Mobile device screen time is associated with poorer language development among toddlers: results from a large-scale survey.

BACKGROUND: Despite young children's widespread use of mobile devices, little research exists on this use and its association with children's language development. The aim of this study was to examine the associations between mobile device screen time and language comprehension and expressive language skills. An additional aim was to examine whether three factors related to the domestic learning environment modify the associations. METHODS: The study uses data from the Danish large-scale survey TRACES among two- and three-year-old children (n = 31,125). Mobile device screen time was measured as time spent on mobile devices on a normal day. Measurement of language comprehension and expressive language skills was based on subscales from the Five to Fifteen Toddlers questionnaire. Multivariable linear regression was used to examine the association between child mobile device screen time and language development and logistic regression to examine the risk of experiencing significant language difficulties. Joint exposure analyses were used to examine the association between child mobile device screen time and language development difficulties in combination with three other factors related to the domestic learning environment: parental education, reading to the child and child TV/PC screen time. RESULTS: High mobile device screen time of one hour or more per day was significantly associated with poorer language development scores and higher odds for both language comprehension difficulties (1-2 h: AOR = 1.30; ≥ 2 h: AOR = 1.42) and expressive language skills difficulties (1-2 h: AOR = 1.19; ≥ 2 h: AOR = 1.46). The results suggest that reading frequently to the child partly buffers the negative effect of high mobile device screen time on language comprehension difficulties but not on expressive language skills difficulties. No modifying effect of parental education and time spent by the child on TV/PC was found. CONCLUSIONS: Mobile device screen time of one hour or more per day is associated with poorer language development among toddlers. Reading frequently to the child may have a buffering effect on language comprehension difficulties but not on expressive language skills difficulties.

Longitudinal associations of screen time, physical activity, and sleep duration with body mass index in U.S. youth.

BACKGROUND: Youth use different forms of screen time (e.g., streaming, gaming) that may be related to body mass index (BMI). Screen time is non-independent from other behaviors, including physical activity and sleep duration. Statistical approaches such as isotemporal substitution or compositional data analysis (CoDA) can model associations between these non-independent behaviors and health outcomes. Few studies have examined different types of screen time, physical activity, and sleep duration simultaneously in relation to BMI. METHODS: Data were baseline (2017-2018) and one-year follow-up (2018-2019) from the Adolescent Brain Cognitive Development Study, a multi-site study of a nationally representative sample of U.S. youth (N = 10,544, mean [SE] baseline age = 9.9 [0.03] years, 48.9% female, 45.4% non-White). Participants reported daily minutes of screen time (streaming, gaming, socializing), physical activity, and sleep. Sex-stratified models estimated the association between baseline behaviors and follow-up BMI z-score, controlling for demographic characteristics, internalizing symptoms, and BMI z-score at baseline. RESULTS: In females, isotemporal substitution models estimated that replacing 30 min of socializing (ß [95% CI] = -0.03 [-0.05, -0.002]), streaming (-0.03 [-0.05, -0.01]), or gaming (-0.03 [-0.06, -0.01]) with 30 min of physical activity was associated with a lower follow-up BMI z-score. In males, replacing 30 min of socializing (-0.03 [-0.05, -0.01]), streaming (-0.02 [-0.03, -0.01]), or gaming (-0.02 [-0.03, -0.01]) with 30 min of sleep was associated with a lower follow-up BMI z-score. In males, replacing 30 min of socializing with 30 min of gaming was associated with a lower follow-up BMI z-score (-0.01 [-0.03, -0.0001]). CoDA estimated that in males, a greater proportion of time spent in baseline socializing, relative to the remaining behaviors, was associated with a higher follow-up BMI z-score (0.05 [0.02, 0.08]). In females, no associations between screen time and BMI were observed using CoDA. CONCLUSIONS: One-year longitudinal associations between screen time and BMI may depend on form of screen time, what behavior it replaces (physical activity or sleep), and participant sex. The alternative statistical approaches yielded somewhat different results. Experimental manipulation of screen time and investigation of biopsychosocial mechanisms underlying the observed sex differences will allow for causal inference and can inform interventions.

Screen time, social media use, and weight-related bullying victimization: Findings from an international sample of adolescents.

