A system dynamics approach to understand Dutch adolescents' sleep health using a causal loop diagram.

BACKGROUND: Healthy sleep is crucial for the physical and mental wellbeing of adolescents. However, many adolescents suffer from poor sleep health. Little is known about how to effectively improve adolescent sleep health as it is shaped by a complex adaptive system of many interacting factors. This study aims to provide insights into the system dynamics underlying adolescent sleep health and to identify impactful leverage points for sleep health promotion interventions. METHODS: Three rounds of single-actor workshops, applying Group Model Building techniques, were held with adolescents (n = 23, 12-15 years), parents (n = 14) and relevant professionals (n = 26). The workshops resulted in a multi-actor Causal Loop Diagram (CLD) visualizing the system dynamics underlying adolescent sleep health. This CLD was supplemented with evidence from the literature. Subsystems, feedback loops and underlying causal mechanisms were identified to understand overarching system dynamics. Potential leverage points for action were identified applying the Action Scales Model (ASM). RESULTS: The resulting CLD comprised six subsystems around the following themes: (1) School environment; (2) Mental wellbeing; (3) Digital environment; (4) Family & Home environment; (5) Health behaviors & Leisure activities; (6) Personal system. Within and between these subsystems, 16 reinforcing and 7 balancing feedback loops were identified. Approximately 60 potential leverage points on different levels of the system were identified as well. CONCLUSIONS: The multi-actor CLD and identified system dynamics illustrate the complexity of adolescent sleep health and supports the need for developing a coherent package of activities targeting different leverage points at all system levels to induce system change.

Associations between parenting, media use, cumulative risk, and children's executive functioning.

OBJECTIVE: This study was designed to examine how parenting style, media exposure, and cumulative risk were associated with executive functioning (EF) during early childhood. METHODS: A nationally representative group of US parents/caregivers (N = 1156) with 1 child between 2 and 8 years participated in a telephone survey. Parents were asked to report on their child's exposure to television, music, and book reading through a 24-hour time diary. Parents also reported a host of demographic and parenting variables as well as questions on their child's EF. RESULTS: Separate multiple regressions for preschool (2-5 years) and school-aged (6-8 years) children grouped by cumulative risk were conducted. Parenting style moderated the risks of exposure to background television on EF for high-risk preschool-age children. Educational TV exposure served as a buffer for high-risk school-aged children. Cumulative risk, age, and parenting quality interacted with a number of the exposure effects. CONCLUSIONS: The study showed a complex pattern of associations between cumulative risk, parenting, and media exposure with EF during early childhood. Consistent with the American Academy of Pediatrics, these findings support the recommendation that background television should be turned off when a child is in the room and suggest that exposure to high-quality content across multiple media platforms may be beneficial.