Article

Decreases in self-reported sleep duration among U.S. adolescents 2009-2015 and links to new media screen time

September 2017
Sleep Medicine 39

DOI:10.1016/j.sleep.2017.08.013

Authors:

Zlatan Krizan

Iowa State University

Garrett Hisler

SilverCloud Health

Study objectives Insufficient sleep among adolescents carries significant health risks, making it important to determine social factors that change sleep duration. We sought to determine whether the self-reported sleep duration of U.S. adolescents changed between 2009 and 2015 and examine whether new media screen time (relative to other factors) might be responsible for changes in sleep. Methods We drew from yearly, nationally representative surveys of sleep duration and time use among adolescents conducted since 1991 (Monitoring the Future) and 2007 (Youth Risk Behavior Surveillance System of the Centers for Disease Control; total N = 369,595). Results Compared to 2009, adolescents in 2015 were 16%–17% more likely to report sleeping less than 7 h a night on most nights, with an increase in short sleep duration after 2011–2013. New media screen time (electronic device use, social media, and reading news online) increased over this time period and was associated with increased odds of short sleep duration, with a clear exposure–response relationship for electronic devices after 2 or more hours of use per day. Other activities associated with short sleep duration, such as homework time, working for pay, and TV watching, were relatively stable or reduced over this time period, making it unlikely that these activities caused the sudden increase in short sleep duration. Conclusions Increased new media screen time may be involved in the recent increases (from 35% to 41% and from 37% to 43%) in short sleep among adolescents. Public health interventions should consider electronic device use as a target of intervention to improve adolescent health.

Digital media and mental health in adolescent athletes

Article

Mar 2023
PSYCHOL SPORT EXERC

Although digital media are increasingly important for adolescent athletes, few studies explore their influence on mental health in this population. This study aimed to examine this relationship in 591 German adolescent athletes (aged 12-19 years) from 42 different sports. Longer daily social media usage was connected to increased negative affect and dysfunctional eating patterns. Similar results were found for cognitive-behavioral symptoms of excessive media usage and mental health. Structural equation modeling revealed these relationships were mediated by social comparison and quality of sleep. Higher athletic performance level was related to increased social comparison, but not to quality of sleep, negative affect, and dysfunctional eating. The negative relationship between excessive media usage and sleep was stronger in competitive and elite than in recreational athletes. Results imply digital media should receive attention when aiming to improve mental health in athletes. Relevant targets for future intervention could be social comparison and sleep.

Time Spent on Daily Activities and Its Association with Life Satisfaction among Czech Adolescents from 1992 to 2019

Article

Full-text available

Aug 2022
Int J Environ Res Publ Health

Life satisfaction, an important precursor of adolescents’ well-being, is linked to daily activities. Substantial changes have been noted in adolescents’ daily activities over the years, raising the question of possible consequences for life satisfaction. This study aimed to explore changes in adolescents’ life satisfaction and their time spent on daily activities (sleeping, engaging in sports, online gaming, school commuting, time spent at school) and further investigate the associations between adolescents’ life satisfaction and these daily activities. The sample comprised 2715 adolescents from birth cohorts surveyed at four time points between 1992 and 2019. Participants were administered the Daily Activities Inventory and the Berne Questionnaire on Adolescents’ Well-Being. Robust ANOVA with post hoc tests and spline regression were employed. We found cohort differences in sleep duration (8.6 h a day on average in 1992 and 7.5 in 2019). Sleep duration of 8 h and 1 h of sports activities had a beneficial effect on life satisfaction, while more than 1 h of online gaming had a negative impact. Neither school attendance nor commuting to school was associated with adolescents’ life satisfaction. The results of this study can inform public-health policies to promote sleeping and sports habits in adolescence.

Time Spent on Private Tutoring and Sleep Patterns of Chinese Adolescents: Evidence from a National Panel Survey

Article

Full-text available

Jul 2023

Objective: In recent decades, there has been a marked increase in private tutoring and a decline in sleep health among adolescents. This study aimed to outline the association between time spent on private tutoring and sleep patterns of Chinese adolescents. Methods: Participants were from a nationwide two-wave panel survey. We performed OLS regressions of sleep duration at wave 2 and Poisson regressions of sleep problems at wave 2 on tutoring time at wave 2, adjusting for baseline sleep duration and other covariates. Tutoring time was assessed by three items: daily hours of tutoring, daily hours of tutoring on weekdays, and daily hours of tutoring on weekends. Results: Overall, more time spent on private tutoring was associated with shorter sleep duration and more sleep problems. Furthermore, both weekday and weekend tutoring can have a positive effect on the number of sleep problems. With regard to sleep duration, weekend tutoring time played a negative role, while the effect of weekday tutoring time was negligible. Conclusion: In the Chinese context, which is characterized by intense academic competition, participation in private tutoring plays a significant role in shaping students' sleep duration and sleep problems. To improve the sleep health of adolescents, the time spent on private tutoring should be carefully monitored and regulated.

Adolescents' interactive electronic device use, sleep and mental health: a systematic review of prospective studies

Article

Apr 2023
J SLEEP RES

Optimal sleep, both in terms of duration and quality, is important for adolescent health. However, young people's sleeping habits have worsened over recent years. Access to and use of interactive electronic devices (e.g., smartphones, tablets, portable gaming devices) and social media have become deep-rooted elements of adolescents' lives and are associated with poor sleep. Additionally, there is evidence of increases in poor mental health and well-being disorders in adolescents; further linked to poor sleep. This review aimed to summarise the longitudinal and experimental evidence of the impact of device use on adolescents' sleep and subsequent mental health. Nine electronic bibliographical databases were searched for this narrative systematic review in October 2022. Of 5779 identified unique records, 28 studies were selected for inclusion. A total of 26 studies examined the direct link between device use and sleep outcomes, and four reported the indirect link between device use and mental health, with sleep as a mediator. The methodological quality of the studies was generally poor. Results demonstrated that adverse implications of device use (i.e., overuse, problematic use, telepressure, and cyber-victimisation) impacted sleep quality and duration; however, relationships with other types of device use were unclear. A small but consistent body of evidence showed sleep mediates the relationship between device use and mental health and well-being in adolescents. Increasing our understanding of the complexities of device use, sleep, and mental health in adolescents are important contributions to the development of future interventions and guidelines to prevent or increase resilience to cyber-bullying and ensure adequate sleep.

Sleep habits and their relation to self-reported attention and class climate in preteens

Article

Jan 2023
SLEEP MED

Objectives/design Sleep is fundamental in daily functioning, especially in teenagers who are in a critical period of their development. Accordingly, a deteriorated sleep, that is increasingly common in this age group, has been related to poorer school performance. The goal of this cross-sectional study was to collect up-to-date sleep data in preteens, and to examine their relation with two important dimensions for school achievement, which are self-reported attention and class climate at school. Methods Data were collected at school in 1151 preteens (597 boys; 554 girls; 11.31 ± 0.62 years old) between June 2021 and March 2022. Self-completion questionnaires evaluated attention and class climate. Sleep questionnaires assessed sleep habits for weekdays and weekends, separately. Results Preteens reported sleeping 8 hours and 39 minutes during weekdays and 9 hours and 32 minutes during weekends. All sleep measures showed a significant change between weekdays and weekends, leading to a longer and better sleep on weekends, likely to compensate for insufficient sleep during the week. In addition, girls woke-up later and spent more time in bed than boys during weekends. Importantly, during weekdays, correlational analysis showed a relationship between sleep measures and both self-reported attention and class climate scores, suggesting that longer and better sleep was related to better attention and perceived class climate at school. Conclusion This study depicted up-to-date sleep habits in preteens, depending on the day of the week and the gender, and highlighted their relation to two potential contributors of academic success, namely attention and class climate.

Effects of Social Media and Technology on Adolescents: What the Evidence is Showing and What We Can Do About It

Article

Full-text available

Apr 2021

Melanie Schmitt

This manuscript discusses the effects of social media and technology usage on adolescents and their emotional and social development and provides recommendations for family and consumer sciences (FCS) professionals. Today's adolescents have been exposed to technology since childhood, and this exposure has led to several effects-both positive and negative. The paper will explain aspects of adolescent development, the implications that technology usage has on this development, and strategies for parents and professionals in promoting positive and safe social media and technology use among their adolescents or those with whom they work. Lastly, the paper will highlight the importance of the FCS profession and how we can address this issue.

Associations of Time Spent on Study and Sleep with Anxiety and Depressive Symptoms in Junior High School Students: Report from the Large-Scale Monitoring of Basic Education Data in China

Article

Full-text available

Aug 2023

Problematic media use in early childhood: The role of parent-child relationships and parental wellbeing in families in New Zealand and the United States

Article

Jul 2023

Protecting the Physical and Psychological Health of Students from Technology Addiction

Article

Full-text available

Jul 2023

This scientific paper focuses on protecting the physical and psychological health of students from technology addiction. Technology, especially mobile phones, the Internet, and electronic gaming devices, has a profound impact on the lives of students and can create significant health challenges. In this study, the implications of excessive use of technology are identified and recommendations are proposed to promote a wiser and healthier use of technology by students. In this study, we analyzed theories and models for the understanding of technology addiction, as well as the implications of technology addiction on students' physical health. We have observed that technology, including electronic devices and the Internet, has a significant impact on the lack of physical activity in children and adolescents. The extensive use of electronic devices is related to the reduction of physical activity and physical health of students. Also, we researched the impact of technology on the psychological health of students. During the study, we identified links between the use of the Internet, and social networks, and psychological concerns such as anxiety and depression. Dependence on technology has been shown to affect feelings of self-isolation and lack of self-awareness, having detrimental effects on students' emotional and psychological well-being. Through this research, we will try to bring attention to the importance of protecting the physical and psychological health of students from technology addiction. At the end of the study, we will provide recommendations to promote a healthy and wise use of technology in the educational context, emphasizing the need for education and awareness of students, parents, and teachers on this important issue.

Exploring the Relationship of Smartphone Addiction on Attention Deficit, Hyperactivity Symptoms, and Sleep Quality among University Students: A Cross-Sectional Study

Preprint

Full-text available

Jun 2023

Background The prevalence of smartphone usage is steadily rising, leading to the potential development of addiction due to problematic use. This study examined the relationship between smartphone addiction, self-perceived attention deficit and hyperactivity symptoms, and sleep quality among 443 university students at Bingöl University. Methods Participants completed several questionnaires, including the Smartphone Addiction Scale-Short Version (SAS-SV), the Pittsburgh Sleep Quality Index (PSQI), and the Adult ADHD Self-Report Scale (ASRS-v1.1). Results This study examined 443 participants, with a mean age of 20.97 ± 3.29, of whom 72.7% (n = 322) were female. The aim was to explore the relationship between smartphone usage patterns and sleep quality. Results showed that the majority of participants primarily used smartphones (94.8%, n = 420) for social media browsing (49.9%, n = 221). Factors such as smoking, preference for smartphone screens, and prolonged screen exposure significantly affected sleep quality. Smartphone addiction rates were notable, with 50.4% (n = 61) of males and 47.2% (n = 152) of females being affected, and this addiction was associated with poorer sleep quality. Correlations were found between age, sleep duration, and scores on smartphone addiction, sleep quality, and attention deficit scales. Linear regression analysis revealed that age, attention deficit scores, and sleep quality scores significantly influenced levels of smartphone addiction. Conclusions These findings contribute valuable insights into the impact of smartphone addiction on attention and sleep in university students.

