Associations between screen time and short sleep duration among adolescents varies by media type: evidence from a cohort study

Associations between bedtime media use and sleep outcomes in an adult population-based cohort

OBJECTIVE

To further examine the relationship between bedtime media use and sleep in adults by taking relevant covariates into account and testing hypothesised mediating and moderating pathways.

METHODS

Bedtime media use and sleep outcomes were examined by questionnaire in 4188 adults (59 % women, aged 19-94 years) from the Specchio cohort based in Geneva, Switzerland. We tested associations between bedtime media use and sleep (bedtimes, rise times, sleep latency, sleep duration, sleep quality, insomnia, and daytime sleepiness), adjusting for prior sleep, mental health, and health behaviours; whether bedtime media use mediates associations between individual susceptibility factors (age, chronotype, and mental health) and sleep; and whether individual susceptibility factors moderate associations between bedtime media use and sleep.

RESULTS

Often using a screen in the 30 minutes before going to sleep at night was associated with a late bedtime (≥midnight; OR [95 % CI] = 1.90 [1.44,2.51], p < 0.001), a short sleep duration (<7 h; 1.21 [1.01,1.46], p < 0.05), and excessive daytime sleepiness (Epworth score >9; 1.47 [1.25,1.74], p < 0.001), adjusting for all covariates. Bedtime media use partly mediated the association between younger age and an evening chronotype and these sleep outcomes. Mental health moderated the association between bedtime media use and sleep quality/insomnia, such that the former was only associated with poorer sleep quality/insomnia among individuals with better mental health.

CONCLUSIONS

Frequent bedtime media use was associated with various sleep outcomes, independently of relevant covariates. Limiting the use of screens at bedtime is important to promote sleep among adults. Individuals with poorer mental health likely require additional support to improve their sleep quality.

Sleep quality and screen time among university professors: impact of emergency remote teaching amidst COVID-19 crisis

PURPOSE

Sleep plays a crucial role in maintaining physical and mental health. The COVID-19 pandemic has brought about unprecedented global changes, and disruptions in sleep quality have emerged as a challenge. The pandemic prompted a dramatic shift in the working landscape for university professors, necessitating emergency remote teaching (ERT). This transition substantially increased professors' screen time for academic and research endeavors. This study explores the relationship between screen time and sleep quality among university professors during the pandemic and examines associated factors, including psychological well-being.

METHODS

An electronic survey, covering demographics, education, screen time, sleep quality, and mental health, was administered to professors who worked during the spring semester of 2020. Standardized measures were used to assess sleep quality and mental health. Correlations, Mann-Whitney tests, and multivariate regression explored associations between screen time, sleep quality, and other variables.

RESULTS

One hundred sixty participants exhibited poor sleep quality, subthreshold insomnia, and mild depression. Increased screen time correlated with poorer sleep quality, elevated stress levels, and heightened depression severity. Evening screen users reported more insomnia than daytime users. Depression emerged as a significant predictor of poor sleep quality and insomnia, along with evening screen use.

CONCLUSION

This study among university professors underscores the impact of screen time on sleep quality during the COVID-19 pandemic. Participants faced poor sleep, largely influenced by heightened screen time due to ERT. Considering these findings, this study emphasizes the importance of curbing daytime screen exposure and abstaining from screens in the evening, especially for university professors reliant on technology for their professional responsibilities.

Self-Selected Versus Assigned Target to Reduce Smartphone Use and Improve Mental Health: Protocol for a Randomized Controlled Trial

BACKGROUND

Smartphones have become integral to people's lives, with a noticeable increase in the average screen time, both on a global scale and, notably, in India. Existing research links mobile consumption to sleep problems, poor physical and mental health, and lower subjective well-being. The comparative effectiveness of monetary incentives given for self-selected versus assigned targets on reducing screen time and thereby improving mental health remains unanswered.

OBJECTIVE

This study aims to assess the impact of monetary incentives and target selection on mobile screen time reduction and mental health.

