Position paper on screen media use and physical activity considering socio-economic status

Screen media has become increasingly pervasive in our everyday lives and has profoundly changed the way people communicate and interact with each other. However, we are still unclear about the long-term influence of screen media use on our physical health, mental health, and social wellbeing. Children and adolescents are in an important stage of brain development and are susceptible to the environmental influence that screen media possess. This dissertation pursued three aims to address research gaps related to screen media use among children and adolescents: 1) identify topics and knowledge gaps in screen media use research among children and adolescents in a large corpus of scientific literature using topic modeling 2) leverage machine learning techniques to assist systematic literature review on the association between screen media use and executive functions among children and adolescents. 3) analyze and classify the public sentiments expressed in the text referring to screen media use and screen media parenting on the Twitter platform. In the first aim, we identified some highly researched topics such as the use of social media platforms for health information and communication, screen media use and health behaviors (e.g., physical activity, sleep, smoking, eating, etc.), and computer-assisted intervention for disease diagnosis and treatment. The less explored topics were dietary management, healthcare-related screen media use for injury rehabilitation, and web information and body image concerns. The second aim found that overall screen media activity was inversely associated with executive functions among children and adolescents. However, the results for television and video games were mixed with positive, negative, and null findings when different content and context in these screen media activities and specific executive functions were examined. This work indicated that the association was nuanced by the type of device used and the nature of the interaction. In addition to the first two aims; the third study found that there was slightly more positive sentiment than negative sentiment related to screen media use and screen media parenting. Among the tweets with negative sentiment, video game violence and gun violence had been extendedly discussed and came out as the top concerns for screen media use among children and adolescents.

Screen media (television, computers, and videogames) use has been linked to multiple child outcomes, including obesity. Parents can be an important influence on children's screen use. There has been an increase in the number of instruments available to assess parenting in feeding and physical activity contexts, however few measures are available to assess parenting practices regarding children's screen media use. A working group of screen media and parenting researchers convened at the preconference workshop to the 2012 International Society for Behavioral Nutrition and Physical Activity (ISBNPA) annual meeting, "Parenting Measurement: Current Status and Consensus Reports," to identify and prioritize issues in assessing screen media parenting practices. The group identified that screen media use can pose different risks for children, depending on their age and developmental stage, across physiologic, psychosocial, and development outcomes. With that in mind, a conceptual framework of how parents may influence their child's screen-viewing behaviors was proposed to include the screen media content, context of viewing, and amount viewed. A research agenda was proposed to prioritize a validation of the framework and enhance the ability of researchers to best assess parenting influences across the three domains of content, context and amount of children's screen media use.

Screen media serves an essential role in adolescents' lives, posing growth opportunities and mental health challenges. Family plays a crucial role in mitigating these challenges. This systematic review offers a comprehensive analysis of the family factors related to adolescent screen media use and mental health. A systematic search was conducted in PubMed, CINAHL, PsycINFO, Scopus, and Embase, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the following inclusion criteria: English, peer-reviewed, observational design, and published since 2013; adolescent samples aged 10-17 years; and examining screen media use, family factors, and internalizing problems. The role of family factors as predictors, moderators, and mediators was also examined. Of the 3587 records, 32 met the inclusion criteria. These studies, primarily cross-sectional, presented a global perspective of 14 countries. A heterogeneous range of family factors, screen media use, and mental health outcomes were examined, revealing significant associations between elevated screen media use and internalizing problems. Positive family processes and democratic media-specific parenting mitigate such association. A few studies underscored family socioeconomic status (SES), noting elevated screen media use and mental health risks among adolescents in families of low SES. Accumulating evidence supports the important role of positive family contexts in fostering balanced screen media use and mental health in adolescents, accentuating the need for professional screening and education to promote positive screen media use among adolescents and families. Further research requires refinement in measurement and methodology to better capture the intricate relationship between family dynamics, screen media use, and adolescent mental health.

Introduction Excessive screen media use has been associated with a number of negative health outcomes in young children, including increased risk for obesity and comparatively lagging cognitive development. The purpose of this study was to assess state licensing regulations restricting screen media use for children under 24 months old in early care and education (ECE) and to compare regulations to a national standard. Methods We reviewed screen media use regulations for all US states for child care centers ("centers") and family child care homes ("homes") and compared these regulations to a national standard discouraging screen media use in children under 24months of age. We assessed associations between state geographic region and year of last update with the presence of regulations consistent with the standard. In centers, 24 states had regulations limiting screen media use for children under 24months of age and 19 states had regulations limiting screen media use in homes. Results More states in the South and fewer states in the Midwest had regulations limiting screen media use. The association between geographic region and regulations was not significant for centers (p = 0.06), but was for homes (p = 0.04). The year of last update (within the past 5years versus older than 5years) was not associated with regulations for centers (p = 0.18) or homes (p = 0.90). DiscussionMany states lacked screen media use regulations for ECE. States should consider adding screen media use restrictions for children under 24 months based on current research data and current recommendations in future regulations updates.