Can mindfulness play a role in building social-emotional capacities among youth exposed to screens?

Article

Full-text available

Jun 2023

Introduction Increased screen time coupled with public safety restrictions may pose a serious challenge to adequate social-emotional development in youth during the pandemic. Social-emotional competence (resilience, self-esteem, and self-compassion) are essential for youth to adapt to the “new normal” in the prolonged pandemic timeline. The current study investigated the efficacy of a mindfulness-based intervention on youth social-emotional capacity while accounting for screen time. Methods One hundred and seventeen youth participated in a 12-week, online mindfulness-based program and completed pre-, post- and follow-up surveys across five cohorts during the COVID-19 pandemic (spring 2021 to spring 2022). Changes in youths’ resilience (RS), self-esteem (SE), and self-compassion (SC) between the three-time points were examined using linear regression analyses (unadjusted, partially adjusted for screen time, and fully adjusted for demographic and screen time variables). The regression models accounted for demographic (age, sex), baseline mental health status, and screen time (passive, social media, video games, and educational types of screen-based behaviours) factors. Results In an unadjusted regression model, resilience [ β = 3.68, 95%CI = 1.78–5.50, p < 0.001], self-compassion [ β = 0.50, 95%CI = 0.34–0.66, p < 0.001], and self-esteem [ β = 2.16, 95%CI = 0.98–3.34, p < 0.001] significantly increased after the mindfulness program, and the effects were maintained in the follow-up. The efficacy of the mindfulness program persisted after controlling for five types of screen time [RS: β = 2.73, 95%CI = 0.89–4.57, p < 0.01; SC: β = 0.50, 95%CI = 0.32–0.67, p < 0.001; SE: β = 1.46, 95%CI = 0.34–2.59, p < 0.01] and in a fully adjusted model which additionally accounted for the baseline mental health status and demographic factors [RS: β = 3.01, 95%CI = 1.20, p < 0.01; SC: β = 0.51, 95%CI = 0.33–0.68, p < 0.001; SE: β = 1.64, 95%CI = 0.51–2.77, p < 0.01] and maintained its impact in the follow-up. Discussion Our findings reinforce the evidence base on the efficacy of mindfulness and support the use of online mindfulness programs in building social–emotional competencies (i.e., self-compassion, self-esteem, and resilience) among youth exposed to screens during the pandemic.

Masters of media: A longitudinal study of parental media efficacy, media monitoring, and child problematic media use across early childhood in the United States

Article

Apr 2023

The development of problematic media use in early childhood is not well understood. The current study examined long-term associations between parental media efficacy, parental media monitoring, and problematic media use across a three-year period of time during early childhood. Participants included 432 parents who reported on their own parenting and their child’s use of problematic media once a year for three years (M age of child at Wave 1 = 29.68 months, SD = 3.73 months). Results revealed that early parental media efficacy predicted lower levels of child problematic media use over time. Restrictive media monitoring was also related to lower levels of child problematic media use over time. Additionally, general parental efficacy was related to parental media efficacy and lower child problematic media use, both at the cross-sectional and longitudinal levels. Discussion focuses on encouraging early parental media efficacy (and exploring other potential mechanisms) as a way to mitigate the development of problematic media use over time.

Pediatric Sleep: Current Knowledge, Gaps, and Opportunities for the Future

Article

Mar 2023
SLEEP

This White Paper addresses the current gaps in knowledge, as well as opportunities for future studies in pediatric sleep. The Sleep Research Society's Pipeline Development Committee assembled a panel of experts tasked to provide information to those interested in learning more about the field of pediatric sleep, including trainees. We cover the scope of pediatric sleep, including epidemiological studies and the development of sleep and circadian rhythms in early childhood and adolescence. Additionally, we discuss current knowledge of insufficient sleep and circadian disruption, addressing the neuropsychological impact (affective functioning) and cardiometabolic consequences. A significant portion of this White Paper explores pediatric sleep disorders (including circadian rhythm disorders, insomnia, restless leg and periodic limb movement disorder, narcolepsy, and sleep apnea), as well as sleep and neurodevelopment disorders (e.g., autism and attention deficit hyperactivity disorder). Finally, we end with a discussion on sleep and public health policy. Although we have made strides in our knowledge of pediatric sleep, it is imperative that we address the gaps in our knowledge and the pitfalls of our methodologies. For example, more work needs to be done to assess pediatric sleep using objective methodologies (i.e., actigraphy and polysomnography), to explore sleep disparities, to improve accessibility to evidence-based treatments, and to identify potential risks and protective markers of disorders in children. Expanding trainee exposure to pediatric sleep and elucidating future directions for study will significantly improve the future of the field.

The Generation Gap Revisited: Generational Differences in Mental Health, Maladaptive Coping Behaviors, and Pandemic-Related Concerns During the Initial COVID-19 Pandemic

Article

Full-text available

Feb 2023
J ADULT DEV

The purpose of this study was to assess differences in mental health symptoms, pandemic-related concerns, and maladaptive coping behaviors among adults in the United States across generations during the initial period of the COVID-19 pandemic. A social media campaign was used to recruit 2696 U.S. individuals to participate in an online survey in April 2020, assessing various validated psychosocial factors, including major depressive disorder, generalized anxiety disorder (GAD), perceived stress, loneliness, quality of life, and fatigue, along with pandemic-specific concerns and changes in alcohol use and substance use. Participants were grouped based on generation status (Gen Z, Millennial, Gen X, and Baby Boomer) and statistical comparisons were conducted based on demographics, psychosocial factors, pandemic-related concerns, and substance use. During the initial period of the COVID-19 pandemic, the younger cohorts (Gen Z and Millennials) rated significantly worse on mental health indices, including major depression, GAD, perceived stress, loneliness, quality of life, and fatigue. Further, the participants in the Gen Z and Millennial generational groups exhibited greater increase in maladaptive coping with substance use, specifically alcohol use and increased use of sleep aids. Our results indicate that during the initial period of the COVID-19 pandemic, members of the Gen Z and Millennial generational cohorts were considered a psychologically vulnerable population due to their mental health and maladaptive coping behaviors. Improving access to mental health resources during early stages of a pandemic is an emerging public health concern.

Has the “Double Reduction” policy relieved stress? A follow-up study on Chinese adolescents

Article

Full-text available

Nov 2022
Child Adolesc Psychiatr Ment Health

Purpose “Double Reduction” Policy requires schools to reduce the burden of excessive homework and off-campus training for Chinese students to reduce their academic stress and promote mental health. We conducted a study in compulsory education students before and after the “Double Reduction” Policy to explore changes in mental health problems and relevant influential factors. Methods A total of 28,398 elementary and junior high school students completed both waves of the survey through electronic questionnaires. Depressive symptoms were assessed using the Patient Heath Questionnaire (PHQ-9), and anxiety symptoms were assessed using the Generalized Anxiety Disorder Scale (GDA-7). Demographic information was evaluated at baseline, and “Double Reduction” related factors and negative life events were measured at follow up. Results The overall depression and anxiety levels significantly decreased after the “Double Reduction” Policy. Girls, poor parental marital quality, chronic physical illness, and psychiatric family history were related to increased occurrence of mental health. Sleep duration > 8 h/night, reduced homework, more extracurricular activities more time with parents, and reduced academic stress were protective factors against mental health problems. Conclusions The “Double Reduction” Policy has improved the mental health symptoms of students to a certain extent. Appropriately increasing sleep time, participating in more extracurricular activities and parental involvement, and reducing the burden of homework are effective ways to promote the development of students’ mental health.

Sleep Health and Its Related Influencing Factors in Primary and Middle School Students in Fuzhou: a Large Multi-Center Crowd-based Cross-sectional Study

Preprint

Full-text available

Sep 2020

Background This current study set out to investigate the status of sleep health in 7-20-year-old students in Fuzhou and explore the related influencing factors of sleep health. MethodsA total of 38467 children and adolescents in Fuzhou were included in the study through a random stratified cluster sampling. Data were collected from May-June 2019, in 18 primary schools and 18 middle schools from 9 Districts, Fuzhou. Children's parents and adolescents of sampled classes were invited to fill a series of questionnaires about the performance of the last 6 months (sociodemographic characteristics, family sleep habits and routine activities before bedtime). Multiple linear regression was carried out to analyze data. ResultsOf the total 40888 questionnaires we released, 38467 were valid and effective with the response rate was 94.08%. The age of the surveyed participants was 11.85±3.1, including 20013 boys and 18454 girls. The multiple linear regression analysis identified factors associated with sleep health ( P <0.05): Grl (coef=-0.073, 95% CI : -0.115--0.03), Age (coeff=0.234, 95% CI : 0.224-0.243), Key school (coeff=-0.149, 95% CI : -0.193- -0.105), Urban (coeff=-0.096, 95% CI : -0.139--0.054), Excessive daytime sleepiness (coeff=0.535, 95% CI : 0.432-0.639), Unhealthy sleep habits (coeff=0.363, 95% CI : 0.307-0.419), Using electronic products in bedroom (coeff=0.074, 95% CI : 0.028-0.121), Screen time per day during school (coeff=0.260, 95% CI : 0.235-0.284), Frequency of using electronics 30 minutes before bedtime (coeff=0.150, 95% CI : 0.134-0.166), Eating before sleep (coeff=0.578, 95% CI : 0.527-0.63), Sleep alone (coeff=-0.204, 95% CI : -0.262--0.147) Intense relationship with parents (coeff=0.361, 95% CI : 0.27-0.452), Intense relationship with peers (coeff=0.267, 95% CI : 0.171-0.363), Excessive homework or learning (coeff=0.189, 95% CI : 0.141-0.237), Time for doing homework (coeff=0.266, 95% CI : 0.245-0.287) and Mood swings frequently (coeff=1.174, 95% CI : 1.127-1.221) had greater impact on sleep health than other factors. Conclusions Sleep health is associated with factors covered sociodemographic characteristics, family sleep habits and routine activities before bedtime, and multiple measures should be taken to improve sleep quality in a targeted manner.

Media & Sleep

Chapter

Nov 2022

Media has become fundamentally integrated into the everyday lives of children and adolescents. Despite this, the consequences of media use on child and adolescent sleep remain incompletely understood. This chapter summarizes the current literature on four main mechanisms through which media consumption affects sleep health. (1) Increased media use is associated with decreased sleep duration secondary to sleep time displacement and delayed sleep onset. (2) Increased media use is associated with decreased sleep quality as a result of heightened arousal and greater sleep fragmentation. (3) Nighttime media use is associated with dysregulation of the circadian rhythm via blue light re-entrainment. (4) Mental health modulates both sleep and media use. Sleep and media use in-turn affect mental health, forming a bidirectional relationship. A biopsychosocial approach is taken to analyze each pathway. Key considerations such as age, sex, type of device used, passive vs. active use, and content of media are considered. Finally, evidence-based recommendations for clinicians, parents and policymakers are offered.