METHODS

We designed a 3-armed randomized controlled trial conducted with employees and students at an educational institution in India. The study is conducted digitally over 12 weeks, including baseline (2 weeks), randomization (1 week), intervention (5 weeks), and postintervention (4 week) periods. We emailed the employees and students to inquire about their interest in participation. Those who expressed interest received detailed study information and consent forms. After securing consent, participants were asked to complete the initial survey and provide their mobile screen time during the baseline period. At the beginning of the intervention period, the participants were randomly allocated into 1 of 3 study groups in a 2:2:1 ratio (self-selected vs assigned vs control). Participants in the self-selected group were presented with 3 target options: 10%, 20%, and 30%, and they were asked to self-select a target to reduce their mobile screen time from their baseline average mobile screen time. Participants in the assigned group were given a target to reduce their mobile screen time from their baseline average mobile screen time. The assigned target was set as the average of the targets selected by participants in the self-selected group. During the intervention period, participants in the self-selected and assigned group were eligible to receive a monetary incentive of INR (Indian Rupee) 50 (US $0.61) per day for successfully attaining their target. Participants in the control group neither received nor selected a target for reducing their mobile screen time and did not receive any monetary incentives during the intervention period. All participants received information regarding the advantages of reducing mobile screen time. As an incentive, all participants would receive INR 500 (US $6.06) upon completion of the study and a chance to win 1 of 2 lotteries valued at INR 5000 (US $60.55) for consistently sharing their mobile screen time data.

RESULTS

Currently, the study intervention is being rolled out. Enrollment occurred between August 21, 2023, and September 2, 2023; data collection concluded in November 2023. We expect that results will be available by early 2024.

CONCLUSIONS

The monetary incentives and self-selected versus assigned targets might be effective interventions in reducing mobile screen time among working professionals and students.

TRIAL REGISTRATION

AsPredicted 142497; https://aspredicted.org/hr3nn.pdf.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/53756.

Interactive Screen-Based Activities Predict Worse Actigraphic Sleep Health That Night Among Adolescents

PURPOSE

To determine the micro-longitudinal effects of duration and timing of screen-based activities on sleep within and between adolescents.

METHODS

Daily survey and actigraphy data from the age 15 wave of the Future of Families and Child Wellbeing Study were analyzed using multilevel modeling. Four hundred seventy five adolescents provided three or more days of valid daily survey and nighttime sleep data.

RESULTS

Within-person results showed that on days when adolescents played video games more than their daytime average ± SE (1.3 ± 1.2 hours), sleep onset (6 ± 2 minutes, p < .01) and midpoint (4 ± 2 minutes, p < .02) were delayed for each additional hour of gaming. Between-person results showed that for each hour adolescents used screens to communicate with friends across the day, sleep onset was later (11 ± 3 minutes, p < .01), sleep midpoint was later (8 ± 3 minutes, p < .01), and sleep duration was shorter (-5 ± 2 minutes, p < .03). Adolescents who used screens to communicate with friends or play video games in the hour before bed had later sleep onset (30 ± 14 minutes, p < .03) and midpoint (25 ± 13 minutes, p < .05).

DISCUSSION

Among adolescents, passive screen usage such as browsing the Internet or watching videos may not affect sleep timing or duration, but limiting interactive screen-based activities could protect adolescent sleep health and well-being.