Excessive screen media use exposure is a robust childhood predictor of sedentary behavior. The association between excessive exposure to sedentary behaviors (e.g., screen media use) and motor skills and how this association differs across sociodemographic strata is an important knowledge gap that needs to be addressed. The study aims to investigate the association of motor skills and screen media use in preschool children, taking into account sociodemographic variables, physical activity, and sleep profile. A cross-sectional survey of 926 children from 27 preschools was performed. The main outcome was defined as motor skills assessed using the general motor quotient (GMQ). Independent variables included sociodemographic variables, screen media use, screen habits, physical activity, and sleep duration. Logistic regression models were used to estimate the associations between the children's motor skills and each exposure factor. More than 55 percent of the children ate while watching television and 28 percent spent a long time watching television, playing video games, or using a computer, tablet, or cell phone. Excessive screen media use increased the risk of a low GMQ by 72 percent and inactivity in children increased the odds by 90 percent; sleep duration at night decreased the odds of a low GMQ by 51 percent and daytime sleep decreased the odds by 33 percent. Excessive screen media use has been associated with poor motor skills and increased physical inactivity in children, especially among those with prolonged exposure. Our findings can alert parents to the consequences of excessive screen media use and can motivate policymakers to encourage sports and other health-promotion strategies.

BackgroundWorldwide, the prevalence of childhood overweight and obesity increases. Children with low socioeconomic status (SES) are more often affected by overweight and obesity. SES is also associated with health behaviours. In order to avoid health disparities, school-based health promotion programmes such as “Join the Healthy Boat” can help. Intervention outcomes can differ by SES; therefore, the purpose of this study was to investigate whether the intervention had equal or differential effects both on weight status and health-related behaviours in children from high and low SES.MethodsOne thousand six hundred twenty children’s data (7.1 ± 0.6 years; 50.6% male) was analysed; anthropometric data was taken on-site, other health-related parameters, such as physical activity, nutrition, and screen media use, as well as SES were assessed subjectively. Logistic regression models and GEEs were calculated.ResultsComparisons by SES show that there were significant differences in children’s characteristics and health behaviours such as migration background, height, weight, BMI percentiles, weight status, family education level, household income, physical activity behaviour, screen media use, soft drink intake and breakfast skipping. After one year, there were no intervention effects for overweight status, physical activity, or screen media use, but children with high SES in the intervention group skipped breakfast significantly less often than in the control group (5.34 [1.44;19.85], p = 0.01). Parental education level and household income were also assessed separately, with similar results. Interaction analysis revealed no significant effects apart from an interaction effect for breakfast behaviour (p = 0.02).ConclusionsThe health-promotion programme “Join the Healthy Boat” has the potential to promote children’s health via a school-based intervention and therefore, reach all children independent from their background. This study shows vast gaps between several health behaviours of primary school children depending on their SES, favouring those children coming from more privileged families. A longer implementation may possibly show more effects.Trial registrationDRKS00000949.

Screen media overuse is associated with negative physical and mental health effects in children. The American Academy of Pediatrics recommends limiting screen media use at home; however, there are no similar guidelines for children's hospitals. This study was conducted to explore caregiver (parent or other guardian) perceptions about screen media use, compare at-home with in-hospital screen media use, and measure screen use among hospitalized children. We obtained data from a convenience cohort of hospitalized children at a single, comprehensive tertiary care children's hospital over 3 periods of 2 weeks each from 2013 to 2014. Home and hospital screen media use was measured through survey and study personnel directly observed hospital screen use. Descriptive statistics are reported and generalized estimating equation was used to identify characteristics associated with screen media use. Observation (n = 1490 observations) revealed screen media on 80.3% of the time the hospitalized child was in the room and awake, and 47.8% of observations with direct attention to a screen. Surveyed caregivers reported their child engaging in significantly more screen media use in the hospital setting as compared with home, and 42% of caregivers reported the amount of screen time used by their child in the hospital was more than they would have liked. Hospitalized children have access to a variety of screen media, and this media is used at rates far higher than recommended by the American Academy of Pediatrics. Children's hospitals should consider developing guidelines for screen media use.

