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.

Exploring Influencing Factors of Anxiety Improvement Following Mindfulness-Based Music Therapy in Young Adults with Cancer.

The purpose of this secondary analysis was to explore physiological, psychological, and situational influencing factors that may affect the impact of a mindfulness-music therapy intervention on anxiety severity in young adults receiving cancer treatment. Young adults receiving cancer treatment for ≥ eight weeks were recruited from adult and pediatric oncology outpatient centers at Dana-Farber Cancer Institute. Participants were asked to attend up to four, in-person (offered virtually via Zoom video conference after the onset of the COVID-19 pandemic) 45-min mindfulness-based music therapy sessions over twelve weeks with a board-certified music therapist. Participants completed questionnaires about anxiety, stress, and other cancer treatment-related outcomes before and after participating in the intervention. Changes in anxiety (i.e., PROMIS Anxiety 4a) over time were compared among baseline physiological (e.g., age or sex), psychological (e.g., stress), and situational influencing (i.e., intervention delivery format) factors using Wilcoxon-rank sum tests. Thirty-one of the 37 enrolled participants completed the baseline and post-intervention measures and were eligible for inclusion in the secondary analysis. Results revealed that higher baseline physical functioning (median change = -6.65), anxiety (median change=-5.65), fatigue (median change = -5.6), sleep disturbance (median change = -5.6),female sex (median change = -5.15), or virtual intervention delivery(median change = -4.65) were potential physiological, psychological, or situational influencing factors associated with anxiety improvement following mindfulness-based music therapy. Additional investigation into physiological, psychological, or situational influencing factors associated with anxiety response will help to tailor the design of future mindfulness-music therapy interventions to decrease psychological distress and address the unique psychosocial concerns among young adults receiving cancer treatment. Trial Registration ClinicalTrials.gov Identifier: NCT03709225.

Exploring Young Adults' Perspectives of Participation in a Mindfulness-Based Music Therapy Intervention Before and During the COVID-19 Pandemic.

Purpose: To explore adolescent and young adults' (AYAs) experiences with participation in a mindfulness-based music therapy intervention during cancer treatment before and during the COVID-19 pandemic. Methods: Sixteen young adults (20-39 years old) who received cancer treatment and participated in a mindfulness-based music therapy intervention for anxiety and stress were interviewed using a semistructured interview guide. Interviews were audio recorded and transcribed verbatim. The interview guide contained prompts about reasons for joining the study, usual coping strategies, experience with the in-person and virtual delivery formats of the intervention, and suggestions for improvement. Themes were derived from the data using inductive content analysis methods. Results: Findings from the interviews included the following: (1) virtual group participants reported difficulty finding a private place to attend the intervention sessions, (2) participants experienced a sense of relaxation in response to intervention participation, (3) in-person group participants felt a sense of connection to the music and their family members who were present during the intervention, while virtual group participants felt a sense of connection to mindfulness, (4) virtual group participants reported that practicing music and mindfulness together was synergistic, and (5) in-person intervention delivery was preferred to virtual intervention delivery. Conclusion: This study provides insight into the contextual factors that impact satisfaction with the intervention and the effect of the intervention on anxiety and stress. Overall, while virtual mindfulness-based music therapy delivery may be more feasible, there are still important advantages to in-person delivery that should be considered in the design of future mindfulness-based music therapy interventions. ClinicalTrials.gov Identifier: NCT03709225.

Brief Report: Investigating the Motivations and Autistic Traits of Video Gamers.

Video games are commonly of interest in autism, with autistic adolescents playing twice as much as their Typically Developing peers. The aims of this study are to investigate whether motivations to play video games measured using the Gaming Attitudes, Motivations and Experiences Scales and autistic traits using the Autism Spectrum Quotient can predict time spent playing video games. 57 participants were recruited from internet forums and completed an online questionnaire. The preliminary results revealed that only escapism and social motivation predicted time spent playing games. Further investigation revealed interactions between autistic traits and several motivational scales, including escapism, completionism, and customisation. This has consequences for future research into how autistic people use video games to ease their anxieties.