Screen time, social media, and weight-related bullying are ubiquitous among adolescents. However, little research has been conducted among international samples. Therefore, the aim of this study was to determine the association between screen time, social media use, and weight-related bullying victimization among an international sample of adolescents from six countries. Data from the 2020 International Food Policy Study Youth Survey were analyzed (N = 12,031). Multiple modified Poisson regression models were estimated to determine the associations between weekday hours of five forms of screen time, and total screen time, and use of six contemporary social media platforms and weight-related bullying victimization. Analyses were conducted among the overall sample, and stratified by country (Australia, Canada, Chile, Mexico, United Kingdom, United States). Greater hours of weekday screen time and use of each of the six social media platforms were associated with weight-related bullying victimization among the sample. Each additional hour of social media use was equivalent to a 13% (confidence interval [CI] 1.10-1.16) increase in the prevalence of weight-related bullying victimization. The use of Twitter was associated with a 69% (CI 1.53-1.84) increase in the prevalence of weight-related bullying victimization. Associations between hours of weekday screen time, use of six social media, and weight-related bullying victimization differed by country. Findings underscore the associations between screen time, social media, and weight-related bullying among a sample of adolescents from six medium- and high-income countries. Country-specific and global public health and technology efforts are needed to address this burgeoning social problem.

Executive dysfunction as a possible mediator for the association between excessive screen time and problematic behaviors in preschoolers.

Excessive screen time in children is a growing concern for parents and healthcare providers worldwide because it frequently leads to behavioral problems. Although executive dysfunction is proposed to be one of the contributing factors to maladaptive behaviors, little is known about the link between screen time and behaviors. This study aimed to identify whether executive dysfunction contributes to the negative behaviors of children exposed to excessive screen time. A cross-sectional study was conducted on preschool-aged children from public and private schools in Chiang Mai, Thailand. The parents/guardians of each child completed the questionnaires regarding clinical characteristics and screen time use, the Behavior Rating Inventory for Executive Function-Preschool (BRIEF-P), and the Strengths and Difficulties Questionnaire (SDQ). Children with more than one hour of media exposure per day were considered to have excessive screen time. Multivariable Gaussian regression was analyzed to compare the BRIEF-P and SDQ scores between the excessive and appropriate screen time groups. Causal mediation analysis was performed to examine the effects of total screen time on increasing behavioral problems with executive functioning as a mediator. A total of 1,126 preschoolers were included in the analyses. After controlling for age, sex, socioeconomic status, and maternal education, the excessive screen time group had significantly higher BRIEF-P global executive composite score than the appropriate screen time group (mean difference of global executive composite score = 1.49, 95% CI [0.12, 2.86], and p = 0.033). Concurrently, there were significant differences in externalizing behavior subscales and SDQ total difficulties scores between the excessive and appropriate screen time groups (mean difference of total difficulties score = 0.90, 95% CI [0.29, 1.50], and p = 0.004). A significant average causal mediation effect (ACME) of screen time on behavioral problems mediated through executive functioning was ß = 0.28, 95% CI [0.13-0.44], which was more than half of the total effect (54.9%, 95% CI [37.4-100%]). The current study suggests that the increase in behavioral issues in preschoolers might be partly explained by the direct effect of excessive screen time and the mediating effect of impaired executive functioning. Our results may raise concerns about the necessity to limit screen time and monitor for executive function deficits and behavioral problems in young children with high screen time.

The relationship between screen time and gross motor movement: A cross-sectional study of pre-school aged left-behind children in China.

OBJECTIVE: To investigate the level of screen time and gross motor movement level and the correlation between them in left-behind children aged 3 to 6 years old in China. METHODS: A randomized whole-group sampling method was used to study 817 left-behind children aged 3-6 years in 15 kindergartens in Xiangcheng city, Henan province. The third version of the Test of Gross Motor Development (TGMD-3) was used to test the children's gross motor movement level, and the screen time questionnaire was used to test the children's screen time level. The relationship between the two and the indicators was explored using Pearson's two-sided correlation and multilevel regression. RESULTS: The average daily screen time of left-behind children aged 3-6 years old increased with age, and the reporting rate of >2 h/d ranged from 22.43% to 33.73%; gross motor movement of left-behind children aged 3-6 years old increased with age, with significant differences between age (p<0.05). There was a low to moderate negative correlation (r = -0.133 to -0.354, p<0.05) between screen time and gross motor movement in children aged 3-6 years, and multiple regression analysis showed that screen time was predictive of gross motor movement in children (p<0.05), with an explanation rate of 21.4%. CONCLUSION: There is a correlation between screen time and gross motor movement development in children aged 3-6 years old left behind, and the gross motor movement ability of children aged 3-6 years old can be developed by reducing screen time and increasing physical activity.