Nocturnal Smartphone Use Affects Sleep Quality and Cognitive and Physical Performance in Tunisian School-Age Children

Nocturnal smartphone use emits blue light, which can adversely affect sleep, leading to a variety of negative effects, particularly in children. Therefore, the present study aimed to determine the effect of acute (AC) (one night) and repeated (RC) (five nights) nocturnal smartphone exposure on sleep, cortisol, and next-day performance in Tunisian children. Thirteen participants (seven girls and six boys, age 9 ± 0.6, height 1.32 ± 0.06, weight 34.47 ± 4.41) attended six experimental nights. The experiment started with a baseline night (BL) with no smartphone exposure, followed by repeated sessions of nocturnal smartphone exposure lasting 90 minutes (08:00 pm-09:30 pm). Actigraphy; salivary cortisol; the Stroop test (selective attention); choice reaction time (CRT); N-back (working memory); counter-movement jump (CMJ), composed of flight time (time spent in the CMJ flight phase) and jump height; and a 30 m sprint were assessed the morning after each condition. Both AC and RC shortened total sleep time (TST) (p < 0.01), with a greater decrease with RC (-46.7 min, ∆% = -9.46) than AC (-28.8 min, ∆% = -5.8) compared to BL. AC and RC significantly increased waking after sleep onset (3.5 min, ∆% = 15.05, to 9.9 min, ∆% = 43.11%) and number of errors made on the Stroop test (1.8 error, ∆% = 74.23, to 3.07 error, ∆% = 97.56%). Children made 0.15 and 0.8 more errors (∆% = 6.2 to 57.61%) and spent 46.9 s and 71.6 s more time on CRT tasks (∆% = 7.22 to 11.11%) with AC and RC, respectively, compared to BL. The high-interference index of the Stroop task, CMJ performance, and 30 m sprint speed were only altered (p < 0.01) following RC (0.36, Δ% = 41.52%; -34 s, Δ% = -9.29%, for flight time and -1.23 m, -8.72%, for jump height; 0.49 s, Δ% = 6.48, respectively) when compared to BL. In conclusion, one- or five-night exposure to smartphones disturbed the children's sleep quality and their performance, with more pronounced effects following RC.

Associations of social jetlag with physical activity and sedentary behaviour in children and adolescents: A systematic review and meta-analysis

Sleep and daytime movement behaviours occur co-dependently with each other within a finite 24 h day. Sleep parameters other than sleep duration, such as social jetlag and chronotype, have been linked to health problems and unhealthy behaviours among children and adolescents. Given the increasing number of studies examining sleep timing/chronotype and weight-related behaviours, including physical activity and sedentary behaviour, in the past decade, this systematic review and meta-analysis collated and evaluated the evidence on the relationships of social jetlag and chronotype with physical activity and sedentary behaviour among children and adolescents aged 3-17 years. Seven databases were searched on 16 March 2022, and 52 studies were identified as eligible for inclusion, 47 of which were suitable for the meta-analysis. A positive association was found between social jetlag and screen media use (r = 0.14, 95% CI: 0.04-0.24; I2  = 96%; p = 0.008). The morning chronotype was associated with a higher level of physical activity and a lower level of sedentary behaviour than the evening chronotype. No relationship was found between social jetlag and physical activity. The magnitude of heterogeneity among the included studies was high. Further experimental studies are urgently required to understand how circadian preference or misalignment affects activity behaviours. Interventions to promote an active lifestyle in young populations should consider their circadian preference, especially among individuals with the evening chronotype.

Combination of sugar-sweetened beverage consumption, screen-based sedentary time, and sleep duration and their association with South Korean adolescents' mental health

Introduction

This study examines the combinations of sugar-sweetened beverage (SSB) consumption, screen-based sedentary time, and sleep duration and their association with adolescents' depressive symptoms and suicidal ideation.

Methods

This research followed a crosssectional study design. Secondary data analysis was conducted on the data collected from 21,046 high school students who had participated in the 17th Korea Youth Risk Behavior Web-Based Survey in 2021. A complex sampling analysis, including descriptive and logistic regression analyses, was conducted in SPSS Statistics 26.0.

Results

The combination of low SSB consumption, excessive screen-based sedentary time, and short sleep duration was associated with an increase in depressive symptoms. In addition, a combination of medium/high SSB consumption, appropriate/excessive screen-based sedentary time, and short sleep duration was associated with an increase in depressive symptoms. Finally, the combination of high SSB consumption, excessive screen-based sedentary time, and short sleep duration was associated with an increase in suicidal ideation.

