Trends in Digital Media Use in Korean Preschool Children

Lack of Parental Control Is Longitudinally Associated With Higher Smartphone Addiction Tendency in Young Children: A Population-Based Cohort Study

The purpose of the current study was to examine the risk factors of young children's smartphone addiction in a longitudinal study design. Data collected from 313 participants (mean age, 4.5 ± 0.82 years; male, 49.8%) over 4 years for Kids Cohort for Understanding of Internet Addiction Risk Factors in Early Childhood were analyzed in this study. Mixed effect models were used to evaluate the influence of various variables on the repeated measures of smartphone addiction tendency in young children over time. The multi-level analysis showed that parents' lack of control over children's smartphone use (t = -4.523; 95% confidence interval [CI], -7.32, -1.72), and parents' higher smartphone addiction proneness (t = 6.340; 95% CI, 0.23, 0.440) predicted higher smartphone addiction tendency in young children. The responsibility of the parents to prevent their children from becoming addicted to smartphones should start in a very early age when they start using the smartphones.

Early childhood eating behaviors associated with risk of overweight and its socio-ecological determinants in Korean preschool children

BACKGROUND/OBJECTIVES

This study aimed to identify preschool children's eating behaviors associated with early childhood obesity and its multi-level, socio-ecological determinants.

SUBJECTS/METHODS

In a cross-sectional study of 364 mothers of preschool children aged 3-5 years, these children's healthy eating behaviors were assessed using a validated preschool nutrition quotient (NQ-P) questionnaire. The children's overweight or obesity statuses were determined based on body mass index percentiles from the 2017 Korean National Growth Chart. The associations between the NQ-P score and risk of overweight or obesity were examined using multivariable logistic regression. The associations of individual, maternal, physical, and media environmental factors with the NQ-P score were also examined using multivariable linear regression.

RESULTS

Preschool children with greater NQ-P scores were at a significantly lower risk of overweight or obesity (P < 0.01). The NQ-P score had a significantly positive association with maternal body mass index and an inverse association with household income (all P < 0.05). Maternal parenting and feeding practices exhibited associations with the NQ-P score. Positive associations were observed with "warm," "structured," and "autonomy-supportive" parenting as well as monitoring feeding practices (all P < 0.05). In addition, the NQ-P score had a significantly positive association with the childcare center's anti-obesogenic environment, such as the provision of nutritional and physical-activity support and vicinity of the built food environment to the home, including access to good-quality food, fruits and vegetables, and low-fat foods (all P < 0.05). Regarding media environments, the NQ-P score demonstrated more significant associations with viewing and eating and/or cooking content displayed on online video platforms (all P < 0.05) than with that on television.

CONCLUSIONS

Our findings confirm the significance of healthy eating behaviors in early-childhood-obesity prevention and underscore the importance of multilevel maternal, physical, and media environmental interventions that effectively guide eating behaviors in preschool children.

Associations between Parent Attitudes and on- and off-Screen Behaviours of Preschool Children in Singapore

The research aims were to examine the relationships between parent and child digital media use and to describe the characteristics of the top and bottom quartiles of child digital media use in meeting the 24 h integrated guidelines for sleep, physical activity, and sedentary behaviour. Parent-reported on- and off-screen habits and quality of life of children were collected from 1481 parents of preschool children aged 2-5 years in 2019. Significant relationships were detected between parent and child digital media use (weekday, r = 0.274; weekend, r = 0.421, p < 0.05) with no sex difference in daily child digital media use (p > 0.05). Age of first exposure to fixed screens, daily digital media use, and physical play durations were significantly different between heavy (child-TQ) and light (child-BQ) child users of digital media (p < 0.05). Parental perceived importance of child digital media use and parental awareness and practice of guidelines for child digital media use differed significantly between parents of child-TQs and parents of child-BQs (p < 0.05). The number of 24 h movement guidelines met between child-TQs and child-BQs differed (p < 0.05). Parents voiced serious concerns for child digital media use, including addiction (75-76%), poor eyesight (73%), access to inappropriate content (73-74%), a lack of parent-child interaction (65%), poor sleep (49-55%), and a lack of physical activity (55-59%), but these findings did not translate to parental enforcement of the guidelines. Parent education on how to get the best digital media use outcomes for preschool children is recommended.

Effects of Frequent Smartphone Use on Sleep Problems in Children under 7 Years of Age in Korea: A 4-Year Longitudinal Study

The use of electronic screen devices has a negative effect on sleep. The purpose of this study is to longitudinally examine the effects of various screen use on sleep problems in children under 7 years of age. A total of 314 caregivers of children aged 4−7 years from three cities in Korea were recruited and responded to a self-administered questionnaire from 2017 to 2020. As a result of the analysis of the mixed model designed as a two-leveled structure, the use frequency of smartphones significantly predicted children’s sleep problems (β = 0.328, p < 0.001) compared to that of TV, PC, and tablet PC. In addition, the frequency of smartphone screen use showed a weak but significant correlation with bedtime resistance (r = 0.067, p = 0.009), sleep duration (r = 0.089, p <0.001), nighttime awakening (r = 0.066, p = 0.010), and daytime sleepiness (r = 0.102, p < 0.001). The results of this study suggest that screen time education in Korea should focus on smartphones above all else.