Association between excessive screen time and school-level proportion of no family rules among elementary school children in Japan: a multilevel analysis.

BACKGROUND: Excessive screen time (ST) in children is a global concern. We assessed the association between individual- and school-level factors and excessive ST in Japanese children using a multilevel analysis. METHODS: A school-based cross-sectional study was conducted in Toyama, Japan in 2018. From 110 elementary schools in Toyama Prefecture, 13,413 children in the 4th-6th grades (boys, 50.9%; mean, 10.5 years old) participated. We assessed lifestyle, recreational ST (not for study use), psychological status, and school and family environment including family rules. We defined ≥3 hours ST as excessive. We calculated the school-level proportions of no family rules and divided them into four categories (<20%, 20% to <30%, 30% to <40%, and ≥40%). A modified multilevel Poisson regression analysis was performed. RESULTS: In total, 12,611 children were included in the analysis (94.0%). The average school-level proportion of those with no family rules was 32.1% (SD = 9.6). The prevalence of excessive ST was 29.9% (34.9% in boys; 24.8% in girls). The regression analysis showed that excessive ST was significantly associated with both individual-level factors, such as boys (adjusted prevalence ratio (aPR); 1.39), older grades (aPR; 1.18 for 5th grades and 1.28 for 6th grades), late wakeup (aPR; 1.13), physical inactivity (aPR; 1.18 for not so much and 1.31 for rarely), late bedtime (aPR; 1.43 for 10 to 11 p.m. and 1.76 for ≥11 p.m.), frequent irritability (aPR; 1.24 for sometimes and 1.46 for often), feelings of school avoidance (aPR; 1.17 for sometimes and 1.22 for often), infrequent child-parental interaction (aPR; 1.16 for rare and 1.21 for none), no family rules (aPR; 1.56), smartphone ownership (aPR; 1.18), and the school-level proportion of no family rules (aPR; 1.20 for 20% to <30%, 1.29 for 30% to <40%, and 1.43 for ≥40%, setting <20% as reference). CONCLUSION: Besides individual factors, a higher school-level proportion of no family rules seemed influential on excessive ST. Increasing the number of households with family rules and addressing individual factors, could be deterrents against excessive ST in children.

When and what: A longitudinal study on the role of screen time and activities in adolescent sleep.

OBJECTIVES: Previous research has highlighted a link between electronic media use and sleep outcomes, but the nuanced impacts of screen use at different time of day and activities on adolescent sleep are underexplored. METHODS: 831 participants underwent online assessment three times with interval of three months regarding their screen time and activities at specific times of the day, daytime sleepiness was assessed with the Epworth Sleepiness Scale, and sleep outcomes were assessed with the Pittsburgh Sleep Quality Index and Insomnia Severity Index. The associations between time spent on various screen activities, and sleep outcomes were examined respectively after controlling for inter-individual differences using the Random Intercept Cross-Lagged Panel Model models and LMMs. RESULTS: The RI_CLPM model revealed that both electronic screen time during daytime and after lights off in the evening in Wave1 negatively predicted the sleep quality in Wave2; the nighttime screen time before lights off in Wave1 significantly negatively predicted the seventy of insomnia in Wave2. Whereas no cross-lag and predictive effects of sleep outcomes on screen time were revealed. Moreover, daytime screen exposure, including T.V. watching and social media use, and nighttime music listening were negatively associated with sleep quality. Conversely, nighttime screen time of shopping and working/studying positively influenced sleep quality. Additionally, daytime screen time of T.V. viewing was positively associated with increased insomnia severity, whereas nighttime work/study-related screen time negatively affected insomnia severity. Nighttime screen time of music listening negatively predicted daytime sleepiness. CONCLUSIONS: The current findings contributed to the existing literature suggesting that the effects of electronic screen time on sleep depended on both the time of day and type of screen activities.