Exploring the Feasibility of a Mindfulness-Music Therapy Intervention to Improve Anxiety and Stress in Adolescents and Young Adults with Cancer.

CONTEXT: Adolescent and young adults (AYAs) with cancer experience significant psychological distress due to cancer treatment that can persist long after treatment. However, little is known regarding optimal interventions to support the psychosocial needs of AYAs with cancer. OBJECTIVE: The overall objective of this single arm, longitudinal, pilot study was to determine the feasibility of implementing a mindfulness-based music therapy intervention to improve anxiety and stress in AYAs receiving cancer treatment. METHODS: AYAs (15 - 39 years old) who were to receive cancer treatment for ≥ eight weeks were recruited from the pediatric, melanoma, sarcoma, breast, lymphoma, and leukemia oncology outpatient centers at Dana-Farber Cancer Institute. The music therapy intervention included four sessions of individual mindfulness-based music therapy in-person or using Zoom over twelve weeks. Prior to-and after the intervention period, participants completed the Patient-Reported Outcomes Measurement Information Anxiety 4a and Perceived Stress Scale. Changes in patient-reported outcomes are compared using Wilcoxon signed-rank tests. RESULTS: Over ∼14 months, 37 of 93 eligible AYAs were enrolled to the study (39.8% consent rate). Overall, 27 of 37 (73%) participants (Median age=32; 56.8% Female) completed at least two music therapy sessions and the baseline measures and end of study measures. Participation in the mindfulness-based music therapy sessions resulted in significant pre-to-posttest improvements in perceived stress (median change: -4.0, P = 0.013) and non-significant changes in anxiety (median change: -1.9, P = 0.20). Satisfaction and acceptability were highly rated. CONCLUSIONS: The delivery of a four-session mindfulness-based music therapy intervention to AYAs receiving chemotherapy was feasible and significantly improved perceived stress. These preliminary findings should be confirmed in a randomized controlled trial. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03709225.

Nodding off but can't disconnect: development and validation of the iNOD index of Nighttime Offline Distress.

BACKGROUND: There is a pressing need to update sleep models, education and treatment to better reflect the realities of sleep in a 24/7 connected social world. Progress has been limited to date by available measurement tools, which have largely focused on the frequency or duration of individuals' social media use, without capturing crucial sleep-relevant aspects of this inherently social and interactive experience. METHODS: Survey data from 3008 adolescents (aged 10-18 years) was used to rigorously develop and validate a new self-report measure that quantifies difficulty disengaging from social media interactions at night: the index of Nighttime Offline Distress (iNOD). Exploratory and Confirmatory Factor analyses in a random split sample produced a ten-item two-factor solution, with subscales capturing concerns about Staying Connected and Following Etiquette (Cronbach's alphas = 0.91 and 0.92 respectively). RESULTS: Those with higher scores on these subscales tended to report using social media for longer after they felt they should be asleep (rs = 0.41 and 0.26, respectively), shorter sleep duration (rs = -0.24 and -0.17, respectively) and poorer sleep quality (rs = -0.33 and -0.31, respectively). Results also pointed towards a potentially fragmented process of sleep displacement for those who may struggle to disconnect - and to stay disconnected - from social interactions in order to allow sufficient uninterrupted sleep opportunity. CONCLUSIONS: These findings can inform current models for understanding normal and disordered sleep during adolescence, whilst highlighting specific social concerns as important potential targets for sleep education efforts.

Lessons learned from the delivery of virtual integrative oncology interventions in clinical practice and research during the COVID-19 pandemic.