Lower-Income Predicts Increased Smartphone Use and Problematic Behaviors Among Schoolchildren During COVID-19 Related School Modification: A Longitudinal Study

BACKGROUND

As the coronavirus disease 2019 (COVID-19) has continued for a couple of years, the long-term effects of the pandemic and the subsequent school curriculum modification on the mental health of children and parents need to be investigated. To clarify the changes that can occur during one school year and to predict the risk factors for vulnerable groups, this study identified parameters relative to children's screen time, their problematic behavior, and parental depression.

METHODS

A total of 186 participants were analyzed who were parents of elementary schoolchildren in South Korea. These parents were required to complete a web-based questionnaire twice. The questionnaires were conducted in June 2020 and September 2021. Participants' general demographics including family income, children's screen time, sleep patterns, problematic behavior, and parental depression were assessed via the parental questionnaire that included various measurement tools.

RESULTS

Children's body mass index (BMI) increased significantly in 2021 (18.94 ± 3.75 vs. 18.14 ± 3.30, P < 0.001). Smartphone frequency of use per week (5.35 vs. 4.54, P < 0.001) and screen time per day (3.52 vs. 3.16, P < 0.001) significantly increased during the period of the COVID-19 pandemic. The television screen time (2.88 vs. 3.26, P < 0.001), frequency of viewing (3.77 vs. 4.77, P < 0.001), and children's problematic behaviors significantly decreased (9.15 vs. 11.85, P < 0.001). A lower income household was a key predictor of increased smartphone frequency (B = 1.840, 95% confidence interval [CI], 0.923-2.757, P < 0.001) and smartphone screen time (B = 1.992, 95% CI, 1.458-2.525, P < 0.001). The results showed that the lower income household (B = 5.624, 95% CI, 2.927-8.320, P < 0.001) and a child's psychiatric treatment history (B = 7.579, 95% CI, 5.666-9.492, P < 0.001) was the most significant predictor of problematic behaviors of children and parental depression (B = 3.476, 95% CI, 1.628-5.325, P < 0.001; B = 3.138, 95% CI, 1.827-4.450, P < 0.001).

CONCLUSION

This study suggested that children's smartphone screen time and BMI increased during COVID-19 because of the school curriculum modification following school closures in South Korea. The increased children's problematic behaviors and parental depression were predicted by lower-income households and the previous psychiatric history of children. These results indicate that multiple social support systems to the vulnerable group are needed during the ongoing pandemic and that a modified school setting is required.

[Strategies and effects of digital interventions in overweight and obesity treatments in children and adolescents-a systematic review]

BACKGROUND

Rising obesity prevalence in childhood and adolescence are characterized by unhealthy lifestyles such as low physical activity due to high media use. Recent studies use the accessibility of this target group through digital media, whereby technologies represent new approaches in the intervention design of weight reduction. However, the question arises as to which digital combinations and methodological program concepts condition effective body mass index (BMI) changes.

AIM

To gain insights into effective program design and media use; digital intervention strategies for BMI reduction in overweight and obese children and adolescents will be analyzed and evaluated.

METHODS

A systematic review was conducted in the databases MEDLINE via PubMed, Science Direct, and Web of Science to analyze studies from 2016 to 2021 on changes in BMI and BMI z‑score of overweight and obese 6‑ to 18-year-olds. Methodological study quality was assessed according to the Cochrane Risk of Bias guidelines.

RESULTS

From 3974 studies, seven articles describing the use of fitness wristbands, smartphones, and computer-based programs were identified. All media achieved BMI reductions, with smartphone interventions via calls and messages causing the most significant changes.

DISCUSSION

Smartphones as providers of digital programs (e.g., apps) offer effective approaches to obesity reduction. Based on the data, the selection and combination of several media as well as the relevance of family involvement and the methodological foundation of the measures are confirmed. Due to the young age of the participants, media interventions must be made accessible to the target group.

Relationship between screen time among children and lower economic status during elementary school closures due to the coronavirus disease 2019 pandemic

BACKGROUND

This study aimed to examine whether the extended use of a variety of digital screen devices was associated with lower economic status and other environmental factors among Korean elementary school children and their caregivers during school closures precipitated by the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

A total of 217 caregivers of children 7-12 years of age from Suwon, Korea, were recruited and asked to respond to a self-administered questionnaire in June 2020. The questionnaire addressed demographic information and children's use of digital media, in addition to their caregivers. The t-test was used for continuous variables, and the Kruskal-Wallis test was used for variables measured on an interval scale. A multiple regression analyses were performed to examine the effects of significant correlative factors on screen time in children as predictors.

RESULTS

Children with lower household incomes demonstrated a higher frequency and longer duration of smartphone and tablet personal computer use compared to those from higher income households. Children of households in which incomes decreased after COVID-19 used smartphones and tablet PCs more often and for longer durations. Children from households that experienced decreased income(s) after COVID-19 used personal computers more often and for a longer duration, and children from low-income families engaged in longer screen time on smartphones. A change in primary caregiver(s) may have increased children's screen time on smartphones.