Late bedtime combined with more screen time before bed increases the risk of obesity and lowers diet quality in Spanish children.

This cross-sectional study aimed to investigate whether the combination of bedtime and screen time (ST) before bed were associated with obesity and diet quality in toddlers and school-aged children. Parents reported children's bedtimes and ST before bed (0 min, 1-30 min, >30 min). We then defined bed + screen time behavior using bedtime median cut-offs (early [EB] or late [LB]) and ST responses, resulting in four groups: EB-0'ST, EB ≤ 30'ST/LB-0'ST, EB > 30'ST/LB ≤ 30'ST, and LB > 30'ST. For all participants (n = 1133; 5.4 ± 2.7 years, 49.7% girls, 51.9% school-aged) we evaluated body mass index (BMI), diet quality, sleep-related variables, physical activity, and health-related quality of life (HRQoL). Outcome variables were compared across bed + screen time behavior groups, stratified by age group (toddlers and school-aged children) using general linear models for continuous variables, as well as chi-squared tests or logistic regressions for categorical variables. Additionally, we calculated linear p-trends. Analyses were adjusted for sociodemographic variables, BMI, and physical activity (unless the variable was tested). The results showed that toddlers and school-aged children in the LB ≥ 30'ST group were more likely to have overweight/obesity (OR: 3.42 [95%CI:1.41,8.26] and OR: 2.53 [95%CI:1.10,5.03], respectively) than those in the EB-0'ST group. Additionally, toddlers and school-aged children in the EB > 30'ST/LB ≤ 30'ST and LB > 30'ST groups showed significantly lower adherence to the Mediterranean diet compared to the other groups (p < 0.001). Regarding sleep-related outcomes, we observed that the combination of LB and more ST was associated with poorer sleep quality and shorter sleep duration in toddlers and school-aged children (p < 0.001). These findings emphasize the importance of promoting earlier bedtimes and limiting ST before bed as part of obesity prevention strategies for children. Furthermore, such intervention could benefit the quality of children's diet and overall lifestyle.

Mothers' perspectives of the barriers and facilitators to reducing young children's screen time during COVID-19: A reddit content analysis.

Screen time for children under 5 is associated with various health risks. Amidst the COVID-19 pandemic, screen use among young children increased significantly. Mothers were more likely than fathers to be the primary caregivers and disproportionally assumed the responsibility of monitoring their children's screen time. Several studies have examined children's screen use throughout the pandemic; however, few have addressed mothers' experiences. Therefore, the current study aimed to investigate mothers' perceptions regarding the barriers and facilitators faced when trying to reduce their child's pandemic screen time, as expressed on Reddit (a social media platform for anonymous discussion and information sharing). Two subreddit forums targeted toward mothers, "mommit" and "beyondthebump," with 646,000 and 554,000 users, respectively, were examined. Posts were collected using related search terms and screened for inclusion by three independent researchers. Inductive thematic content analysis was leveraged to identify themes. In total, 582 posts were reviewed from March 14th, 2020, to August 31st, 2022. Qualitative analysis yielded 5 themes; 6 barriers and 2 facilitators were derived from themes and/or subthemes, where applicable. Results suggest that mothers faced barriers when trying to reduce their child's screen time, including their competing work and in-home obligations, using screens to occupy their child during travel, child screen use with other caregivers, offering their child screen time while they needed rest, pandemic changes in routine, and using screens to encourage their child to engage in necessary behaviours. However, facilitating factors, including advice received from other mothers on how to reduce their child's screen time and the sharing of non-screen alternatives supported mothers in lowering their children's screen time. These results are important for future interventions, which may utilize the conclusions of this study to address what mothers perceive to be helping or hindering them, thus empowering mothers to successfully limit their children's screen time.

Screen Time, Sociodemographic Factors, and Psychological Well-Being Among Young Children.