Sluggish Cognitive Tempo among Iranian Children and Adolescents: A Validation Study of the Farsi Child and Adolescent Behavior Inventory (CABI)–Parent Version

Article

Full-text available

Oct 2022

Abstract: Background: Sluggish cognitive tempo (SCT), recently renamed cognitive disengagement syndrome (CDS), is a set of behavioral symptoms that includes excessive daydreaming, mental confusion, and fogginess, being lost in one’s thoughts, and slowed behavior and thinking. Symptoms of SCT show overlap with a broad range of other symptoms such as attention-deficit/hyperactivity disorder inattention, anxiety, depression, or oppositional defiant disorder (ODD). To measure SCT, one of the optimal measures is the Child and Adolescent Behavior Inventory (CABI). Here, we report the psychometric properties of the Farsi version of the CABI Parent Version, including the CABI SCT scale and its subscales. Methods: The participants were the parents of 209 children and adolescents (53.9% girls; ages 8–19 years; Mage = 14.23, SDage = 2.72). Parents completed the SCT, ADHD inattention (ADHD-IN), ADHD-hyperactivity/impulsivity (ADHD-HI), oppositional defiant disorder (ODD), limited prosocial emotions (callous-unemotional (CU) traits), anxiety, depression, social impairment, and academic impairment scales of the Child and Adolescent Behavior Inventory (CABI). Parents also completed four dimensions of the Strengths and Difficulties Questionnaire (SDQ: emotional problems; conduct problems; peer problems; prosocial behavior), and five dimensions of the Kidscreen questionnaire (physical health; psychological well-being; autonomy and parental well-being; peers and social support; school environment). Results: SCT symptoms demonstrated strong discriminant validity from the ADHD-IN symptoms. SCT showed stronger first-order and unique associations than ADHD-IN with anxiety, depression, and ODD, whereas ADHD-IN showed stronger first-order and unique associations than SCT with ADHD-HI, CU, and social and academic impairment. Further, SCT showed stronger first-order and unique associations than ADHD-IN with more emotional problems, peer problems, and with lower prosocial behavior, as assessed with the SDQ. Higher scores for SCT were associated with lower psychological well-being, autonomy and parental relations, and lower peer and social support, as assessed with the Kidscreen. Higher ADHD-IN scores were associated with lower peer and social support, and a lower school environment. Conclusions: The Farsi version of the CABI–Parent Version has very good psychometric properties for assessing SCT and other dimensions of psychopathology/impairment and replicating the findings from similar studies with children and adolescents from South Korea, Spain, Turkey, and the United

The association of smartphone screen time with sleep problems among adolescents and young adults: cross-sectional findings from India

Article

Full-text available

Sep 2022
BMC PUBLIC HEALTH

Background Although sleep problem is a growing public health issue with the advancement of technology, especially among adolescents and young adults, it received little attention. The study aimed to examine the association of screen time on smartphone with sleep problems among adolescents and young-adults in India. Methods We used data from the “Understanding the lives of adolescents and young-adults” (UDAYA, 2018). The effective sample size for the study was 16,292 adolescents and young adults (males-4428 and females-11,864). Descriptive statistics and bivariate analysis with percentages and chi-square test were used to report the preliminary results. Multivariable logistic regression analysis was conducted to examine the association between smartphone screen time and sleep problems, separately for adolescents and young adults. Results Nearly 15.6% of males and 23.5% of females had sleep problems in their adolescence in the last 15 days, while these percentage were high among young-adults (18.4% males and 33.24% females). Adolescents [AOR: 1.55; CI: 1.21-1.99] and young adults [AOR: 1.48; CI: 1.24-1.75], who spent more than 2 h on smartphone had higher odds of reporting sleep problems than those who did not use smartphone in the last 24 hours. Adolescent females who used smartphone for less or equal to 2 h and three or more hours respectively, had 2.11 [AOR: 2.11; CI: 1.63-2.73] and 2.94 times [AOR: 2.94; CI: 1.97-4.38] higher odds of reporting sleep problems than adolescent males who did not use smartphones. Additionally, among the young adult females, the odds of sleep problems were 1.66 times [AOR: 1.66; CI: 1.55-2.38] and 2.36 times [AOR: 2.36; CI: 1.59-3.51] greater than the non-users young adult males. Conclusion The increased time spent on mobile phones’s screen among adolescents and young-adults, particularly in females is associated with a higher likelihood of reporting sleeping problems. The current findings have important implications for adolescence and young-adults’ mental health programmes. The findings can also be used to further inform how different strategies need to be developed for better sleep outcome during adolescence and young-adults.

What's “app”-ning to adolescent sleep? Links between device, app use, and sleep outcomes

Article

Aug 2022
SLEEP MED

This study investigated the associations between adolescent evening use of technology devices and apps, night time sleep, and daytime sleepiness. Participants were 711 adolescents aged 12–18 years old (46% Female, Mage = 15.1, SD = 1.2). Time spent using technology devices and apps in the hour before bed, and in bed before sleep onset, was self-reported. Participants additionally completed a questionnaire about their sleep on school nights and next day sleepiness. In the hour before bed, 30 min of phone use was associated with a 9-min delay in bedtimes. Thirty minutes spent using laptops, gaming consoles, and watching YouTube was associated with later lights out times of 9 min, ∼16 min and ∼11 min respectively, while watching TV was associated with a 9 min earlier lights out times. Using gaming consoles and watching YouTube were associated with greater odds of receiving insufficient sleep (≤7 h TST). In bed before sleep onset, 30 min spent using laptops, phones, iPad/tablets, and watching YouTube were linked with later lights out times of ∼7 min for phones and laptops, 9 min for iPad/tablets, and ∼13 min for YouTube. Watching Netflix was associated with greater daytime sleepiness. YouTube at this time point was associated with increased odds of sleeping ≤7 h on school nights. Adolescents are engaging with a wide range of technology devices and apps in the evenings. However, certain devices and apps (e.g., phones, laptops, gaming and YouTube) might lead to more negative sleep outcomes for adolescents on school nights compared to others.

Beneficial effects of sleep extension on daily emotion in short-sleeping young adults: An experience sampling study

Article

Full-text available

Jul 2022

Objectives Short sleep duration has been linked to disrupted emotional experiences and poor emotion regulation. Extending sleep opportunity might therefore offer a means to improve emotion functioning. This study used experience sampling to examine the effect of sleep extension on daily emotion experiences and emotion regulation. Participants Participants were young adults (n = 72), aged 18-24 years who reported consistently sleeping less than 7 hours in a 24-hour period in the past 2 weeks. Design and setting For 14 consecutive days, participants completed experience sampling questions related to sleep, emotion, and emotion regulation via a smartphone application. Procedures were identical for all participants for the first 7 days (“baseline” assessments). Intervention From days 8-14, participants were randomly assigned to either a “sleep extension” condition, in which they were instructed to increase their sleep opportunity by 90 minutes or a “sleep as usual” condition. Measurements Duration and quality of the previous night's sleep were reported each morning and daytime experiences of positive and negative emotion and emotion regulation were measured at pseudorandom timepoints 6 times a day. Results Multilevel modeling demonstrated that participants in the sleep extension condition reported significantly longer sleep times and improved sleep quality, as well as higher positive and lower negative daily emotion, compared to those in the sleep as usual condition. Conclusion A brief experimental paradigm to extend sleep length has the potential to improve sleep quality and to a minor extent mood, among young adults with short sleep.

The effect of laying down posture while using smartphone among school children in Nakhon Si Thammarat, Thailand

Article

Full-text available

Jun 2022

Background: Lots of children use the smartphone in lying down posture that is unappreciated posture. The postures of children while using a smartphone affect their musculoskeletal pain and can enhance Musculoskeletal Disorders (MSDs). Objective: To study the effect of lying down posture while using smartphone among school children in Nakhon Si Thammarat, Thailand. Materials and methods: This survey study employed a Descriptive Cross-Sectional Design. The population was Grade 1-6 students studying in a primary school in Nakhon Si Thammarat. There were 122 samples selected based on the Volunteer Sampling Technique under the written consent of the students' guardians. The research instruments employed in this study were: 1) Questionnaire adapted from Nordic Musculoskeletal Questionnaire asking musculoskeletal symptoms, 2) Posture Assessment using Kinovea Software to measure the angles of the muscle and postures during photo and video shooting of the smartphone users. The data were analyzed using descriptive statistics while Chi-square and Mann-Whitney U tests were used to test the mean differences. Results: There is a significant difference at p<0.05 level in mean angles of the neck, trunk, shoulder, and lower arms when using smartphones in supine and prone postures. The correlation between smartphone usage postures and musculoskeletal symptoms at the head/neck, trunk, and upper arm are found significantly different at p<0.05 level. The statistically significant difference at p<0.05 level is also found in the differences of age, length of smartphone ownership, position when using smartphone, and length of a smartphone usage in lying down positions. Conclusion: Smartphone usage in lying down positions of the participants can cause musculoskeletal pain especially in prone posture. It is recommended that guardians or relevant sectors have greater attention to smartphone usage among children to prevent their long-term musculoskeletal problems.

Revista completa

Article

Apr 2021

Miguel Bordera Pascual

The Effect of Digital Screen Exposure and Temperament on Sleep Problems in Children During the COVID-19 Pandemic: Rural Area in Turkey

Article

Full-text available

May 2022

Objective:More and more children experience sleep problems, which are believed to be exacerbated by the Coronavirus disease-2019 (COVID-19) pandemic and digital screen exposure. This descriptive and cross-sectional study investigated the relationship between sleep problems and digital screen exposure and temperament in children during the COVID-19 pandemic.Materials and Methods:The sample consisted of 122 parents of children aged 3-6 years. Data were collected using a descriptive characteristics questionnaire, the children’s sleep habits questionnaire, and the short temperament scale for children.Results:Most children have been watching more TV (77.9%) and spending more time on computers/tablets/smartphones (89.3%) since the COVID-19 pandemic. There was a relationship between screen time and sleep duration (

Divergent decennial trends in mental health according to age reveal poorer mental health for young people: repeated cross-sectional population-based surveys from the HUNT Study, Norway

Article

Full-text available

May 2022

Objectives Public health trends are formed by political, economic, historical and cultural factors in society. The aim of this paper was to describe overall changes in mental health among adolescents and adults in a Norwegian population over the three last decades and discuss some potential explanations for these changes. Design Repeated population-based health surveys to monitor decennial changes. Setting Data from three cross-sectional surveys in 1995–1997, 2006–2008 and 2017–2019 in the population-based HUNT Study in Norway were used. Participants The general population in a Norwegian county covering participants aged 13–79 years, ranging from 48 000 to 62 000 000 in each survey. Main outcome measures Prevalence estimates of subjective anxiety and depression symptoms stratified by age and gender were assessed using the Hopkins Symptom Checklist-5 for adolescents and the Hospital Anxiety and Depression Scale for adults. Results Adolescents’ and young adults’ mental distress increased sharply, especially between 2006–2008 and 2017–2019. However, depressive symptoms instead declined among adults aged 60 and over and anxiety symptoms remained largely unchanged in these groups. Conclusions Our trend data from the HUNT Study in Norway indicate poorer mental health among adolescents and young adults that we suggest are related to relevant changes in young people’s living conditions and behaviour, including the increased influence of screen-based media.

