGD.

RESULTS

The results showed significant effects of the prevention intervention on Internet and gaming use (at T2, time spent was significantly lower in the PIG), an important increase of IGD prevalence between baseline and follow-up in the control group, and decreased rates of IGD among adolescents in the PIG between post-intervention and follow-up. Between baseline and follow-up, the control group showed a more significant increase of minutes per day during the week and the weekend on Internet versus during the week on video games. The impact of the prevention intervention on adolescents' beliefs varied according to gender. Girls had a better understanding generally of the potential dangers of and reasons for IGD.

DISCUSSION

Implications for future research and prevention approaches are discussed in this study.

An Explanatory Model for the Relationship between Motivation in Sport, Victimization, and Video Game Use in Schoolchildren

(1) Background: Society is changing amazingly fast, and this is bringing about changes in the way that people spend their free time. In the 21st century, free time is increasingly spent using technological devices such as video games, thus increasing levels of sedentariness. The aim of the present study was to define an explanatory model for the problematic use of video games, physical activity, motivational climate in sports, and victimization in schoolchildren, and to analyze the relationships between these variables according to gender; (2) Methods: A total of 734 schoolchildren, of both sexes, participated in this research study. They were aged from 10 to 12 and lived in the province of Granada (Spain). The main instruments used were the questionnaires PMCSQ-2, PAQ-C, QERV, and SVS. A multigroup structural equation model was used, which had an excellent fit (χ² = 319.472; df = 72; p < 0.001; CFI = 0.962; NFI = 0.952; IFI = 0.962; RMSEA = 0.048); (3) Results: The practice of physical activity was related negatively and indirectly to the problematic use of video games ((r = −0.085, boys); (r = −0.081, girls)), and this in turn was related positively and directly to victimization ((r = 0.094, boys); (r = 0.174, girls)). Additionally, task climate was inversely related to the problematic use of video games for girls (r = −0.133), and ego climate was directly related to the use of these devices only with regard to boys (r = 0.250). (4) Conclusions: It must be noted that schoolchildren’s pathological use of video games is closely related to lower levels of physical activity. In addition, those motivational climates in sports that are oriented towards performance exacerbate this pathological behavior, which accentuates the importance of promoting motivational climates that are oriented towards tasks in schoolchildren.