Importance: Young children's screen time increased during the COVID-19 lockdown in 2020, but it is unknown whether their screen time returned to prepandemic levels in 2021. Knowledge of the relationship between screen time and child development and health will inform prevention and intervention targets and strategies. Objective: To evaluate screen time by family income and race and ethnicity in the prepandemic (ie, 2018, 2019) and pandemic (ie, 2020, 2021) periods and to examine the relationship between screen time and psychological well-being among young children in the US. Design, Setting, and Participants: Cross-sectional population-based web or mail survey study of 2018-2021 National Survey of Children's Health participants aged 6 months to 5 years. Exposure: Daily screen time (<1, 1, 2, 3, or ≥4 h/d) reported by participants' primary caregivers. Main outcomes and Measures: Flourishing and externalizing behaviors, as indicators of psychological well-being. All analyses were weighted, accounting for the complex survey sample design. Results: Of the 48 775 participants (50.7% female), the proportion of those with high screen time (defined as ≥1 h/d for children aged 6 months-1 year and ≥2 h/d for children aged 2-5 years) was 48.5% (95% CI, 46.3%-50.7%) in 2018, 49.2% (95% CI, 47.0%-51.5%) in 2019, 55.3% (95% CI, 53.4%-57.2%) in 2020, and 50.0% (95% CI, 48.3%-51.6%) in 2021. Among children living in poverty (federal poverty level <100%), the proportion of those with high screen time was 48.7% (95% CI, 42.8%-54.6%) in 2018, 52.0% (95% CI, 45.4%-58.6%) in 2019, 60.9% (95% CI, 55.4%-66.4%) in 2020, and 58.9% (53.7%-64.1%) in 2021. Adjusted odds ratio of flourishing was 0.66 (95% CI, 0.51-0.85), 0.81 (95% CI, 0.66-0.99), 0.68 (95% CI, 0.52-0.88), and 0.53 (95% CI, 0.42-0.69) for less than 1, 2, 3, and 4 or more hours per day vs 1 hour per day of screen time, respectively, among children aged 3 to 5 years. No association between screen time and flourishing was found among children aged 6 months to 2 years. An adjusted externalizing behavior score was higher by 0.2 points (95% CI, -0.1 to 0.5), 0.5 points (95% CI, 0.3 to 0.8), 1.3 points (95% CI, 1.0 to 1.6), and 2.1 points (95% CI, 1.7 to 2.5) for less than 1, 2, 3, and 4 or more hours per day vs 1 hour per day of screen time, respectively, among children aged 3 to 5 years. Conclusions and Relevance: In this multiyear cross-sectional study of a representative sample of young children in the US, the increased prevalence of high screen time in 2020 returned to prepandemic levels in 2021; however, it remained elevated in children living in poverty. Two hours or more of daily screen time was associated with lower psychological well-being among preschool-aged children.

Screen Time and Parent-Child Talk When Children Are Aged 12 to 36 Months.

Importance: Growing up in a language-rich home environment is important for children's language development in the early years. The concept of "technoference" (technology-based interference) suggests that screen time may be interfering with opportunities for talk and interactions between parent and child; however, limited longitudinal evidence exists exploring this association. Objective: To investigate the longitudinal association between screen time and 3 measures of parent-child talk (adult words, child vocalizations, and conversational turns) when children are 12 to 36 months of age. Design, Setting, and Participants: This Australian prospective cohort study used advanced speech recognition technology to capture young children's screen time and home language environment, on an average 16-hour day. Data were collected from 220 families once every 6 months in the family home when children were 12, 18, 24, 30, and 36 months of age, from January 1, 2018, to December 31, 2021. Statistical analysis took place from November 1, 2022, to July 31, 2023. Exposure: Language Environment Analysis (LENA) technology provided automated counts of children's language environment and exposure to electronic noise. The exposure of interest was screen time, which was calculated based on manual coding of LENA electronic noise audio segments. Main Outcomes and Measures: Three measures of parent-child talk were outcomes of focus: adult words, child vocalizations, and conversational turns. Separate models were run for each of the 3 outcomes and included adjustment for child sex, child age, maternal educational level, number of children at home, number of home activities, and primary caregiver's psychological distress. Results: The study included 220 families (120 girls [54.6%]; mean [SD] gestational age of children, 39.3 [1.5] weeks; mean [SD] age of mother at childbirth, 31.3 [4.8] years). Adjusted linear mixed-effect models demonstrated that increases in screen time were associated with decreases in measures of parent-child talk. The largest decreases were seen at 36 months, when an additional minute of screen time was associated with a reduction of 6.6 (95% CI, -11.7 to -1.5) adult words, 4.9 (95% CI, -6.1 to -3.7) child vocalizations, and 1.1 (95% CI, -1.4 to -0.8) conversational turns. Conclusion and Relevance: Findings of this study support the notion of technoference for Australian families, whereby young children's exposure to screen time is interfering with opportunities to talk and interact in their home environment. This finding has implications for interventions and supports aimed at promoting a language-rich home environment, with families needing support in understanding the potential association of screen time with opportunities for children and adults to talk and interact in their home environment.