Evaluation de déterminants influençant le sommeil : effets de l'activité physique, et des caractéristiques de population (âge et handicap)

Thesis

Dec 2021

Duy Thai Nguyen

La mauvaise qualité du sommeil est reconnue comme un facteur de risque majeur d’altération de la santé, augmentant l'incidence des maladies chroniques graves. Dans la population générale, les troubles du sommeil concernent environ une personne sur trois. Dans la population avec handicap, les troubles du sommeil sont très fréquents puisqu’ils concerneraient plus de 80 %. Dans ce travail de thèse, nous nous sommes intéressés à l’évaluation de déterminants qui peuvent être en lien avec la quantité et la qualité de sommeil. Des facteurs "âge", "genre", "niveau d’activité physique" et "présence ou non de handicap" ont été ainsi évalués.Trois études ont été menées.La première a évalué la relation entre le manque de sommeil et les comportements d’agressivité chez 11 912 adolescents d'âge scolaire (âge moyen : 14,5 ans). Nos résultats montrent que la durée du sommeil chez les adolescents semble être un prédicteur significatif des comportements d’agression physique. Ce comportement d’agressivité est en lien avec les traits de personnalité d’anxiété et de dépression.La seconde étude de cette thèse s’est intéressée aux effets des niveaux d'activité physique sur le sommeil de 50 enfants avec troubles du spectre de l’autisme (âge moyen : 10,8 ans) comparés à des enfants témoins du même âge.Les résultats confirment une participation limitée aux activités physiques et une qualité de sommeil inférieure chez les enfants avec autisme à celle des enfants au développement typique. Il est aussi montré que l'activité physique d'intensité modérée à vigoureuse a un impact positif sur la qualité du sommeil de ces enfants avec autisme.Dans l’étude n°3, nous nous sommes intéressés à évaluer les effets des caractéristiques de la trisomie 21 et leur impact sur les niveaux d’activité physique et la qualité de sommeil, chez des adultes avec trisomie 21 (âge moyen : 29,7 ans). Le fait d’être un homme, d’être plus âgé, d’avoir un surpoids et/ou une obésité ainsi qu’une ouverture de l’angle goniaque plus grande, sont liés à un indice d’apnées-hypopnées plus élevé chez les adultes avec T21. Par ailleurs, la pratique d'une activité physique régulière améliore significativement cet indice d’apnées-hypopnées au sein de cette population.Ce travail de thèse a permis de mettre en évidence différents déterminants qui peuvent avoir un impact sur le sommeil comme : le niveau d’activité physique, les caractéristiques morphométriques et anatomiques, le fait d’être ou non porteur d’un handicap, et ce dans 3 groupes d’âge différents : enfants, adolescent et adultes.

Parent and child problematic media use: The role of maternal postpartum depression and dysfunctional parent-child interactions in young children

Article

Apr 2022
COMPUT HUM BEHAV

Problematic media use, or media use that interferes with daily functioning, is most often studied in adolescent or young adult age groups. Less research has examined problematic media use within the family system, among parents and young children. The current three-year longitudinal study examines associations between symptoms of maternal postpartum depression at Time 1 and parent and child problematic media use and parental depression at Time 3, with parent-child dysfunctional interactions at Time 2 as a potential mediating variable. At Time 1, 491 mothers of children less than one year old responded to survey questions involving maternal postpartum depression and parent-child dysfunctional interaction. One year later, mothers reported on parent-child dysfunctional interaction, and two years later reported on parent and child problematic media use and parental depressive symptoms. Results suggest that symptoms of postpartum depression at Time 1 is associated with parent-child dysfunctional interaction at Time 2, and parent and child problematic media use and depression at Time 3. Parent-child dysfunctional interaction at Time 2 mediated associations between postpartum depression at Time 1 and parent depression at Time 3. Parent-child dysfunctional interaction did not mediate associations between postpartum depression at Time 1 and parent or child problematic media use at Time 3. Discussion focuses on the implications of problematic media use in the family setting.

Sleep and dropout from upper secondary school: A register-linked study

Article

Jul 2023

Objective: The present study investigates the association between sleep in late adolescence and completion of upper secondary school. Methods: The data are drawn from the youth@hordaland study, a large population-based study conducted in 2012, linked with official educational data in Norway (N = 8838). Results: High school dropout was more prevalent among adolescents who had insomnia (20.6%) compared to those without insomnia (14.3%; adjusted risk ratios = 1.50; 95% confidence intervals: [2.19-2.92]). There was also a higher rate of school dropout among those who had symptoms of delayed sleep-wake phase (21%) compared to those without delayed sleep-wake phase (14.3%); adjusted risk ratios = 1.43, 95% confidence intervals: (1.28-1.59). School noncompleters were also characterized by reporting 44 minutes shorter sleep duration, longer sleep onset latency, and wake after sleep onset (both approx. 15 minutes) compared to school completers. Conclusion: The importance of sleep for high school dropout rates highlights the importance of including sleep as a risk indicator and a possible target for preventive interventions in late adolescence.

Sleep time and quality associated with depression and social anxiety among children and adolescents aged 6–18 years, stratified by body composition

Article

Jun 2023
J AFFECT DISORDERS

Background: Sleep has been suggested as risk factors for depression and social anxiety in children and adolescents, but little is known about the role of individual body composition on these association. Method: We conducted a cross-sectional survey of children and adolescents aged 6-18 years in Beijing, China, in 2020, and assessed body composition by using iDXA dual-energy X-ray bone densitometer. Generalized liner model (GLM) and restricted cubic spline (RCS) were employed to analyze the associations between sleep and depression and social anxiety with different body composition. The attributable fraction (AFs) to assess the benefits of improvements of sleep in reducing depression and social anxiety odds. Results: Depression and social anxiety accounted for 13.1 % and 30.3 % of the study population. Sleep time was significantly associated with depression (HR = 2.35[1.58, 3.50]), and social anxiety (HR = 1.65[1.24, 2.20]); and sleep quality was significantly associated with depression (HR = 7.27[4.87, 10.84]), and social anxiety (HR = 2.54 [1.99, 3.25]) among children and adolescents. The exposure to both insufficient sleep time and poor sleep quality were associated with a higher odd of depression and social anxiety, but lower BF%, higher muscle rate and FFM/FM alleviated the adverse effects of sleep quality on depression and social anxiety. Limitations: Conclusions about causality remain speculative because of the cross-sectional design. Conclusion: Insufficient sleep time, poor sleep quality, high BF%, low muscle rate and FFM/FM can jointly associate with anxiety and depression. This study provides new evidence support for accurate prevention and control of mental diseases in children and adolescents with different body types.

Impact of smartphone overuse on health and well-being: Review and recommendations for life-technology balance

Article

Jan 2023

Nidhi Gupta

Internet use time and mental health among rural adolescents in China: A longitudinal study

Article

May 2023
J AFFECT DISORDERS

Background: The digital divide between urban and rural adolescents is widening. Many existing studies have found an association between internet use and adolescent mental health, but few use longitudinal data to focus on rural adolescents. We aimed to identify the causal relationships between internet use time and mental health in Chinese rural adolescents. Methods: Using a sample of 3694 participants (aged 10-19) from the 2018-2020 China Family Panel Survey (CFPS). Fixed effects model, mediating effect model and instrumental variables method was used to evaluate the causal relationships between internet use time and mental health. Results: We find that more time spent on the internet has a significant negative effect on participants' mental health. This negative impact is stronger in female and senior students groups. Mediating effects analysis suggests that more time spent on the internet increase risk of mental health problems by reducing sleep duration and parent-adolescent communication. Further analysis find that online learning and online shopping is associated with higher depression scores, while online entertainment with lower depression scores. Limitations: The data do not investigate the specific time spent on internet activities (e.g., learning, shopping, and entertainment), and the long-term impacts of internet use time and mental health have not been tested. Conclusions: Internet use time has a significant negative impact on mental health by crowding out sleep duration and parent-adolescent communication. The results provide an empirical reference for the prevention and intervention of mental disorders in adolescents.

Effects of Smartphone Addiction on Sleep in University Students

Research Proposal

May 2023

Muhammad Shoaib

Yeni Medya'da Çerçeveleme DinamikleriFraming Dynamics In New Media

Article

Full-text available

Jan 2023

İletişim çerçeveleri medya yoluyla iletişimde mesajın içeriğini oluşturan ögeleri yani konusunu, sorunsal niteliğini, atıfta bulunduğu toplumsal sorumluluk ilişkilerini, yargılamayı, çözüm önerisini içeren retorik sistemini oluşturmaktadır. Buna göre kültüre yerleşmiş çerçeveler iletişimde bağlam özeti ve etiketi olarak okur/izleyici ile medya çalışanı ve yöneticisi arasında kararlaştırılmış kodlardan oluşmaktadır. Medya çerçeveleri üzerinde sahip oldukları denetimle ana akım medya kurumları ve aktörleri kamusal iletişim üzerinde çok önemli gündem kurma ve kamuoyu hâkimiyeti kurmuştur. Ancak Internet çağının başlangıcından itibaren ortaya çıkan Yeni Medya; iletişimcileri ve kullanıcıları, yeni iletişim sistemini farklı temel dinamikler üzerine inşa etmeye çalışmaktadırlar. Diğer yandan yeni medyanın geleneksel medyayla kurduğu karma medya sistemi eski toplumsal iletişim yapılarının işlevlerini sürdürmelerine de yardımcı olmuştur. Kamusal iletişim ile kişiler arası iletişimin iç içe girdiği bu alanda medya çerçeveleri ile okur çerçeveleri tanımı, sosyal medyada çerçeve kurma süreçleri, yayılan çerçevelerin yaşam döngüsü, yeni medya ile ana akım haber medyası arasındaki çerçeveleme etkileşimleri vb. gibi tartışma konuları araştırılmaktadır. Literatür taramamızda yeni medyada çerçeveleme teorisinin kullanıldığı bu yeni boyutlar sistematik olarak incelenmektedir.

Digital media use and sleep in late adolescence and young adulthood: A systematic review

Article

Dec 2022
SLEEP MED REV

Despite much attention on digital media use and young peoples’ sleep, the literature on digital media and its impact on sleep in older adolescents and young adults remains to be synthesized. We conducted a systematic review of studies including young people aged 16–25 years. We searched Medline, Web of Science, and CINAHL for observational studies, identifying 60 studies. These studies were assessed for methodological quality. Only studies rated as moderate or high-quality studies were included (n = 42). A narrative synthesis summarized the impact of digital media use on eight sleep outcomes: Bedtime; Sleep onset latency or problems falling asleep; Sleep duration; Early awakening; Sleep disturbance; Daytime tiredness and function; Sleep deficits; Sleep quality. In summary, digital media use was associated to shorter sleep duration and poorer sleep quality. These associations were found for general screen use and use of mobile phone, computer, internet, and social media, but not for television, game console, and tablet use. Most studies investigating bedtime or nighttime use found associations to poor sleep outcomes. Later bedtime and daytime tiredness were associated with mobile phone use at night. Additional research is warranted to draw solid conclusions about the causal direction and to understand the underlying mechanisms.

Associations between sleepiness, sleep duration, and academic outcomes in early adolescence

Article

Dec 2022

Insufficient sleep and sleepiness are common in adolescence and can negatively impact school performance. The current study examined sleep duration and sleepiness in academic performance and cognitive processes in early adolescence. Middle school students (N = 288; Mage = 12.01; 54% female; 48% Black, 37% White, 10% Hispanic) wore activity watches for seven nights, reported on daytime sleepiness, and completed computerized tests of attention and episodic memory. Academic performance was assessed with parent and teacher reports, and math and English/language arts (ELA) grades. Results revealed unique associations between daytime sleepiness and academic outcomes, but not cognitive processes. Both shorter and longer sleep duration were related to fewer academic enablers and lower academic skills and math grades. Students with the highest levels of academic performance occurred near 8 h of sleep per night. These results support the importance of addressing daytime sleepiness and optimal sleep duration in early adolescents. 1. Adequate sleep during adolescence is crucial for cognitive processes important for learning. 2. Long and short sleep duration, in addition to daytime sleepiness, can have a negative impact on academic performance. 3. Proximal and distal factors should be considered when developing interventions to help youth obtain adequate sleep and reduce sleepiness. Adequate sleep during adolescence is crucial for cognitive processes important for learning. Long and short sleep duration, in addition to daytime sleepiness, can have a negative impact on academic performance. Proximal and distal factors should be considered when developing interventions to help youth obtain adequate sleep and reduce sleepiness.