The outbreak of the coronavirus disease 2019 (COVID-19) and subsequent need for disease transmission mitigation efforts have significantly altered the delivery of cancer care (e.g., rise of telemedicine), including within the field of integrative oncology. However, little has been described about how National Cancer Institute-Designated Cancer Centers have transformed integrative oncology care delivery in response to the COVID-19 pandemic. The purpose of this commentary is to describe the delivery of integrative oncology clinical services and conduct of research at The Leonard P. Zakim Center for Integrative Therapies and Healthy Living at Dana-Farber Cancer Institute during the COVID-19 pandemic. Clinical services transitioned from an array of in-person appointment-based services, such as acupuncture and massage, and group programs, such as yoga and nutrition seminars to a combination of live-streamed and on-demand virtual group programs and one-on-one virtual appointments for services such as acupressure and self-care massage. Group program volume grew from 2189 in-person program patient visits in the 6 months prior to onset of the COVID pandemic to 16,366 virtual (e.g., live-streamed or on-demand) patient visits in the first 6 months of the pandemic. From a research perspective, two integrative oncology studies, focused on yoga and music therapy, respectively, were transitioned from in-person delivery to a virtual format. Participant accrual to these studies increased after the transition to virtual consent and intervention delivery. Overall, our clinical and research observations at Dana-Farber Cancer Institute suggest that the delivery of virtual integrative oncology treatments is feasible and appealing to patients. Trial Registration: NCT03824860 (Yoga); NCT03709225 (Music Therapy).

Social media use and adolescent sleep patterns: cross-sectional findings from the UK millennium cohort study.

OBJECTIVES: This study examines associations between social media use and multiple sleep parameters in a large representative adolescent sample, controlling for a wide range of covariates. DESIGN: The authors used cross-sectional data from the Millennium Cohort Study, a large nationally representative UK birth cohort study. PARTICIPANTS: Data from 11 872 adolescents (aged 13-15 years) were used in analyses. METHODS: Six self-reported sleep parameters captured sleep timing and quality: sleep onset and wake times (on school days and free days), sleep onset latency (time taken to fall asleep) and trouble falling back asleep after nighttime awakening. Binomial logistic regressions investigated associations between daily social media use and each sleep parameter, controlling for a range of relevant covariates. RESULTS: Average social media use was 1 to <3 hours per day (31.6%, n=3720). 33.7% were classed as low users (<1 hour; n=3986); 13.9% were high users (3 to <5 hours; n=1602) and 20.8% were very high users (5+ hours; n=2203). Girls reported spending more time on social media than boys. Overall, heavier social media use was associated with poorer sleep patterns, controlling for covariates. For example, very high social media users were more likely than comparable average users to report late sleep onset (OR 2.14, 95% CI 1.83 to 2.50) and wake times (OR 1.97, 95% CI 1.32 to 2.93) on school days and trouble falling back asleep after nighttime awakening (OR 1.36, 95% CI 1.10 to 1.66). CONCLUSIONS: This study provides a normative profile of UK adolescent social media use and sleep. Results indicate statistically and practically significant associations between social media use and sleep patterns, particularly late sleep onset. Sleep education and interventions can focus on supporting young people to balance online interactions with an appropriate sleep schedule that allows sufficient sleep on school nights.

Identifying drivers for bedtime social media use despite sleep costs: The adolescent perspective.

OBJECTIVES: Bedtime social media use is associated with poor sleep during adolescence, which in turn contributes to poor mental health, impaired daytime functioning and lower academic achievement. However, the underlying drivers for these bedtime social media habits remain understudied. This study adds an adolescent perspective on motivations for bedtime social media use and perceived impact on sleep. METHODS: Adolescents aged 11-17 years (n = 24) participated in focus group discussions exploring their experiences of using social media, particularly at night. Inductive reflexive thematic analysis produced themes that captured underlying drivers for social media use and associated impact on sleep. RESULTS: Our analyses produced two overarching themes: Missing Out and Norms & Expectations. Adolescents' nighttime social media use was driven by concerns over negative consequences for real-world relationships if they disconnected (often reporting delayed bedtimes, insufficient sleep and daytime tiredness). These concerns included the risk of offline peer exclusion from missing out on online interactions, and the fear of social disapproval from violating norms around online availability and prompt responses. CONCLUSIONS: These findings offer novel insight into why adolescents may choose to prioritize social media over sleep. Researchers and practitioners can respond to the evolving needs of today's adolescents by approaching social media use not as a technology-based activity, but as an embedded social experience underpinned by the same concerns as offline interactions.