Effectiveness of multi-component modular intervention on screen-based and non-screen-based sedentary time among adolescents in an urban area of Mangalore: a school-based cluster randomised controlled trial-protocol.

Background: Behavioural risk factors may often present during adolescence and account for 70% of premature deaths during adulthood. Excessive sedentary behaviour and screen time have become significant concerns, especially among adolescents, due to their potential negative impact on physical and mental health. Adolescents with a high screen-based sedentary time are more likely to be physically inactive, have unhealthy body structure and poor academic performance. The objective of our study is to assess the effect of multi-component modular educational intervention on screen-based sedentary time (SST) and non-screen-based Sedentary time (NSST) among adolescents. Methods: Ethical approval for the study has been obtained from the institutional Ethics Committee of Kasturba Medical College in Mangalore, India. This cluster randomized control trial will be carried out in schools located in the urban area of Mangalore. Using simple randomization, the eligible schools will be randomized into intervention and control arms, each consisting of 10 clusters. A multi-component modular educational intervention will be administered to participants in the intervention group at baseline, second and fourth month. The control group will receive the standard curriculum. Both the groups will be assessed at baseline and at second month, fourth month and sixth month of follow up for SST, NSST and level of physical activity. Anthropometric measurements like height, weight, waist circumference and hip circumference will be taken at baseline and sixth month of follow up. Results: A comprehensive school-based modular educational intervention can have cumulative advantages by reducing screen- and non-screen-based sedentary time, and encouraging physical activity. Similar modular teaching can be incorporated into the curriculum, which will promote healthy life-style among the adolescents.

Regional trends in the moderate-to-vigorous intensity physical activity and screen time of Canadians before and during the COVID-19 pandemic.

Background: During the COVID-19 pandemic, public health approaches and disease-transmission varied widely across Canadian regions. This may have led to different trajectories for moderate-to-vigorous intensity physical activity (MVPA) and screen time during this period. The purpose of this investigation was to describe age- and gender-specific regional trends in MVPA and screen time for Canadian youth (ages 12-17 years) and adults (ages 18+) from 2018 to 2021. Methods: Data was collected using the Canadian Community Health Survey, which includes representative data for 5 distinct regions: Atlantic Canada, Québec, Ontario, the Prairie Provinces, and British Columbia (BC). Participants aged 12+ in each region self-reported their total daily screen time, as well as MVPA in 5 domains: overall, recreational, school, occupational/household and active transportation. Results were compared for 2018 (pre-pandemic), January-March of 2020, September-December of 2020, and 2021 using repeated measures t-tests. Results: Among youth, all regions except for Atlantic Canada and BC experienced significant reductions in the proportion of youth meeting MVPA recommendations in the fall of 2020 (all p < 0.001), although these had returned to baseline for all regions except Ontario by 2021. Trends varied across regions among adults aged 18-64 years. In Québec, there was 7-percentage point reduction in the proportion of males meeting the MVPA recommendations in the fall of 2020 compared to 2018, while there was a 4-percentage point increase among females in 2021 (all p < 0.05). In Ontario and the Prairie provinces, males saw a 4-percentage point decrease in activity recommendation adherence in 2021, when compared to 2018 (p < 005). There were no other significant differences for any region when comparing the fall of 2020 or 2021 with 2018 (all p > 0.05). Among adults aged 65+ years, significant increases in MVPA were observed in Atlantic Canada and the Prairies in the fall of 2020, and in Atlantic Canada, Québec and the Prairies in 2021 (all p < 0.05). With limited exceptions, self-reported screen time increased significantly across regions and age groups for both males and females (all p < 0.05). Conclusions: MVPA levels of Canadians during the COVID-19 pandemic varied both by region and age group. Self-reported MVPA of Canadian youth dropped in most regions in the fall of 2020, before returning to pre-pandemic levels in 2021. Activity levels of Canadians aged 18-64 years were relatively stable during the pandemic and increased for Canadians aged 65+ in most regions. Differences in trajectories across genders observed at the national level were often less apparent in individual regions. Recreational screen use increased across all regions, ages and genders with very few exceptions. These results highlight the differences and similarities in activity and screen time trajectories across the Canadian population and suggest the need for additional research to identify best practices for promoting healthy movement behaviours during future pandemics.