CONCLUSION

Lower household income was associated with longer screen time among children, and poor mental health among caregivers during school closures precipitated the COVID-19 pandemic.

Measurement of screen time among young children aged 0-6 years: A systematic review

The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.

Parental Mental Health and Children's Behaviors and Media Usage during COVID-19-Related School Closures

BACKGROUND

Coronavirus disease 2019 (COVID-19) is different from previous disasters in that it continues to the present and has affected all aspects of family life. During epidemics, psychosocial support is not less important than infection control. During COVID-19-related school closures, prolonged partial closures of schools could have detrimental social and health consequences for children and may increase the burden on the family. Based on a community sample in Korea, this study identified parental concerns, children's media usage, other various factors and examined whether parental stress level or depression were positively associated with problem behaviors, media exposure, and sleep problems of the primary school children during school closure under COVID-19.

METHODS

Participants were 217 parents residing in Suwon, South Korea, who had primary school children and responded to a web-based questionnaire on parental concerns from school closure under COVID-19, subjective stress, depression, whether having received mental health services, and family characteristics; children's sleep patterns, problem behaviors, media usage during the online-only class period, and changes in activity level following the pandemic.

RESULTS

During school closure, children gained body weight, spent less time in physical activities and more in media usage. Besides online learning content (97.2%), YouTube was highly used content (87.6%), and games followed (78.3%). Parental subjective stress index was highly associated with parental depression (Pearson correlation 0.439, P < 0.001), children's sleep problems (0.283, P < 0.001), tablet time (0.171, P = 0.012) and behavior problems (0.413, P < 0.001). Parental depression was associated with children's sleep problems (0.355, P < 0.001), TV time (0.153, P = 0.024), tablet time (0.159, P = 0.019), and behavior problems (0.524, P < 0.001). Parents who previously received mental services seemed to be more concerned about the problems their children already have getting worse because of COVID-19 than the disease itself. Children's sleep problem was associated with tablet (0.172, P = 0.011) and smartphone time (0.298, P < 0.001), but not its frequency.

CONCLUSION

During COVID-19-related school closures, many parents and children had various difficulties relating to mental health. Ongoing monitoring of mental health of high-risk groups and multiple support systems may need to be expanded to cover those parents having difficulty in caring for their children.

The Relationship between Mother's Smartphone Addiction and Children's Smartphone Usage

OBJECTIVE

As smartphone use is becoming more common, the age of initial exposure to devices is becoming younger. Young children's screen use is influenced by various factors; it is more directly dependent on family environment than school-aged children. Our study aimed to examine the effect of mother's smartphone addition on their child's smartphone use.

METHODS

Participants were from the Kids Cohort for Understanding of internet addiction Risk factors in early childhood (K-CURE) study. Adult smartphone addiction self-diagnosis scale was used to evaluate smartphone addiction degree of mother. Child's smartphone use was assessed by parental questionnaire. Using logistic regression analysis, we examine the association between mother's smartphone addiction and child's smartphone use.

RESULTS

After adjusting for other factors, mother's smartphone addiction is related with early smartphone exposure of children. Highrisk group's children was exposed to smartphone earlier than low risk group (adjusted OR, 0.418; p=0.021). Contrary to expectation, there is no correlation between mother's smartphone addiction and child's smartphone use time.

CONCLUSION

Our study explain that mother's smartphone addiction can affect early smartphone exposure on children. Based on our findings, further study might explore the effect of early smartphone exposure on children.

Associations Between Screen Exposure in Early Life and Myopia amongst Chinese Preschoolers

This study aimed to explore the association between screen exposure in early life and preschool myopia. During the baseline survey of the Longhua Child Cohort Study (LCCS), data of 29,595 preschoolers were collected via a caregiver-reported questionnaire regarding children’s socio-demographic characteristics, visual status, screen exposure and relevant parental information. Data of 26,433 preschoolers with normal eyesight or myopia were included in the analysis and cox regression modelling was employed to assess the associations. Results suggested the hypothesis that screen exposure in early life could be significantly and positively associated with preschool myopia, and in agreement with this hypothesis was the association being strengthened with the increasing daily exposure duration and total years of exposure; in the stratification analysis based on the presence of parental myopia, these associations still existed, and the strength of associations was stronger in preschoolers with myopic parents than those without. Moreover, a statistically significant association was only observed between initial screen exposure that occurred during 0–1-years old and myopia for preschoolers without myopic parents, while the significant associations were observed between initial screen exposure that occurred during 0–1, 1–2, 2–3, and after 3 years old and myopia for preschoolers who had myopic parents, with the strongest association found in the group of children initially exposed to electronic screens during 0–1 year old. Thus our findings indicated the hypothesis that screen exposure in early life might be associated with the occurrence of preschool myopia, and that the postnatal first year might be the sensitive period for the association. However, it is premature to conclude that early screen time leads to myopia with current data. Further longitudinal studies performed with cycloplegia are necessary to verify the hypothesis and shed light on the more urgent question whether early screen exposure contributes to the later myopia epidemic of school-aged children.