Fear of missing out and sleep: Cognitive behavioural factors in adolescents' nighttime social media use.

INTRODUCTION: Social media use has been linked to poor adolescent sleep outcomes, but the mechanisms behind this association are not yet well understood. This study examines links between adolescents' social media habits, fear of missing out and sleep outcomes, using path analysis to evaluate a model of proposed underlying mechanisms. METHODS: Adolescents aged 12-18 years (N = 101) completed questionnaire measures. RESULTS: Nighttime social media use was associated with later bedtimes, increased pre-sleep cognitive arousal, longer sleep onset latency and shorter sleep duration. Path analysis supported a model whereby fear of missing out predicted shorter sleep duration via two distinct mechanisms: (1) at a behavioural level, by driving late night social media use, which delays bedtimes; (2) at a cognitive level, by increasing pre-sleep cognitive arousal, thus further delaying sleep onset. CONCLUSIONS: Efforts to develop and evaluate intervention strategies should therefore consider not only social media behaviours but also underlying cognitive factors, such as fear of missing out.

#Sleepyteens: Social media use in adolescence is associated with poor sleep quality, anxiety, depression and low self-esteem.

This study examined how social media use related to sleep quality, self-esteem, anxiety and depression in 467 Scottish adolescents. We measured overall social media use, nighttime-specific social media use, emotional investment in social media, sleep quality, self-esteem and levels of anxiety and depression. Adolescents who used social media more - both overall and at night - and those who were more emotionally invested in social media experienced poorer sleep quality, lower self-esteem and higher levels of anxiety and depression. Nighttime-specific social media use predicted poorer sleep quality after controlling for anxiety, depression and self-esteem. These findings contribute to the growing body of evidence that social media use is related to various aspects of wellbeing in adolescents. In addition, our results indicate that nighttime-specific social media use and emotional investment in social media are two important factors that merit further investigation in relation to adolescent sleep and wellbeing.

Sleep-related attentional bias in insomnia: A state-of-the-science review.

Prominent models of insomnia posit that sleep-related attentional bias plays an important role in the development and maintenance of insomnia. Here we conduct the first systematic review of the sleep-related attentional bias construct, indexed through reaction time-based experimental tasks. Literature search identified 13 studies that met pre-defined inclusion/exclusion criteria. Included studies involved between-group comparisons (poor sleepers versus controls), as well as sleep manipulations and correlational investigations with healthy sleepers. For studies involving comparisons between poor sleepers and healthy controls, effect size estimates were computed for task-relevant dependent variables. Six of the nine studies comparing poor sleepers and controls revealed statistically significant group differences in support of a differential sleep-related attentional bias (medium-to-large effect sizes), with flicker, dot-probe and Posner tasks being most sensitive to group effects. Due to the paucity of studies and variability in design and measurement, no conclusions could be reached regarding manipulation or induction of attentional bias in good sleepers. Results from the relatively small number of studies support the presence of sleep-related attentional bias in insomnia; however, its role in the development and/or maintenance of insomnia remains to be elucidated. We set out a research agenda aimed at advancing the understanding of sleep-related attention bias.

Evaluation of health promotion training for the Western Australian Aboriginal maternal and child health sector.