A Review of Sleep Process and Influencing Factors

Article

Full-text available

Sep 2022

Zhangnan Jin

In modern society, people often have difficulty in sleeping because of various reasons including psychological or physiological factors, environment, life rhythm and diet. This paper illustrates this effect by integrating various surveys. According to clinical trials, insomniacs normally share common characteristics such as poor sleep habits. In this essay, the main structure of sleep will be first introduced in detail, namely NREM and REM. Then it will discuss certain elements that affect sleep patterns, together with proper improvement methods. While these statistics are based on the majority of people, they don't necessarily apply to everyone. If the phenomenon that the sleep quality is poor exists for a long time, it is advisable to seek medical assistance. Additionally, the importance of both the number of awakenings and the quality of breathing in assessing sleep quality together with some reasonable advice will be put after description of sleep process.

Do objective data support the claim that problematic smartphone use has a clinically meaningful impact upon adolescent sleep duration?

Article

Oct 2022

Sleep insufficiency is a risk factor for mental and physical ill-health. In recent years, research has attributed sleep insufficiency to problematic smartphone use (PSU). In addition, research has indicated a relationship between sleep and the construct of mental toughness (MT). However, previous research exploring the relationship between sleep, PSU and MT has relied on self-report measures. Therefore, this study aimed to explore the tentative links between sleep, PSU and MT by gathering objective data. 2053 participants completed measures of sleep quality, PSU and MT. Objective smartphone usage data were collected using pre-installed smartphone applications. A sub-sample of 614 participants provided sleep duration data from validated sleep tracking devices. In line with previous research, sleep quality was found to correlate weakly with both MT and PSU. While several significant correlations emerged when objective data were explored, in all cases, the effect sizes were negligible. This study does not support the claim that PSU has a clinically meaningful impact upon sleep duration. Sleep hygiene recommendations with more well-established empirical support should be prioritised during sleep promotion efforts.

Young people need experiences that boost their mental health

Article

Oct 2022
NATURE

More policymakers and practitioners should encourage exploration and discovery during youth, to prevent adolescents from reaching crisis. More policymakers and practitioners should encourage exploration and discovery during youth, to prevent adolescents from reaching crisis.

The longitudinal relationship between sleep length and psychotic-like experiences in adolescents

Article

Oct 2022

The longitudinal relationship between psychotic-like experiences (PLEs) and short habitual sleep in adolescents remains to be investigated. We examined the effect of habitual sleep length (time-in-bed: TIB) on the risk of subsequent year PLEs and vice versa, in grade 7-12 students (ages: 12-18, n = 1,685) followed over 6 years. Yearly longitudinal data were analyzed using cross-lagged panel models. Shorter weekday TIB was associated with a higher risk of subsequent year PLEs; PLEs did not affect subsequent year TIB. Compared to a TIB of 8-9 h, 5-6 h increased PLEs likelihood 1.8 times; <5 h increased this 6-fold.

Family and Consumer Sciences Teacher, Parent, and Student Perspectives on Quantity vs. Quality of Screen Time and the Effectiveness of Classroom Implementation of Digital Wellness Curriculum on Adolescent Health

Thesis

Full-text available

Aug 2022

The generation that teachers are currently working with has never known a time without devices, and it is changing them in many ways and all different areas of development. One of the most concerning things evident with current youth is a much higher level of depression and anxiety. The characteristics which encompass the adolescent period, coupled with an increased amount of time on devices, can affect social-emotional health—especially if teens are not equipped with positive coping mechanisms. The types of activities adolescents use their devices for also affect their health. Recent research has shown what adolescents are doing with technology can have as much effect as how much time they spend on technology. By looking at productive and unproductive screen time uses, some discrepancies should be evident in how this affects overall social-emotional health. With the continuously growing trend in technology among adolescents, it is crucial to ascertain its effects on adolescent health. Therefore, the purpose of this mixed-methods experimental study was to investigate the relationship between adolescent screen time and adolescent social-emotional health. The differences in technology usage by adolescents were examined through three perspectives: adolescents, parents, and Family and Consumer Sciences (FCS) teachers. In addition, a digital wellness curriculum called, Intentionally Unplugged™ was implemented and evaluated in FCS classrooms to determine the effectiveness of the curriculum regarding adolescent behavioral improvement in screen time quantity and quality.

Associations between adolescent sleep difficulties and active versus passive screen time across 38 countries

Article

Sep 2022
J AFFECT DISORDERS

Background High screen use has been adversely linked with mental wellbeing; however, little is known about how active versus passive screen time are associated with sleep-onset difficulties among adolescents. Methods We analysed data from 38 European and North American countries that participated in the 2014 Health Behaviour in School-aged Children (HBSC) survey. Difficulties in falling sleep were assessed using a self-reported item with a 5-point Likert scale, and then dichotomised. Participants reported h/day of discretional time spent watching television, electronic gaming, and computer use. Results Of the 195,668 participants (Mage 13.59 [1.62] years; 51 % girls), about 25 % of girls reported sleep-onset difficulties, while the rate was 18 % in boys. Adolescents who played electronic games >4 h/day (≤1 h/day as reference) had 30 % higher odds in boys (OR 1.30; 95 % CI: 1.23–1.38) and 38 % higher odds in girls (OR 1.38; 95 % CI: 1.31–1.45) of reporting sleep difficulties. High computer use (>4 h/day) increased the odds of sleep difficulties by 41 % in boys (OR 1.41, 95 % CI: 1.33–1.49) and 61 % in girls (OR 1.61, 95 % CI: 1.53–1.69). Similarly, high television time (>4 h/day) had increased the odds of sleep difficulties by 15 % in boys (OR 1.15, 95 % CI: 1.08–1.22) and 19 % in girls (OR 1.19, 95 % CI: 1.12–1.25). Limitations Cross-sectional analyses cannot establish causality of the associations. Conclusions Higher levels of recreational screen use of any type were associated with sleep-onset difficulties among adolescents with adverse effects being more prevalent in active than passive screen time. Prospective research with objective measures is warranted to understand causality of these relationships.

Persistent obstructive sleep apnoea in children: treatment options and management considerations

Article

Sep 2022

Unresolved obstructive sleep apnoea (OSA) after an adenotonsillectomy, henceforth referred to as persistent OSA, is increasingly recognised in children (2–18 years). Although associated with obesity, underlying medical complexity, and craniofacial disorders, persistent OSA also occurs in otherwise healthy children. Inadequate treatment of persistent OSA can lead to long-term adverse health outcomes beyond childhood. Positive airway pressure, used as a one-size-fits-all primary management strategy for persistent childhood OSA, is highly efficacious but has unacceptably low adherence rates. A pressing need exists for a broader, more effective management approach for persistent OSA in children. In this Personal View, we discuss the use and the need for evaluation of current and novel therapeutics, the role of shared decision-making models that consider patient preferences, and the importance of considering the social determinants of health in research and clinical practice. A multipronged, comprehensive approach to persistent OSA might achieve better clinical outcomes in childhood and promote health equity for all children.

Are mobile phone ownership and age of acquisition associated with child adjustment? A 5‐year prospective study among low‐income Latinx children

Article

Full-text available

Sep 2022

This prospective, longitudinal study examined associations between whether and when children first acquire a mobile phone and their adjustment measures, among low‐income Latinx children. Children (N = 263; 55% female; baseline Mage = 9.5) and their parents were assessed annually for 5 years from 2012. Children first acquired a mobile phone at a mean (SD) age of 11.62 (1.41) years. Pre‐registered multilevel models tested associations linking phone ownership, phone acquisition age, and the interaction between ownership and acquisition age to levels and changing trends of depressive symptoms, school grades, and reported and objectively assessed sleep. Results showed no statistically significant associations, controlling the False Discovery Rate. Findings suggest an absence of meaningful links from mobile phone ownership and acquisition age to child adjustment.

Why Don't We Sleep Enough? A Field Experiment Among College Students

Article

Jan 2022

Gender differences in the interference of sleep difficulties and daytime sleepiness on school and social activities in adolescents

Article

Aug 2022
SLEEP MED

Objectives During adolescence, changes in the circadian and homeostatic systems, combined with psychosocial factors, create a phase delay in the sleep of adolescents. These changes in sleep are associated with increased sleep difficulties and a shortened sleep duration, which has a negative impact on daytime functioning of adolescents. Some studies showed that teenage girls report worse sleep quality and shorter sleep duration than boys during adolescence. The objective of this study was to investigate gender differences in the impact of sleep difficulties and sleepiness on daytime functioning in adolescents and to measure which aspect of sleep may interfere with daytime functioning in boys and girls. Method A total of 731 adolescents (311 boys, 420 girls; age 13 to 17,5 years) completed questionnaires on sleep and daytime functioning. Results Compared to boys, teenage girls reported a significantly greater impact of short sleep duration and sleep difficulties on their school and social activities. Furthermore, our results suggest that the factors predicting the negative interference on daytime functioning seem to be more complex and multifactorial for girls than for boys. Conclusions This study further emphasizes the importance of monitoring insufficient and poor sleep quality in adolescents, as these sleep variables seem to have a significant impact on their daytime functioning. Clinicians should also take into account gender when considering sleep issues in adolescents, as teenage girls and boys have different vulnerabilities and needs.

Sleep health and its related influencing factors in primary and middle school students in Fuzhou: A large multi-center cross-sectional study

Article

Full-text available

Aug 2022

Background This current study set out to investigate the status of sleep health in 7–20-year-old students in Fuzhou and explore the related influencing factors of sleep health. Methods A total of 38,467 children and adolescents in Fuzhou were included in the study through a random stratified cluster sampling. Data were collected from May to June 2019, in 18 primary schools and 18 middle schools from nine districts, Fuzhou. Children's parents and adolescents of sampled classes were invited to fill out a series of questionnaires about the performance of the last 6 months (sociodemographic characteristics, sleep-related lifestyle behaviors, and electronic-products usage). Multiple linear regression was carried out to analyze data. Results Of the total 40,888 questionnaires we released, 38,467 were valid and effective with the response rate was 94.08%. The age of the surveyed participants was 11.85 ± 3.1, including 20,013 boys and 18,454 girls. The multiple linear regression analysis identified factors associated with sleep health ( p < 0.05): Boy (coef = 0.073, 95% CI: 0.030–0.115), age (coef = 1.797, 95% CI: 0.224–0.243), key school (coef = 2.069, 95% CI: 0.105–0.193), urban (coef = 0.096, 95% CI: 0.054–0.139), excessive daytime sleepiness (coef = 0.535, 95% CI: 0.432–0.639), unhealthy sleep habits (coef = 0.363, 95% CI: 0.307–0.419), eating before sleep (coef = 0.578, 95% CI: 0.527–0.630), using electronic products in bedroom (coef = 0.074, 95% CI: 0.028–0.121), screen time per day during school (coef = 0.260, 95% CI: 0.235–0.284), frequency of using electronics 30 min before bedtime (coef = 0.150, 95% CI: 0.134–0.166), strained relationship with parents (coef = 0.361, 95% CI: 0.270–0.452), strained relationship with peers (coef = 0.267, 95% CI: 0.171–0.363), excessive homework or learning (coef = 0.189, 95% CI: 0.141–0.237), time for doing homework (coef = 0.266, 95% CI: 0.245–0.287), and mood swings frequently (coef = 1.174, 95% CI: 1.127–1.221) negatively impact sleep health. Sleep alone (coef = −0.204, 95% CI: −0.262–0.147) were the risk factors for sleep health. Furthermore, frequent mood swings was considered the most influential factor on overall variables. Conclusions Sleep health is associated with factors covered sociodemographic characteristics, family sleep habits, and routine activities before bedtime. Multiple measures should be taken to improve sleep quality in a targeted manner.