Effectiveness of eHealth Interventions Promoting Physical Activity in Children and Adolescents: Systematic Review and Meta-Analysis.

BACKGROUND: eHealth interventions have been postulated as a feasible, acceptable, and possibly effective tool to promote physical activity (PA) among children and adolescents; however, a comprehensive quantitative analysis of the effects of eHealth interventions promoting PA is lacking. OBJECTIVE: This study aims to conduct a systematic review and meta-analysis on experimental studies reporting the effects of eHealth interventions aimed at promoting PA on PA parameters and sedentary behavior parameters in children and adolescents. METHODS: The CENTRAL, MEDLINE, Embase, and Web of Science databases were searched from inception to February 2022 for randomized controlled trials that analyzed the effects of eHealth interventions aimed at promoting PA on PA and sedentary parameters in children and adolescents. The Hartung-Knapp-Sidik-Jonkman random effects method was used to determine the mean differences (MDs) with their respective 95% CIs. The risk of bias was assessed using the Risk of Bias 2 (RoB2; Cochrane) tool and its extension for cluster randomized controlled trials. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. RESULTS: A total of 20 trials reporting the effects of different eHealth interventions aimed at promoting PA were included. Results for each parameter were as follows: counts per minute (MD -16.11 counts, 95% CI -122.76 to 90.53; k=3; n=402; I2=69%; favoring control), steps per day (MD 593.46 steps, 95% CI -2102.27 to 3289.19; k=2; n=152; I2=0%; favoring intervention [FI]), moderate to vigorous PA (MD -1.99 min/d, 95% CI -8.95 to 4.96; k=14; n=2336; I2=86%; favoring control), light PA (MD 3.28 min/d, 95% CI -15.48 to 22.04; k=5; n=355; I2=67%; FI), screen time (MD -31.48 min/d, 95% CI -68.62 to 5.65; k=5; n=904; I2=0%; FI), and sedentary time (MD -33.12 min/d, 95% CI -57.27 to -8.97; k=8; n=819; I2=75%; FI). Our results should be interpreted cautiously because of important limitations such as the scarcity of evidence, overall risk of bias, and low to very low certainty of evidence. CONCLUSIONS: We did not find conclusive evidence regarding the impact of PA-targeted eHealth interventions on PA parameters, but the very low certainty of evidence suggests that eHealth interventions may reduce sedentary time in children and adolescents. Our results may have important scientific implications as they highlight that the rapid development of eHealth interventions to promote PA lacks robust supporting evidence. TRIAL REGISTRATION: PROSPERO CRD42020211020; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=211020.

Physical Activity, Sedentary Behavior, Sleep and Screen Time of Healthy Under-Fives Attending Selected Immunization Clinics and Anganwadis of South Kerala, India.

OBJECTIVE: To estimate the proportion of healthy under-fives whose physical activity, sedentary behavior, sleep and screen time adhered to WHO 2019 recommendations and to identify risk factors for non-adherence. METHODS: A cross-sectional study was conducted among 480 healthy children (6 mo - 4 years) who attended 20 selected urban anganwadis or immunization clinics in South Kerala, India. Sociodemographic, anthropometric and outcome variables (duration of physical activity, sedentary behavior, sleep and screen time) were collected for all participants. RESULTS: Physical activity, sedentary behavior, sleep and screen time recommendations were adhered by 63.3%, 22.7%, 82.2% and 22.7% under-five children, respectively. Risk factors for inadequate physical activity were female sex, nuclear family, maternal education below college level, unskilled maternal occupation/housewife, unskilled paternal occupation and low monthly income. Risk factors for non-adherence to recommended sedentary behavior duration included joint family, paternal education college level/above, unskilled maternal occupation/housewife, unskilled paternal occupation and low monthly income. CONCLUSION: Under-fives should reduce sedentary behaviors and screen time and spend more time on physical activities.