Digital mental health interventions (DMHIs) show promise in improving children's mental health, but there is limited understanding of how technology and screen media influence treatment outcomes. The purpose of this study was to leverage retrospective data to explore the relationships of technology and screen media use with mental health symptoms among children participating in a pediatric DMHI. Children ages 6-12 years who participated in a DMHI, Bend Health Inc, in the United States were included. Caregivers reported their child's screen media use and mental health symptoms every 30 days. Associations of screen media use with mental health symptoms were examined at baseline and throughout DMHI participation. Nearly all children (98.0%) used screen media, with 58.3% exhibiting problematic use and 23.2% showing elevated use at baseline. Elevated screen media use was associated with more severe depressive (z = 2.19, P = .022) and anxiety symptoms (z = 2.36, P = .019) at baseline, though associations differed by type. Video streaming, internet use, and gaming were linked to inattention, hyperactivity, and oppositional behavior (P's < 0.05). While screen media use decreased for most children during care (93.1%), those with elevated use showed marginally greater improvements in anxiety (z = -1.87, P = .062) and inattention symptoms (z = -1.90, P = .058). Findings suggest a nuanced interaction between technology use and DMHIs. Future research should explore the specific contexts of screen media use to optimize DMHI effectiveness and address the potential adverse effects of certain screen media activities.

Child screen media use may cause family conflict, and risk factors for such conflict are not well characterized. This study examined risk factors of persistent requesting to use screen media among preschool-age children, focusing on parent-reported characteristics of parent and child screen media use. Data was collected through an online survey completed in 2017 by a nationally recruited sample of 383 parents of 2-5-year-old children. Parents reported on their child's and their own screen media use, household/sociodemographic measures, and child requests to use screen media. Persistent requesting was defined as exhibiting "bothersome" or "very bothersome" behaviors to use screen media. Poisson regression with robust standard errors computed the prevalence risk ratio of persistent requests on parent and child screen media use characteristics, adjusted for household and sociodemographic characteristics. Overall, based on parents' reports, 28.7% of children exhibited persistent requesting, which was often accompanied by whining, crying, gesturing, or physically taking a device. In an adjusted regression model, higher amounts of parental time spent using social media, but not parental time spent using other screen media, was associated with a greater prevalence of children's persistent requests. In latter models, children's use of smartphones and engagement with online videos were independently related to persistent requests. Across all models, children's total quantity of screen media use was unrelated to persistent requests. Practitioners advising families on managing conflict around child screen media use should consider characteristics of both child and parent screen media use.

Objectives: This study aims to investigate the differences in preschooler self-regulation of media use depending on screen media use environments (physical, situational, and parental factors).Methods: A total of 989 parents of 4-6-years-olds were surveyed to identify the differences in media use self-regulation depending on the environmental factors. An analysis of covariance was performed, controlling for the sex and age of preschoolers.Results: The self-regulation of media usage scores ordered by type was: TV, Tablet PC/Personal Computer/Laptop, and Smartphone. The self-regulation of media use scores by platform was: OTT, IPTV, terrestrial TV, cable TV, and YouTube. Regarding whether or not preschooler have channel selection, it was found that the group with channel seledtion for preschooler had lower self-regulation score than the group without it. The group viewing screen media with their mothers exhibited the highest screen media use self-regulation score. In contrast, the group viewing with grandparents showed the lowest screen media use self-regulation score. Concerning parental factors, self-regulation scores were lower in the infant-centered low-motivation group than in the high-motivation group. For parent-centered motivation, the opposite result was found. Fathers’ media usage time-high group had lower self-regulation scores than the low group.Conclusion: The appropriate preparation of the screen media use environment is an essential factor in improving the self-regulation of preschooler screen media use. Specifically, it is necessary to create an appropriately controlled media use environment to improve preschooler self-regulation of media use.

ObjectiveAccurate measurement of adult and child screen media use are needed to robustly assess its impact on health outcomes. Our objective was to systematically review screen media use measurement tools that have been validated against an objective “gold standard” tool.MethodsThe search strategy was initially conducted in Medline Ovid and translated to Embase, Web of Science, PsychInfo and Cochrane. A modified natural language search was conducted in Google Scholar and IEEE. The initial search was conducted in March 2021, and an updated search was conducted in June 2022. Additional studies were included from the references. Studies had to describe the validation of a tool to measure screen media use on participants of any age against a ‘gold standard’ or comparable objective measure. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) was used to assess the criterion validity. Four authors reviewed the titles in two rounds and extracted data.ResultsTwenty-nine articles were included in the review. Studies measured TV, computer, mobile device and social media site screen media use through: self or parent report, direct or video observation, computer and mobile device use tracking programs, and through other novel devices such as wearable devices and cameras. Correlations of self or parent report of screen media with the gold standard were lower than correlations of technology-based measures, and video observation with the gold standard. The COSMIN criterion validity ratings ranged from poor to excellent; most of the studies received a global score of fair or poor.ConclusionsTechnology based validated tools that more directly measure screen use are emerging that have been validated against a gold standard for measuring screen use. However, practical, objective measures of diverse types of screen media use that have been tested on diverse populations are needed to better understand the impact of screen media use on the development and physical and mental health of children and adults.