Sleep–wake patterns and disturbances in Portuguese primary school children: a comparison between 1995 and 2016

Article

Jul 2022
SLEEP BIOL RHYTHMS

PurposeIt is often assumed sleep duration has decreased and sleep schedules have delayed over the last decades, as society modernized. We aimed to investigate changes in the sleep patterns of school-age children over time.Methods We compared the sleep timings, durations, and disturbances of primary school-age children in 1995 and roughly two decades later, in 2016. Data from 666 children attending the 3rd and 4th grades of basic education were combined from two different cross-sectional school-based studies conducted within the same educational region of mainland Portugal using the same parent-report questionnaire (Children’s Sleep–wake Patterns Questionnaire).ResultsMean sleep duration did not differ significantly between the two time points (schooldays: t = .118, p = .906; free days: t = 1.310, p = .191), albeit the percentage of children sleeping the recommended number of hours decreased significantly in 2016 when compared to 1995 (schooldays: χ2 = 4.406, p = .036; free days: χ2 = 16.859, p < .001). Wake-times advanced on free days in 2016. Difficulties on settling to sleep alone and returning to sleep were more prevalent in 2016, as well as fearing the dark and needing lights on or parent’s presence to fall asleep.Conclusions Sleep onset-related disturbances appear to have increased from 1995 to 2016. One possible explanation for this increase might be the change in parental practices preventing children from learning to fall asleep autonomously.

SleepyCloud: Examining the Effect of Odor Cue on Reducing Bedtime Procrastination

Chapter

Jun 2022

Bedtime procrastination refers to delaying bedtime without external reasons. It has become serious among the younger generation due to smartphone popularity, leading to several physical and mental disorders. Odor cue has the potential to reduce bedtime procrastination, as prior research has demonstrated its effectiveness in conveying information and triggering desired emotion and behaviors. However, limited research investigates the effect of odor on bedtime regulation outside of clinical settings. We designed and implemented SleepyCloud, a device aiming to deliver odor cue one hour before people’s scheduled bedtime. Our study examines the effectiveness of odor cue on reducing students’ bedtime procrastination using SleepyCloud. Our results suggested that the odor cue was helpful on reducing bedtime procrastination for those who procrastinated due to leisure activities, and that the odor cue also helped regulate sleep. We provide implications for future investigation on this topic.

A systematic review on sedentary behavior and sleep among adolescents

Article

Full-text available

Mar 2020

Introduction: Adolescents often engage in sedentary behavior and encounter sleep problems. Numerous studies have shown that both sedentary behavior and sleep problems negatively impact physical and mental health among adolescents. However, no studies exist that systematically summarize empirical findings of sedentary behavior and sleep problems on adolescents. The purpose of this systematic review was to explore empirical findings concerning the associations between sedentary behavior and sleep on adolescents. Methods: Major electronic databases in English and Chinese were searched from January 2015 to January 2019. Nineteen quantitative studies met the criteria for reporting the association between sedentary behavior and sleep on adolescents. Results: Among 19 articles, the modes of sedentary behavior were mainly TV watching and computer/internet use (7 studies each). There were 4 studies including non-screen sedentary behavior (non-screen telephone, reading, doing homework, listening to music, chatting, or playing cards). Total sedentary behavior or total screen behavior were collected in 10 studies. Regarding the measures of sleep, only 1 study used objective measure (actigraphy) and the others were self-reported. The sleep parameters included sleep duration (12 studies), sleep onset latency (4 studies), sleep disturbance/awakening (4 studies), delayed bedtime (3 studies), and insomnia (3 studies). A few studies mentioned sleep quality, daytime sleepiness, or sleep efficiency. Conclusion: Adolescents who spent more time on sedentary behavior (especially computer and internet use) had higher risks of insufficient sleep duration, sleep disturbance, insomnia, and delayed bedtime. No conclusion could be made about the association between sedentary behavior types and sleep efficiency, sleep quality, daytime sleepiness and/or fatigue due to limited research. Future research should investigate associations between different modes of objectively derived sedentary behavior and various sleep parameters with experimental and longitudinal study design to better understand the mechanisms of associations and the impacts of sedentary behavior on sleep problems and wider health outcomes.

Associations between screen time and internalizing disorder diagnoses among 9- to 10-year-olds

Article

May 2022
J AFFECT DISORDERS

Background Children and adolescents spend an increasing amount of time with screen media. Identifying correlates of youth mental disorders has become more urgent with rates of depression, self-harm, suicide attempts, and suicide deaths rising sharply among U.S. children and adolescents after 2012. This study examined the relationship between screen time and internalizing disorders in preadolescent children between the ages of 9 and 10. Methods Participants were 9- and 10-year-old youth (n = 11,780) in the baseline of the multi-site Adolescent Brain and Cognitive Development Study (ABCD). Youth reported the number of hours a day they spent watching TV shows or movies, watching videos online, playing video games, texting, using social media, and video chatting. Youth responded to an abbreviated version of the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-5), a semi-structured clinical interview measuring current and past symptoms of internalizing disorders using DSM-5 criteria. Results Youth spending 2 or more hours (vs. less than 2) a day with screen media were more likely to fit criteria for depressive disorders, self-harm, and suicidal ideation or attempts, even after adjustment for demographic covariates. For anxiety disorders, associations with digital media use (social media, texting, gaming, and online videos) were stronger than with screen time generally. Limitations This is a cross-sectional study utilizing retrospective screen time reports, which limits our ability to determine causality and the accuracy of the reports. Conclusions Preadolescents who spend more time using screens, especially digital media, are more likely to fit DSM-5 criteria for internalizing disorders.

Association Between Portable Screen-Based Media Device Access or Use and Sleep Outcomes: A Systematic Review and Meta-analysis

Article

Full-text available

Oct 2016

Importance: Sleep is vital to children's biopsychosocial development. Inadequate sleep quantity and quality is a public health concern with an array of detrimental health outcomes. Portable mobile and media devices have become a ubiquitous part of children's lives and may affect their sleep duration and quality. Objective: To conduct a systematic review and meta-analysis to examine whether there is an association between portable screen-based media device (eg, cell phones and tablet devices) access or use in the sleep environment and sleep outcomes. Data sources: A search strategy consisting of gray literature and 24 Medical Subject Headings was developed in Ovid MEDLINE and adapted for other databases between January 1, 2011, and June 15, 2015. Searches of the published literature were conducted across 12 databases. No language restriction was applied. Study selection: The analysis included randomized clinical trials, cohort studies, and cross-sectional study designs. Inclusion criteria were studies of school-age children between 6 and 19 years. Exclusion criteria were studies of stationary exposures, such as televisions or desktop or personal computers, or studies investigating electromagnetic radiation. Data extraction and synthesis: Of 467 studies identified, 20 cross-sectional studies were assessed for methodological quality. Two reviewers independently extracted data. Main outcomes and measures: The primary outcomes were inadequate sleep quantity, poor sleep quality, and excessive daytime sleepiness, studied according to an a priori protocol. Results: Twenty studies were included, and their quality was assessed. The studies involved 125 198 children (mean [SD] age, 14.5 [2.2] years; 50.1% male). There was a strong and consistent association between bedtime media device use and inadequate sleep quantity (odds ratio [OR], 2.17; 95% CI, 1.42-3.32) (P < .001, I2 = 90%), poor sleep quality (OR, 1.46; 95% CI, 1.14-1.88) (P = .003, I2 = 76%), and excessive daytime sleepiness (OR, 2.72; 95% CI, 1.32-5.61) (P = .007, I2 = 50%). In addition, children who had access to (but did not use) media devices at night were more likely to have inadequate sleep quantity (OR, 1.79; 95% CI, 1.39-2.31) (P < .001, I2 = 64%), poor sleep quality (OR, 1.53; 95% CI, 1.11-2.10) (P = .009, I2 = 74%), and excessive daytime sleepiness (OR, 2.27; 95% CI, 1.54-3.35) (P < .001, I2 = 24%). Conclusions and relevance: To date, this study is the first systematic review and meta-analysis of the association of access to and the use of media devices with sleep outcomes. Bedtime access to and use of a media device were significantly associated with the following: inadequate sleep quantity, poor sleep quality, and excessive daytime sleepiness. An integrated approach among teachers, health care professionals, and parents is required to minimize device access at bedtime, and future research is needed to evaluate the influence of the devices on sleep hygiene and outcomes.

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

Article

Full-text available

Aug 2016
J ADOLESCENCE

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 Duration and Injury-Related Risk Behaviors Among High School Students - United States, 2007-2013

Article

Full-text available

Apr 2016

Insufficient sleep is common among high school students and has been associated with an increased risk for motor vehicle crashes (1), sports injuries (2), and occupational injuries (3). To evaluate the association between self-reported sleep duration on an average school night and several injury-related risk behaviors (infrequent bicycle helmet use, infrequent seatbelt use, riding with a driver who had been drinking, drinking and driving, and texting while driving) among U.S. high school students, CDC analyzed data from 50,370 high school students (grades 9-12) who participated in the national Youth Risk Behavior Surveys (YRBSs) in 2007, 2009, 2011, or 2013. The likelihood of each of the five risk behaviors was significantly higher for students who reported sleeping ≤7 hours on an average school night; infrequent seatbelt use, riding with a drinking driver, and drinking and driving were also more likely for students who reported sleeping ≥10 hours compared with 9 hours on an average school night. Although insufficient sleep directly contributes to injury risk, some of the increased risk associated with insufficient sleep might be caused by engaging in injury-related risk behaviors. Intervention efforts aimed at these behaviors might help reduce injuries resulting from sleepiness, as well as provide opportunities for increasing awareness of the importance of sleep.