Discussion

The findings demonstrate that healthcare providers should develop and conduct family-and school-based programs to restrict SSB consumption, screen-based sedentary behaviors, and sleep duration to improve adolescents' mental health.

Sociodemographic, temporal and bedtime routine correlates of sleep timing and duration in South Asian and white children: A Born in Bradford study

Objective

The study aimed to examine sociodemographic, temporal and bedtime routine correlates of parent-reported sleep duration and timing in a biethnic sample of 18 month and 36 month old children from a disadvantaged location.

Methods

Between October 2010 and September 2012, parents completed a bespoke three day sleep diary when their child was approximately 18 months (n = 276) and 36 months of age (n = 262) (45.1% South Asian; 54.9% white). Parents reported their child's overnight sleep duration (h/day), the time their child fell asleep, their wake time and their child's bedtime and napping routines. Data were available at both time points for 135 children.

Results

In line with previous literature, South Asian children had shorter overnight sleep duration and later sleep and wake times than white children. In both ethnic groups, children slept and woke up later on weekends, and children went to bed earlier and slept longer in winter. In white children only, napping duration was associated with overnight sleep period. No significant associations were found between napping frequency and overnight sleep duration. Based on parent-reported data, children who consistently adhered to regular bedtimes and had set times for sleeping tended to go to sleep earlier, wake earlier and have longer overnight sleep.

Conclusions

The data showed parent-reported variation in sleep patterns between two ethnic groups within a single geographical and deprived area. It is important that researchers, clinicians and early years workers are considerate of cultural norms in sleep practices.

Sleep Patterns in Children With Blindness: A Comparison With Normally Sighted Peers

Purpose

Studies showing problematic sleep patterns in blind and visually impaired children are often based on (parent) self-report. The purpose was to compare sleep patterns of blind children to normally sighted peers using objective measures.

Methods

In this cross-sectional study, 100 blind (best-corrected visual acuity <3/60) and 100 age- and gender-matched normally sighted children aged 7 to 17 years wore a digital activity monitoring device for 1 week. Sleep quantity (i.e., total sleep time and total time in bed) and sleep quality (number of awakenings, latency, efficiency, wake after sleep onset [WASO], and sleep fragmentation index) were measured. Adjusted linear regression analyses were used to model group differences in sleep parameters.

Results

Data of 163 children were included. Blind children spent significantly less total time in bed in minutes (β, -31; 95% confidence interval, -56 to -6) and had a lower total sleep time (-41; -66 to -17), smaller number of awakenings (-2.8; -4.5 to -1.0), a lower WASO (-10; -16 to -5), and a more efficient sleep pattern (1.5; 0.1 to 2.8) compared to normally sighted children.

Conclusions

Although sleep quantity and recommended hours of sleep per night were lower among blind children than normally sighted children, their sleep quality was better. This contradicts findings of self-report studies and warrants further studies to measure sleep objectively. Further, the discrepancy between previous findings and our findings regarding sleep quality may be explained by the house rules of the boarding schools attended by blind children, which may facilitate improved sleep hygiene.

The influence of cognitive activity on subsequent daytime nap: A deep neural network model based on sleep spindles

OBJECTIVES

Understanding the influence of cognitive activity on subsequent sleep has both theoretical and applied implications. This study aims to investigate the effect of pre-sleep cognitive activity, in the context of avoiding emotional interference, on macro-sleep and sleep spindles.

METHODS

In a within-subjects design, participants' sleep electroencephalography was collected in both the with and without pre-sleep cognitive activity conditions. Subsequent macro-sleep (i.e., sleep stage distribution and sleep parameters) and spindle characteristics (i.e., density, amplitude, duration, and frequency) were analyzed. In addition, a novel machine learning framework (i.e., deep neural network, DNN) was used to discriminate between cognitive activity and control conditions.

