Algorithmic Content Recommendations on a Video-Sharing Platform Used by Children.

Importance: Free video-sharing platforms (VSPs) make up a high proportion of children's daily screen use. Many VSPs make algorithmic recommendations, appearing as thumbnail images from the video, which content creators use to advertise their video content. Objective: To explore how VSP thumbnails use attention-capture designs to encourage engagement with content and to test whether VSP algorithmic recommendations offer more problematic thumbnail features over time. Design, Setting, and Participants: In this cross-sectional study conducted in January 2022, researchers mimicked the search behavior of children on a popular VSP by randomly clicking on recommended videos in order to test whether thumbnail designs changed over 20 sequential video engagements. A digital, footprint-free data collection setting was created by using a new computer and wireless internet router. Data were collected from YouTube via an internet browser not logged into a user account. Data analysis occurred from April to December 2022. Exposures: Manual searches using 12 top-searched terms popular with school-aged children were conducted. Researchers captured the video thumbnails recommended at the end of each video and randomly clicked subsequent videos for 20 sequential engagements. Main Outcomes and Measures: Thumbnail content codes were developed through iterative review of screenshots by a multidisciplinary research team and applied by trained coders (reliability, κ >.70). The prevalence of problematic thumbnail content and change in prevalence over 20 engagements was calculated using the Cochran-Armitage trend test. Results: A total of 2880 video thumbnails were analyzed and 6 features were coded, including visual loudness; drama and intrigue; lavish excess and wish fulfillment; creepy, bizarre, and disturbing; violence, peril, and pranks; and gender stereotypes. A high proportion contained problematic features including the creepy, bizarre, and disturbing feature (1283 thumbnails [44.6%]), violence, peril, and pranks feature (1170 thumbnails [40.6%]), and gender stereotypes feature (525 thumbnails [18.2%]). Other features included attention-capture designs such as the visual loudness feature (2278 thumbnails [79.1%]), drama and intrigue feature (2636 thumbnails [91.5%]) and lavish excess and wish fulfillment feature (1286 thumbnails [44.7%]). Contrary to the hypotheses, problematic feature prevalence did not increase over time, but the gender stereotypes feature increased with more engagement in the recommendations feed (P for trend < .001). Conclusions and Relevance: In this study of video recommendations for search terms popular with children, thumbnails contained problematic and attention-capturing designs including violent, stereotyped, and frightening themes. Research is needed to understand how children respond to thumbnail designs and whether such designs influence the quality of content children consume.

Parents' Desire to Change Phone Use: Associations with Objective Smartphone Use and Feelings About Problematic Use and Distraction.

We examined objective smartphone use (via a mobile sensing application) and self-reported desire to change phone use among a sample of 268 U.S. parents of infants. Using the Transtheoretical Stages of Change model as a conceptual foundation, we contextualized their attitudes and behaviors and explored how phone use and desire to change relate to perceptions of distraction and problematic phone use around their child. Latent profile analysis of parents' precontemplation, contemplation, and action scores revealed two classes-precontemplators (15%) and contemplators (85%). Contemplators-those considering or desiring change-showed more bedtime phone use and general social networking than precontemplors; however, there were no significant differences between groups on other objective use measures (e.g., total daily duration of phone use, phone use around child, etc.). Contemplators also showed greater perceptions of problematic use around their child and parenting distraction. Moreover, parents' problematic use and distraction were predictive of higher contemplation scores, even after controlling for demographic and objective phone use variables. Taken together, these results suggest that perceptions of phone use as problematic may be more important than actual phone habits, especially total phone use duration, for desire to change. Suggestions for future research and intervention are provided.

Longitudinal Associations Between Use of Mobile Devices for Calming and Emotional Reactivity and Executive Functioning in Children Aged 3 to 5 Years.