ISSUE ADDRESSED: The evaluation of health promotion training for the Western Australian (WA) Aboriginal maternal and child health (MCH) sector. METHODS: Fifty-one MCH professionals from five regions in WA who attended one of three health promotion short courses in 2012-2013 were invited to complete an online survey or a telephone interview, between 4 to 17 months post-course. Respondents were asked how they had utilised the information and resources from the training and to identify the enabling factors or barriers to integrating health promotion into their work practices subsequently. RESULTS: Overall response rate was 33% (n=17); 94% of respondents reported they had utilised the information and resources from the course and 76% had undertaken health promotion activities since attending the course. Building contacts with other MCH providers and access to planning tools were identified as valuable components of the course. Barriers to translating knowledge into practice included financial constraints and lack of organisational support for health promotion activity. CONCLUSIONS: Health promotion training provides participants with the skills and confidence to deliver health promotion strategies in their communities. The training presents an opportunity to build health professionals' capacity to address some determinants of poor health outcomes among pregnant Aboriginal women and their babies. SO WHAT?: Training would be enhanced if accompanied by ongoing support for participants to integrate health promotion into their work practice, organisational development including health promotion training for senior management, establishing stronger referral pathways among partner organisations to support continuity of care and embedding training into MCH workforce curricula.

Young Aboriginal women's voices on pregnancy care: factors encouraging antenatal engagement.

BACKGROUND: Rates of adolescent pregnancy in Australia have decreased over time for all population groups but for Aboriginal adolescents remain higher than their non-Aboriginal counterparts. There is limited literature identifying the motivations of young Aboriginal women to present for pregnancy care. AIM: Understanding young Aboriginal women's views on pregnancy care is important knowledge to assist maternity services develop localised pathways that encourage engagement with pregnancy care. METHODS: A descriptive qualitative study with data collected using a bi-cultural research approach and an interview method known as yarning, with data interpretation informed by first hand cultural knowledge and current evidence. FINDINGS: The sample included 28 young women and 56 senior women and service providers. Typical actions indicative of antenatal engagement included: female relatives directing young woman to pregnancy care; availability at Aboriginal Health Services or in public hospitals and community based settings of multidisciplinary teams (midwife/Aboriginal Health Worker and/or Grandmother Liaison Officer); and, a continuous relationship with known and trusted care providers. Factors such as relocation for childbirth may interrupt pregnancy care. Active measures such as providing appointment reminders and transport to and from appointments assists young women to maintain antenatal contact. CONCLUSION: The role of female relatives in directing young women's engagement with pregnancy care is crucial combined with availability of known and trusted care providers. Relocation from a home community to the nearest birth facility, and associated accommodation and transport options, are causes of concern requiring health system changes which more fully support culturally safe maternity options regardless of location.

What are you looking at? Moving toward an attentional timeline in insomnia: a novel semantic eye tracking study.

STUDY OBJECTIVES: To date, cognitive probe paradigms have been used in different guises to obtain reaction time measurements suggestive of an attention bias towards sleep in insomnia. This study adopts a methodology which is novel to sleep research to obtain a continual record of where the eyes-and therefore attention-are being allocated with regard to sleep and neutral stimuli. DESIGN: A head mounted eye tracker (Eyelink II,SR Research, Ontario, Canada) was used to monitor eye movements in respect to two words presented on a computer screen, with one word being a sleep positive, sleep negative, or neutral word above or below a second distracter pseudoword. Probability and reaction times were the outcome measures. PARTICIPANTS: Sleep group classification was determined by screening interview and PSQI (> 8 = insomnia, < 3 = good sleeper) score. MEASUREMENTS AND RESULTS: Those individuals with insomnia took longer to fixate on the target word and remained fixated for less time than the good sleep controls. Word saliency had an effect with longer first fixations on positive and negative sleep words in both sleep groups, with largest effect sizes seen with the insomnia group. CONCLUSIONS: This overall delay in those with insomnia with regard to vigilance and maintaining attention on the target words moves away from previous attention bias work showing a bias towards sleep, particularly negative, stimuli but is suggestive of a neurocognitive deficit in line with recent research.