[Screens and adolescence: what issues for the Z generation?] / Écrans et adolescence : quels enjeux pour la Génération Z ?

Digital media and screens are ubiquitous in the daily lives of adolescents. The screen-addicted portrait of young people has gained public attention, and health professionals are often consulted about the impact of screen use on teenagers' physical and mental health. Scientific evidence suggests that screen use is associated with risks and benefits that need to be weighed up in a nuanced way. This paper takes a critical look at the issue of screen time and at the models for understanding a problematic screen use. These considerations underline the importance of adopting a contextual understanding of screen use in adolescence.

Les médias numériques sont omniprésents dans la vie quotidienne des adolescent-es. La figure de l'adolescent-e « addict-e ¼ aux écrans est devenue un sujet de préoccupation dans l'opinion publique et il est fréquent que les professionnel-les de la santé soient sollicité-es pour répondre aux interrogations sur l'impact de l'utilisation des écrans sur la santé mentale et physique des jeunes. Les données scientifiques indiquent que l'usage des écrans est associé à des risques et des bénéfices qu'il s'agit d'évaluer de manière nuancée. Dans cet article, nous discutons en particulier et de façon critique du temps d'écran et des modèles de compréhension de l'usage problématique de celui-ci. Ces réflexions nous amènent à souligner l'importance d'adopter une compréhension contextualisée de cet usage à l'adolescence.

Screen time and pediatric headache: A scoping review of the literature.

OBJECTIVE: The aim of this study was to summarize the evidence regarding screen use as a contributing factor in pediatric headache and migraine. BACKGROUND: Screen exposure is often reported as a headache trigger, though there is no current consensus in terms of how screen type, duration, or frequency influences pediatric headache and the associated burden of disease. METHODS: A systematic search in PubMed, Scopus, Cochrane Library, ProQuest Health and Medical Database, and Google Scholar was performed through November 2022 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. All English-language articles of pediatric patients aged ≤18 years evaluating screen use in relation to headache were included. RESULTS: A total of 48 studies were included. Nearly all studies were cross-sectional and represented international samples. The strongest association between screen use and headache found was for duration of use, and computer use emerged as the most common device type related to headache. While there were mixed findings related to screen use and specific headache diagnosis, migraine appeared to confer a higher risk. Across studies, there were insufficient data to assess the impact of screen use on headache frequency or headache-related disability. Several studies demonstrated changes in screen use and headache patterns related to the COVID-19 pandemic and computer vision syndrome was commonly reported. CONCLUSIONS: While there is preliminary evidence supporting possible associations between screen use and pediatric headache, there are several limitations in the present review including a lack of prospective and randomized controlled trials to better demonstrate causal relationships as well as methodological limitations with significant variability in how both headache and screen use are defined and measured. Future studies including real-time screen use and device monitoring are needed to better understand the influence of screen use behaviors on pediatric headache and to help further define best-use guidelines around these technologies.

Associations of Broader Parental Factors with Children's Happiness and Weight Status through Child Food Intake, Physical Activity, and Screen Time: A Longitudinal Modeling Analysis of South Korean Families.

This study investigated how broader parental factors including parental happiness, parental play engagement, and parenting stress are related to Korean children's happiness and weight status across three years via indirect pathways through the children's energy-related behaviors of healthy and unhealthy food intake, physical activity, and screen time. Data from 1551 Korean parent pairs and 7-year-old children in the Panel Study on Korean Children were analyzed. A path analysis and gender-based multi-group analysis were conducted. Maternal happiness was negatively related to child screen time. Maternal play engagement showed positive concurrent associations with child healthy food intake and physical activity and negative associations with screen time. Maternal parenting stress was negatively related to child healthy eating. There was one significant finding related to fathers' role on children's energy-related behaviors, happiness, and weight status: the positive association between parental happiness and boys' unhealthy food intake. Child screen time was positively related to child weight status and negatively to child happiness at each age. Broader maternal parenting factors can serve as a protective factor for childhood happiness and weight status in 7-to-9-year-olds through being associated with a reduction in child screen time.