Sleep Duration and Risk of Type 2 Diabetes: A Meta-analysis of Prospective Studies

Article

Full-text available

Mar 2015
DIABETES CARE

It remains unclear how many hours of sleep are associated with the lowest risk of type 2 diabetes. This meta-analysis was performed to assess the dose-response relationship between sleep duration and risk of type 2 diabetes. PubMed and Embase were searched up to 20 March 2014 for prospective observational studies that assessed the relationship of sleep duration and risk of type 2 diabetes. Both semiparametric and parametric methods were used. Ten articles with 11 reports were eligible for inclusion in the meta-analysis. A total of 18,443 incident cases of type 2 diabetes were ascertained among 482,502 participants with follow-up periods ranging from 2.5 to 16 years. A U-shaped dose-response relationship was observed between sleep duration and risk of type 2 diabetes, with the lowest risk observed at a sleep duration category of 7-8 h per day. Compared with 7-h sleep duration per day, the pooled relative risks for type 2 diabetes were 1.09 (95% CI 1.04-1.15) for each 1-h shorter sleep duration among individuals who slept <7 h per day and 1.14 (1.03-1.26) for each 1-h increment of sleep duration among individuals with longer sleep duration. Our dose-response meta-analysis of prospective studies shows a U-shaped relationship between sleep duration and risk of type 2 diabetes, with the lowest type 2 diabetes risk at 7-8 h per day of sleep duration. Both short and long sleep duration are associated with a significantly increased risk of type 2 diabetes, underscoring the importance of appropriate sleep duration in the delay or prevention of type 2 diabetes. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

The Great Sleep Recession: Changes in Sleep Duration Among US Adolescents, 1991-2012

Article

Full-text available

Feb 2015

Average nightly sleep times precipitously decline from childhood through adolescence. There is increasing concern that historical shifts also occur in overall adolescent sleep time. Data were drawn from Monitoring the Future, a yearly, nationally representative cross-sectional survey of adolescents in the United States from 1991 to 2012 (N = 272 077) representing birth cohorts from 1973 to 2000. Adolescents were asked how often they get ≥7 hours of sleep and how often they get less sleep than they should. Age-period-cohort models were estimated. Adolescent sleep generally declined over 20 years; the largest change occurred between 1991-1995 and 1996-2000. Age-period-cohort analyses indicate adolescent sleep is best described across demographic subgroups by an age effect, with sleep decreasing across adolescence, and a period effect, indicating that sleep is consistently decreasing, especially in the late 1990s and early 2000s. There was also a cohort effect among some subgroups, including male subjects, white subjects, and those in urban areas, with the earliest cohorts obtaining more sleep. Girls were less likely to report getting ≥7 hours of sleep compared with boys, as were racial/ethnic minorities, students living in urban areas, and those of low socioeconomic status (SES). However, racial/ethnic minorities and adolescents of low SES were more likely to self-report adequate sleep, compared with white subjects and those of higher SES. Declines in self-reported adolescent sleep across the last 20 years are concerning. Mismatch between perceptions of adequate sleep and actual reported sleep times for racial/ethnic minorities and adolescents of low SES are additionally concerning and suggest that health education and literacy approaches may be warranted. Copyright © 2015 by the American Academy of Pediatrics.

Sleep and use of electronic devices in adolescence: Results from a large population-based study

Article

Full-text available

Jan 2015

Adolescents spend increasingly more time on electronic devices, and sleep deficiency rising in adolescents constitutes a major public health concern. The aim of the present study was to investigate daytime screen use and use of electronic devices before bedtime in relation to sleep. A large cross-sectional population-based survey study from 2012, the youth@hordaland study, in Hordaland County in Norway. Cross-sectional general community-based study. 9846 adolescents from three age cohorts aged 16-19. The main independent variables were type and frequency of electronic devices at bedtime and hours of screen-time during leisure time. Sleep variables calculated based on self-report including bedtime, rise time, time in bed, sleep duration, sleep onset latency and wake after sleep onset. Adolescents spent a large amount of time during the day and at bedtime using electronic devices. Daytime and bedtime use of electronic devices were both related to sleep measures, with an increased risk of short sleep duration, long sleep onset latency and increased sleep deficiency. A dose-response relationship emerged between sleep duration and use of electronic devices, exemplified by the association between PC use and risk of less than 5 h of sleep (OR=2.70, 95% CI 2.14 to 3.39), and comparable lower odds for 7-8 h of sleep (OR=1.64, 95% CI 1.38 to 1.96). Use of electronic devices is frequent in adolescence, during the day as well as at bedtime. The results demonstrate a negative relation between use of technology and sleep, suggesting that recommendations on healthy media use could include restrictions on electronic devices. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Sleep Duration From Ages 1 to 10 Years: Variability and Stability in Comparison With Growth

Article

Full-text available

Nov 2007
Pediatrics

Our goal was to describe the variability of sleep duration (time in bed per 24 hours) in healthy children from 1 to 10 years of age in comparison with growth measures. A total of 305 children were followed with structured sleep-related interviews and measurements of height and weight 12, 18, and 24 months after birth and then at annual intervals until 10 years of age. SD scores were calculated, and smooth curves were fitted by smoothing splines through the SD scores. The long-term variability channel within children (units SD score) was defined as the difference between the maximum and the minimum of the smooth curves and the short-term variability channel (units SD score) as the difference of the largest and the smallest deviations of the original SD scores from the smooth curve. Sleep duration remained within a long-term variability channel <0.5 SD score in 21% of the children (34% for height, 21% for weight). Nearly every second child (46%) stayed within a long-term variability channel <1.0 SD score (76% for height, 64% for weight). Sleep duration of approximately 90% of all children ran within a long-term variability channel of <2.0 SD score (corresponding, eg, to the range between the 2nd and the 50th percentile). No single child's sleep duration remained within a short-term variability channel <0.5 SD score, indicating fluctuations from year to year (60% for height, 53% for weight). An association between aspects of sleep duration and somatic growth was not observed at any age. Sleep duration during early and middle childhood shows large variability among children, as well as trait-like long-term stability and state-like yearly fluctuations within children. An individual approach to the child's sleep behavior is needed; expectations in terms of appropriate sleep duration of the child should be adjusted to the individual sleep need.

Sleep and Mortality: A Population-Based 22-Year Follow-Up Study

Article

Full-text available

Oct 2007

Long and short sleep have been associated with increased mortality. We assessed mortality and 3 aspects of sleep behavior in a large cohort with 22-year follow-up. Prospective, population-based cohort study. 21,268 twins aged > or =18 years responding to questionnaires administered to the Finnish Twin Cohort in 1975 (response rate 89%), and 1981 (84%). N/A. Subjects were categorized as short (<7 h), average, or long (>8 h) sleepers; sleeping well, fairly well, or fairly poorly/poorly; no, infrequent, or frequent users of hypnotics and/or tranquilizers. Cox proportional hazard models were used to obtain hazard ratios (HR) for mortality during 1982-2003 by sleep variable categories and their combinations. Adjustments were done for 10 sociodemographic and lifestyle covariates known to affect risk of death. Significantly increased risk of mortality was observed both for short sleep in men (+26%) and in women (+21%), and for long sleep (+24% and +17%), respectively, and also frequent use of hypnotics/tranquilizers (+31% in men and +39% in women). Snoring as a covariate did not change the results. The effect of sleep on mortality varied between age groups, with strongest effects in young men. Between 1975 and 1981, sleep length and sleep quality changed in one-third of subjects. In men there was a significant increase for stable short (1.34) and stable long (1.29) sleep for natural deaths, and for external causes in stable short sleepers (1.62). Our results show complicated associations between sleep and mortality, with increased risk in short and long sleep.

Increases in Depressive Symptoms, Suicide-Related Outcomes, and Suicide Rates Among U.S. Adolescents After 2010 and Links to Increased New Media Screen Time

Article

Nov 2017

In two nationally representative surveys of U.S. adolescents in grades 8 through 12 (N = 506,820) and national statistics on suicide deaths for those ages 13 to 18, adolescents’ depressive symptoms, suicide-related outcomes, and suicide rates increased between 2010 and 2015, especially among females. Adolescents who spent more time on new media (including social media and electronic devices such as smartphones) were more likely to report mental health issues, and adolescents who spent more time on nonscreen activities (in-person social interaction, sports/exercise, homework, print media, and attending religious services) were less likely. Since 2010, iGen adolescents have spent more time on new media screen activities and less time on nonscreen activities, which may account for the increases in depression and suicide. In contrast, cyclical economic factors such as unemployment and the Dow Jones Index were not linked to depressive symptoms or suicide rates when matched by year.

Changes in sleep duration and recreational screen time among Canadians, 1998-2010

Article

Dec 2016
J SLEEP RES

Judith A. Leech

It is commonly claimed that sleep duration has declined in recent years - over a period coinciding with a marked increase in personal electronics and communications use. The aim of this study was to assess change in sleep duration among Canadians from 1998 to 2010, and examine any associations with non-work-related screen time. The analysis uses population-representative data from Statistics Canada's General Social Survey cycles of 1998 and 2010; the respective samples numbered 10 749 and 15 390 individuals. Response rates were 80% in 1998 and 55% in 2010. Respondents were aged 15 years and older, residing in private households in the 10 Canadian provinces. The General Social Survey is administered by computer-assisted telephone interviewing. Data on sleep duration (excluding naps outside essential sleep time) and recreational screen time were obtained using a 24-h time-use diary. Survey weights were applied to adjust for non-response and non-landline households. Frequencies (respondent characteristics) and averages (time-use variables) were estimated by age group and sex. Sleep duration was examined by weighted quartile of screen time. Confidence intervals (95%) were calculated around estimates. Average sleep duration increased from 8.1 h in 1998 to 8.3 h in 2010. Average screen time increased from 140 min in 1998 to 154 min in 2010. Sleep duration and screen time were positively related in both years. The percentage of people averaging less than 6 h sleep decreased from 9.6% in 1998 to 8.6% in 2010. Between 1998 and 2010, increases in screen time did not occur at the expense of sleep duration.

Monitoring the Future. National Survey Results on Drug Use

Article

Jan 2003

Sleep as a Mediator of Screen Time Effects on US Children's Health Outcomes

Article

Feb 2012

There is growing concern regarding the influence of media exposure on American children's health and development. The current prospective study tested the direct relations between media exposure, sleep, and various health outcomes (e.g. attention problems, aggression, and body composition) and the indirect effect of media exposure through sleep disturbances. Child participants (N = 1,317) completed measures of media consumption and sleep. Teachers reported on children's attention problems and use of physical aggression. Results showed that media exposure at Time 1 was indirectly related to attention, physical aggression, and Body Mass Index at Time 3 (13 months later), mediated by sleep at Time 2. Overall, these results support the hypothesis that screen time is negatively related to health outcomes, and that displaced sleep is one of the mediating mechanisms underlying these relations.

Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness

Article

Dec 2014

Significance The use of light-emitting electronic devices for reading, communication, and entertainment has greatly increased recently. We found that the use of these devices before bedtime prolongs the time it takes to fall asleep, delays the circadian clock, suppresses levels of the sleep-promoting hormone melatonin, reduces the amount and delays the timing of REM sleep, and reduces alertness the following morning. Use of light-emitting devices immediately before bedtime also increases alertness at that time, which may lead users to delay bedtime at home. Overall, we found that the use of portable light-emitting devices immediately before bedtime has biological effects that may perpetuate sleep deficiency and disrupt circadian rhythms, both of which can have adverse impacts on performance, health, and safety.

Insufficient Sleep in Adolescents and Young Adults: An Update on Causes and Consequences

Article

Aug 2014

Judith Owens

Chronic sleep loss and associated sleepiness and daytime impairments in adolescence are a serious threat to the academic success, health, and safety of our nation's youth and an important public health issue. Understanding the extent and potential short- and long-term repercussions of sleep restriction, as well as the unhealthy sleep practices and environmental factors that contribute to sleep loss in adolescents, is key in setting public policies to mitigate these effects and in counseling patients and families in the clinical setting. This report reviews the current literature on sleep patterns in adolescents, factors contributing to chronic sleep loss (ie, electronic media use, caffeine consumption), and health-related consequences, such as depression, increased obesity risk, and higher rates of drowsy driving accidents. The report also discusses the potential role of later school start times as a means of reducing adolescent sleepiness.