This study uses both quantitative and qualitative data to examine how screen media use and problematic media use changed over the course of the COVID-19 pandemic (pre-onset, 3-months and 15-months post-onset). We examined changes in screen media use (time spent) and problematic media use (seemingly addicted behavior) in children ages 1.17–11.42 years across three time points (N = 316, 51.7% girls, 83.9% White; primarily middle-to-high income). Qualitative findings provided insight into parent perceptions of the long-lasting effects of COVID-19 media behaviors, some parents experiencing burnout over fighting with their children about screens, and families finding a balance with screens. Quantitatively, both screen and problematic media use increased from 2019 to 2020 (small-medium effect size) and decreased from 2020 to 2021 (small effect size), though not all the way to 2019 levels. There were significant interactions between screen media use and child age/negative parent perceptions, but none with problematic media use. This is the first study to elucidate that while many parents were seeing a return to normal for their child’s media use 15 months post-onset, many were struggling just as much as they were at COVID-19 onset, indicating the pandemic’s potentially long-lasting effect on child media use behaviors.

Screen media use by children has been a subject of constant concern by parents, teachers, pediatricians, psychiatrists, and policymakers. The potential for its misuse often shadows media use in terms of its educational and communication opportunities. Adding to the concerns is that excessive screen media use is associated with poor physical and mental health. COVID-19 lockdowns, school closure, and online classes have increased media exposure to children. The prevailing risky situation has prompted global health agencies and professional societies to issue guidelines for safe media use. Parents in their day-to-day life grapple with the problem of knowing how much media is good are media addicting and how to regulate media use in their children. Whether working from home or on-site, working parents face more complex problems wherein their media use is known to shape the kids' screen media use. This viewpoint discussed the problem statement, and the possible solutions for the already overburdened parents juggling work demands, childcare, and screen media use in their children.

Parental mediation of screen media (e.g., television, video games) is associated with better outcomes for children. Although much research has examined parental mediation of television (TV), there is a dearth of research examining communication about mobile media (e.g., Smartphones, tablets) in the digital age. This study seeks to identify themes of family communication around media and mobile devices using naturalistic observational methodology. The sample consisted of 21 toddlers (ages 12-24-months old), 31 preschool-age children (3-5 years old), and 23 school-age (10-13 years old) children and their families. Children wore Language ENvironment Analysis (LENA) audio recording devices, which recorded vocalizations and other sounds proximal to the child wearing the device in the home environment, as well as audible screen media use. ATLAS.ti was used to transcribe dialogue from the audio recordings that pertained to screen media. Experts from the fields of communication, clinical child psychology, and developmental-behavioral pediatrics independently analyzed the transcripts to identify common themes. Five main themes emerged. First, parental mediation of screen media was primarily restrictive, reactive, and focused on technology functionality. Second, active mediation was child-driven. Third, siblings played a more dominant role in mediation than parents. Fourth, parents and children negotiated screen time limits. Finally, parallel family media use was common. Multiple family members engaged with their own mobile devices while simultaneously being exposed to background screen media (i.e., media multitasking). Assessing media use in the naturalistic home environment elucidated current patterns of family media use and communication about media in the digital age.

To explore the impact of exercise self-efficacy on college students' emotion management ability and to analyze the mediating effects of exercise behavior and screen media use between exercise self-efficacy and emotion management ability. This study adopted stratified, whole-cluster, and staged sampling methods, using an online questionnaire that included demographic information, exercise self-efficacy, exercise behavior, screen media use, and other relevant aspects, obtaining a total of 12,687 valid questionnaires. The study indicated a significant positive correlation between exercise self-efficacy and emotion management ability (r = 0.349, p < 0.01). There was also a positive correlation between physical exercise and emotion management ability (r = 0.128, p < 0.01). In contrast, smartphone use showed a significant negative correlation with emotion management ability (r = -0.102, p < 0.01). Additionally, exercise persistence and electronic health literacy presented significant positive correlations with emotion management ability (r = 0.370, p < 0.01; r = 0.502, p < 0.01). Chain-mediated effect analysis revealed that exercise self-efficacy positively affected emotion management ability by enhancing physical exercise and reducing smartphone use (95% CI: [0.001, 0.002]). Furthermore, exercise self-efficacy positively influenced emotion management ability by enhancing exercise persistence and e-health literacy (95% CI: [0.029, 0.042]). These two variables acted as chain mediators, demonstrating the pathways through which exercise self-efficacy affects emotion management ability. This study deepened the understanding of the interplay between exercise behavior, screen media use, and emotion management ability. It suggested that emotion management ability could be enhanced through strategies of improving exercise persistence, physical exercise, electronic health literacy, and reducing smartphone use while considering differences in gender, academic year, and regional factors in intervention programs.