Importance: Mobile devices are often used to keep young children occupied or calm, but it is not known whether this practice influences child development. Objective: To examine the longitudinal, bidirectional associations between the parent-reported frequency of using mobile devices to calm young children and children's executive functioning (EF) and emotional reactivity, testing moderation by child sex and temperament. Design, Setting, and Participants: This prospective cohort study included a community-based convenience sample of English-speaking parents of typically developing children aged 3 to 5 years. The study duration was from August 2018 to January 2020, with baseline (T1), 3-month follow-up (T2), and 6-month follow-up (T3) waves. Exposures: Parent-reported frequency of use of mobile devices to calm children when upset (5-point Likert scale). Main Outcomes and Measures: At each wave, the child's EF was assessed with the Behavior Rating Inventory of Executive Function-Preschool Version Global Executive Composite and emotional reactivity with the Child Behavior Checklist Emotional Reactivity subscale. Structural equation models were built to examine cross-lagged associations of the use of devices for calming, EF, and emotional reactivity, testing for moderation by child sex or temperament (Child Behavior Questionnaire-Very Short Form surgency score, median split). Results: Of 422 eligible parents with data at T1, 375 (88.9%) provided data at T2 and 366 (86.7%) at T3. At baseline, the mean (SD) age of the 422 children was 3.8 (0.5) years, the number of boys in the sample was 224 (53.1%), the number of individuals of non-Hispanic White race and ethnicity was 313 (74.2%), and among the parents, 254 (60.2%) had a college degree or higher. Among the boys, the use of devices to calm at T2 was associated with higher emotional reactivity at T3 (r [standardized regression coefficient] = 0.20; 95% CI, 0.10-0.30), while higher emotional reactivity at T2 had a nonsignificant association with increased device use for calming at T3 (r = 0.10; 95% CI, -0.01 to 0.21). Among children with high temperamental surgency, the use of devices to calm at T2 was associated with increased emotional reactivity at T3 (r = 0.11; 95% CI, 0.01-0.22), while higher emotional reactivity at T2 was associated with increased device use for calming at T3 (r = 0.13; 95% CI, 0.02-0.24). Conclusions and Relevance: The findings of this study suggest that the frequent use of mobile devices for calming young children may displace their opportunities for learning emotion-regulation strategies over time; therefore, pediatric health care professionals may wish to encourage alternate calming approaches.

Child Media Use During COVID-19: Associations with Contextual and Social-Emotional Factors.

OBJECTIVE: The aim of this study was to test associations between (1) contextual factors and types of digital media use and (2) types of digital media use and children's social-emotional and sleep outcomes during COVID-19. METHODS: In February to March 2021, 303 parents of elementary schoolers participated in this cross-sectional survey gathering information on demographics, child school format, contextual factors, duration of types of digital media use, social-emotional outcomes, and sleep. Multivariable regressions examined associations outlined in the objective, adjusting for school format, only child, race/ethnicity, and parental stress, depressive symptoms, education, and material hardship. RESULTS: Children were aged 5 years to younger than 11 years and spent approximately 4 hours on screen media daily. In multivariable analyses, remote school format; greater material hardship; Black, Indigenous, and people of color child race/ethnicity; lower parenting stress; and parent depressive symptoms were associated with longer duration of various digital media. Longer daily duration of streaming video and video chat were associated with higher prosocial scores, while console games, mobile apps/games, and video-sharing platforms were associated with greater problematic media use (PMU) (defined as interfering with adaptive functioning). More time on mobile apps/games, video-sharing platforms, and video streaming was linked with shorter sleep. CONCLUSION: Lower parenting stress predicted greater digital media use. Greater digital media use during the pandemic may have enabled parents to focus on other needs. Use of media for social connection predicted greater prosocial behaviors. Engagement-prolonging digital media predicted PMU. Pediatric providers may wish to consider family context when addressing digital media use and encourage socially oriented digital media.

Prevalence and Characteristics of Manipulative Design in Mobile Applications Used by Children.