Screen Time and Sleep among School-Aged Children and Adolescents: A Systematic Literature Review

Article

Aug 2014
SLEEP MED REV

We systematically examined and updated the scientific literature on the association between screen time (e.g., television, computers, video games, and mobile devices) and sleep outcomes among school-aged children and adolescents. We reviewed 67 studies published from 1999 to early 2014. We found that screen time is adversely associated with sleep outcomes (primarily shortened duration and delayed timing) in 90% of studies. Some of the results varied by type of screen exposure, age of participant, gender, and day of the week. While the evidence regarding the association between screen time and sleep is consistent, we discuss limitations of the current studies: 1.) causal association not confirmed; 2.) measurement error (of both screen time exposure and sleep measures); 3.) limited data on simultaneous use of multiple screens, characteristics and content of screens used. Youth should be advised to limit or reduce screen time exposure, especially before or during bedtime hours to minimize any harmful effects of screen time on sleep and well-being. Future research should better account for the methodological limitations of the extant studies, and seek to better understand the magnitude and mechanisms of the association. These steps will help the development and implementation of policies or interventions related to screen time among youth.

The Sleep and Technology Use of Americans: Findings from the National Sleep Foundation's 2011 Sleep in America Poll

Article

Dec 2013

To describe the technology use and sleep quality of Americans, and the unique association between technology use and sleep disturbances. Interviews were conducted via random digit dialing (N = 750) or the Internet (N = 758). 1,508 Americans (13-64 years old, 50% males) matched to 2009 U.S. Census data provided complete interviews. The sample was further divided into adolescents (13-18 years, N = 171), young adults (19-29 years, N = 293), middle-aged adults (30-45 years, N = 469), and older adults (46-64 years, N = 565) to contrast different generations' technology use. Participants answered a 47-item semi-structured survey, including questions about their sleep habits, and the presence and use of technology in the hour before bed in the past 2 weeks. Nine of 10 Americans reported using a technological device in the hour before bed (e.g., TVs the most popular; 60%). However, those under 30 years of age were more likely to use cell phones (72% of adolescents, 67% of young adults) than those over 30 years (36% of middle-aged, and 16% of older adults). Young adults' sleep patterns were significantly later than other age groups on both weekdays and weekend nights. Unlike passive technological devices (e.g., TV, mp3 music players), the more interactive technological devices (i.e., computers/laptops, cell phones, video game consoles) used in the hour before bed, the more likely difficulties falling asleep (β = 9.4, p < 0.0001) and unrefreshing sleep (β = 6.4, p < 0.04) were reported. Technology use near bedtime is extremely prevalent in the United States. Among a range of technologies, interactive technological devices are most strongly associated with sleep complaints. A commentary on this article appears in this issue on page 1301. Gradisar M; Wolfson AR; Harvey AG; Hale L; Rosenberg R; Czeisler CA. The sleep and technology use of Americans: findings from the National Sleep Foundation's 2011 Sleep in America Poll. J Clin Sleep Med 2013;9(12):1291-1299.

Sleep Duration versus Sleep Insufficiency as Predictors of Cardiometabolic Health Outcomes

Article

Nov 2012

Objective: The objective of the present study was to investigate the relationship between sleep insufficiency and sleep duration, particularly regarding negative cardiometabolic health outcomes already considered to be affected by reduced sleep time. Methods: A total of N=30,934 participants from the 2009 Behavioural Risk Factor Surveillance System (BRFSS) answered questions about their sleep duration as well as subjective feelings of sleep insufficiency. Outcomes included body mass index (BMI), obesity (BMI ≥ 30kgm(-2)) and history of hypertension, diabetes, hypercholesterolaemia, heart attack and stroke. Linear and logistic regression models examined whether cardiometabolic outcomes were associated with (1) sleep duration alone, (2) sleep insufficiency alone and (3) the combined effect of sleep duration and sleep insufficiency. Results: Results indicated that, when examined alone, sleep duration <5h (versus 7h) was related to BMI (B=2.716, p<0.01), obesity (B=2.080, p<0.000001), diabetes (B=3.162, p<0.000001), hypertension (B=2.703, p<0.000001), hypercholesterolaemia (B=1.922, p<0.00001), heart attack (B=4.704, p<0.000001) and stroke (B=4.558, p<0.000001), and sleep insufficiency (days per week, continuous) was related to BMI (B=0.181, p<0.01), obesity (B=1.061, p<0.000001) and hypercholesterolaemia (B=1.025, p<0.01). All of these relationships remained significant after adjustment for covariates, except for diabetes and sleep duration. Also, after adjustment, a significant relationship between insufficient sleep and hypertension emerged (B=1.039, p<0.001). When evaluated together, after adjustment for covariates, significant relationships remained between sleep duration <5h (versus 7h) and BMI (B=1.266, p<0.05), obesity (B=1.389, p<0.05), hypertension (B=1.555, p<0.01), heart attack (B=2.513, p<0.01) and stroke (B=1.807, p<0.05). It should be noted that relationships between sleep duration >9h (versus 7h) were seen for heart attack (B=1.863, p<0.001) and stroke (B=1.816, p<0.01). In these models, sleep insufficiency was associated with hypercholesterolaemia (B=1.031, p<0.01) and hypertension (B=1.027, p<0.05). Conclusions: These analyses show that both sleep duration and insufficiency are related to cardiometabolic health outcomes, and that when evaluated together, both variables demonstrate unique effects.

Secondary Sexual Characteristics in Boys: Data From the Pediatric Research in Office Settings Network

Article

Oct 2012
Pediatrics

Background: Data from racially and ethnically diverse US boys are needed to determine ages of onset of secondary sexual characteristics and examine secular trends. Current international studies suggest earlier puberty in boys than previous studies, following recent trend in girls. Methods: Two hundred and twelve practitioners collected Tanner stage and testicular volume data on 4131 boys seen for well-child care in 144 pediatric offices across the United States. Data were analyzed for prevalence and mean ages of onset of sexual maturity markers. Results: Mean ages for onset of Tanner 2 genital development for non-Hispanic white, African American, and Hispanic boys were 10.14, 9.14, and 10.04 years and for stage 2 pubic hair, 11.47, 10.25, and 11.43 years respectively. Mean years for achieving testicular volumes of ≥ 3 mL were 9.95 for white, 9.71 for African American, and 9.63 for Hispanic boys; and for ≥ 4 mL were 11.46, 11.75, and 11.29 respectively. African American boys showed earlier (P < .0001) mean ages for stage 2 to 4 genital development and stage 2 to 4 pubic hair than white and Hispanic boys. No statistical differences were observed between white and Hispanic boys. Conclusions: Observed mean ages of beginning genital and pubic hair growth and early testicular volumes were 6 months to 2 years earlier than in past studies, depending on the characteristic and race/ethnicity. The causes and public health implications of this apparent shift in US boys to a lower age of onset for the development of secondary sexual characteristics in US boys needs further exploration.

Neuroticism and sleep-onset: What is the long-term connection?

Article

Mar 2010
PERS INDIV DIFFER

People with sleep-onset problems often experience neuroticism. To what extent the one problem leads to the other is unknown. We used self-reported data from a Swedish longitudinal project to examine developmental links between neuroticism and sleep-onset problems. A sample of 212 people, followed from birth to midlife, was part of a cohort study spanning 37 years. Adolescent neuroticism was measured at age 16 with the High School Personality Questionnaire (HSPQ, Form A) and in midlife at age 37 with the Eysenck Personality Questionnaire (EPQ). Sleep-onset problems were measured at ages 15 to 17, 25, and 37 with items developed for the Solna Project. Adolescent neuroticism failed to predict sleep-onset problems. Instead, sleep-onset problems in adolescence and young adulthood predicted midlife neuroticism. We found that sleep-onset problems during adolescence were a direct risk for midlife neuroticism, as well as, an indirect risk through continuance of sleep-onset problems into adulthood. This study provides longitudinal support for adolescent sleep-onset problems as a potent risk factor for heightened neuroticism in midlife.

Sleep and society: An epidemiological perspective

Article

Sep 2009

Edward Bixler

The relationship between good health and sleep duration has been clearly established in epidemiological studies, although exactly which factors are involved in altering sleep patterns remains to be fully determined. This, at least in part, reflects the complex and multifactorial mechanisms involved in sleep. Subjective sleep duration has slowly declined over the last 50 years, and suboptimal sleep duration and poor sleep quality are becoming widespread in modern society. Suboptimal sleep duration has a strong association with mortality and morbidity; hence there is a need to more clearly understand the mechanisms involved in regulating sleep duration and patterns and to identify high-risk individuals who are in greatest need of preventive strategies. This review focuses on epidemiological evidence of the relationship between sleep duration and various risk factors, including socioeconomic, behavioural and metabolic aspects.

Teens, social media and technology overview 2015: smartphones facilitate shifts in communication landscape for teens

Jan 2015
1-47

A Lenhart

Lenhart A. Teens, social media and technology overview 2015: smartphones facilitate shifts in communication landscape for teens. Pew Res Cent 2015: 1e47. https://doi.org/10.1016/j.chb.2015.08.026.

Washington, DC: Pew Res Center's; 2013. p. 1e19. Internet Am Life Proj

Jul 2013

M Madden
A Lenhart
M Duggan

Madden M, Lenhart A, Duggan M, et al. Teens and technology 2013. Washington, DC: Pew Res Center's; 2013. p. 1e19. Internet Am Life Proj 2013, doi: July 7, 2013.

Why Today's super-connected kids are growing up less rebellious, more tolerant, less happy e and completely unprepared for adulthood

Jan 2017

J M Twenge
Igen

Twenge JM. iGen:Why Today's super-connected kids are growing up less rebellious, more tolerant, less happy e and completely unprepared for adulthood. New York: Atria Books; 2017.

Monitoring the future: a continuing study of American youth (8th-and 10th-grade surveys)

Jan 2015

L D Johnston
J G Bachman
O Malley

Johnston LD, Bachman JG, O'Malley PM, et al. Monitoring the future: a continuing study of American youth (8th-and 10th-grade surveys), 2015. https://doi.org/10.3886/ICPSR36407.v1.

Monitoring the future: a continuing study of american Patent (12th-Grade Survey)

Jan 2015

L D Johnston
J G Bachman
O Malley

Johnston LD, Bachman JG, O'Malley PM, et al. Monitoring the future: a continuing study of american Patent (12th-Grade Survey), 2015. https://doi. org/10.3886/ICPSR36408.v1.

Sleep duration: how well do selfreports reflect objective measures? The CARDIA Sleep study

Jan 2008
EPIDEMIOLOGY
838-883

D S Lauderdale
L K Knutson
L L Yan

Lauderdale DS, Knutson LK, Yan LL, et al. Sleep duration: how well do selfreports reflect objective measures? The CARDIA Sleep study. Epidemiology 2008;19(6):838e45. https://doi.org/10.1097/EDE.0b013e318187a7b0.Sleep.

Decreases in self-reported sleep duration among U.S. adolescents 2009-2015 and links to new media screen time

Abstract

No full-text available

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