Importance: Manipulative design features (known as dark patterns) are common in video games and adult-directed technologies, but their prevalence in children's interactive media has not been described. Objectives: To develop a reliable coding scheme for gathering data on manipulative digital designs, describe their prevalence within apps used by a community-based sample of young children, and test hypotheses about associations of manipulative design features with socioeconomic status (SES). Design, Setting, and Participants: This cross-sectional study of a convenience sample of parents of children aged 3 to 5 years was conducted online. Eligible parents were legal guardians of a 3-to-5-year-old child, lived with their child at least 5 days per week, understood English, and were part of a family that owned at least 1 Android or iOS tablet or smartphone. For each participant, the 3 apps used for the longest duration by children with their own mobile devices were downloaded, played, and coded. Data were analyzed between April and August 2021. Exposures: Child SES, operationalized as parent educational attainment and household income-to-needs ratio. Main Outcomes and Measures: Researchers assigned each child a prevalence score for manipulative design features (overall, gameplay pressure, purchase pressure, and advertisement viewing pressure) within the apps children played. Results: Of 160 children in the sample, mean (SD) age was 4.0 (0.6) years; 120 children (75.0%) were non-Hispanic White, and 96 (60.0%) had a parent with a college degree or more. Manipulative designs promoted prolonged gameplay or purchases through 4 user experience typologies: parasocial relationship pressure occurred in 33 (24.8%) and 25 (18.8%) apps with characters; time pressure in 23 (17.3%) and 14 (10.5%) apps; navigation constraints in 61 (45.9%) and 49 (36.8%) apps; and attractive lures in 60 (45.1%) and 61 (45.9%) apps, respectively. Children from households whose parents had lower education levels had higher manipulative design prevalence scores than children whose parents had graduated from college (median [IQR] 3.7 [2.5-5.0] vs 3.0 [2.0-4.0]; P = .02), gameplay-prolonging design (2.3 [1.6-3.0] vs 2.0 [1.5-2.8]; P = .047), and purchase pressure (1.0 [0.5-1.5] vs 0.6 [0-1.3]; P = .02). Purchase pressure prevalence scores were higher for children from households with lower income (R = -0.18; P = .02). Conclusions and Relevance: Design features that encourage monetization of children's digital experiences were common in this sample and disproportionately occurred in apps used by children with lower SES.

Remote and Hybrid Schooling During COVID-19: Associations with Child Behavior and Sleep.

OBJECTIVE: The purpose of this study was to assess the prevalence of child behavior, academic and sleep concerns, and parent stress and depression symptoms during COVID-19; to test associations of parent-child well-being with child school format; and to examine effect moderation by child race/ethnicity and material hardship. METHODS: A total of 305 English-speaking parents of elementary school-age children completed online surveys regarding demographics, child school format, behavior, learning-related experiences, sleep, and parent stress and depression symptoms. Multivariable linear and logistic regression analyses examined associations of school format with child and parent outcomes. RESULTS: Children were aged 5.00 to 10.99 years, with 27.8% underrepresented minority race/ethnicity. Per parental report, 27.7% attended school in-person, 12.8% hybrid, and 59.5% remote. In multivariable models, compared with children receiving in-person instruction, children receiving remote instruction exhibited more hyperactivity (ß 0.94 [95% confidence interval, 0.18-1.70]), peer problems (ß 0.71 [0.17-1.25]), and total behavioral difficulties (ß 2.82 [1.11-4.53]); were less likely to show academic motivation (odds ratio [OR] 0.47 [0.26-0.85]) and social engagement (OR 0.13 [0.06-0.25]); were more likely to show schoolwork defiance (OR 2.91 [1.56-5.40]); and had a later sleep midpoint (ß 0.37 [0.18-0.56]) and higher odds of cosleeping (OR 1.89 [1.06-3.37]). Associations of remote learning with behavior difficulties were stronger for children without material hardships. CONCLUSION: Children receiving remote and hybrid instruction were reported to have more difficulties compared with children receiving in-person instruction. Children with material hardships showed more behavior challenges overall but less associated with school format. Therefore, planning for a return to in-person learning should also include consideration of family supports.

Young Children's Use of Smartphones and Tablets.

BACKGROUND AND OBJECTIVES: Child mobile device use is increasingly prevalent, but research is limited by parent-report survey methods that may not capture the complex ways devices are used. We aimed to implement mobile device sampling, a set of novel methods for objectively measuring child mobile device use. METHODS: We recruited 346 English-speaking parents and guardians of children aged 3 to 5 years to take part in a prospective cohort study of child media use. All interactions with participants were through e-mail, online surveys, and mobile device sampling; we used a passive-sensing application (Chronicle) in Android devices and screenshots of the battery feature in iOS devices. Baseline data were analyzed to describe usage behaviors and compare sampling output with parent-reported duration of use. RESULTS: The sample comprised 126 Android users (35 tablets, 91 smartphones) and 220 iOS users (143 tablets, 77 smartphones); 35.0% of children had their own device. The most commonly used applications were YouTube, YouTube Kids, Internet browser, quick search or Siri, and streaming video services. Average daily usage among the 121 children with their own device was 115.3 minutes/day (SD 115.1; range 0.20-632.5) and was similar between Android and iOS devices. Compared with mobile device sampling output, most parents underestimated (35.7%) or overestimated (34.8%) their child's use. CONCLUSIONS: Mobile device sampling is an unobtrusive and accurate method for assessing mobile device use. Parent-reported duration of mobile device use in young children has low accuracy, and use of objective measures is needed in future research.