RESULTS

There were no significant differences in macro-sleep and sleep spindles between the cognitive activity and control conditions. Spindles-based DNN models achieved over 96% accuracy in differentiating between the two conditions, with fast spindles performing better than full-range and slow spindles.

CONCLUSIONS

These results suggest a weak but positive effect of pre-sleep cognitive activity on subsequent sleep. It sheds light on a possible low-cost and easily accessible sleep intervention strategy for clinical and educational purposes.

The effect of watching OTT late at night on the sleep pattern of users

This study aimed to answer the question of how media users will reallocate their sleep time when their main content channel changes from real-time broadcasting to selective viewing through the over-the-top (OTT) media streaming service. To draw a causal inference between OTT consumption and sleep patterns, the difference-in-difference (DID) estimation method was applied. With the DID approach, a clear distinction between treatment and control groups is essential because the main treatment effects can be screened by the compounding effects. While the conventional way of dividing two groups relies on the selection of limited variables, this study adopted random forest nearest-neighbor propensity score matching based on a machine learning algorithm to divide the two groups. This allows for meticulous matching of the two groups except for treatment. Results show that watching OTT late at night has a significant effect on reducing the total sleep duration on average by about 18-20 min (maximum about 30 min at 95% confidence level) and delaying bedtime by about 18 min (maximum about 26 min at 95% confidence level). This study showed that the selective viewing of content through OTT has the advantage of widening the range of content choices for media users and helping in arranging their time more autonomously, but watching content through OTT late at night leads to media users' departure from the existing sleep routine.

Screen time and sleep among medical students in Germany

Medical students are a vulnerable group for harmful health behaviours due to academic stress. Increased screen time is associated with adverse health behaviour, particularly delayed bedtime, shorter sleep duration and poorer sleep quality. This possible relationship has not yet been examined among medical students in Europe. Medical students at the Technical University of Dresden were invited to participate in an online questionnaire based cross-sectional study. To analyse correlations between screen time and sleep parameters, correlation coefficients, linear regression and mixed-model analysis were calculated. 415 students (average age 24 years, 70% female) were included in the analysis. The students reported an average of 7 h screen time per day and 7.25 h sleep duration per night. Approximately 23% (n = 97) reported sleeping less than 7 h per night and 25% (n = 105) reported fairly to very poor sleep quality. Students who reported more screen time for leisure went to bed significantly later (r = 0.213, p < 0.001). Students who spent more screen time for study/work tended to sleep shorter (r = - 0.108, p < 0.015). There was no significant association between screen time and sleep quality (p = 0.103). The results show a need for educational interventions to promote healthy sleep behaviour and to limit screen time.

Media screen time use and mental health in school aged children during the pandemic

BACKGROUND

Children's screen time activity has increased significantly during the pandemic. Extended school closures and heightened parent stress are associated with children's behavioural difficulties and time spent watching screens. The primary aim of this study was to determine which school and household factors were associated with challenging behaviours in Canadian schoolchildren during the COVID-19 pandemic.

METHODS

This longitudinal survey study examined the association amongst screen time, internalizing and externalizing behaviours in school-aged children at two time points over the 2020-2021 academic school year. Parents completed survey measures on their parental involvement, stress levels, and their child's screen time use as well as their emotional and behavioural difficulties.

RESULTS

Children's average daily screen time was 4.40 h (SE = 18.45) at baseline and 3.89 h (SE = 16.70) at 1-year follow up, with no significant change across the school year (p = .316). Increased screen time use was associated with a greater incidence of internalizing behaviours in children (p = .03). Children who spent more time on screens and who were in households with parents reporting higher stress levels had increased internalizing behaviours (p < .001). No association between screen time use and externalizing behaviours was evident; however, parent stress was positively associated with children's externalizing behaviours (p < .001).

CONCLUSIONS

Children's screen time use has remained high during the pandemic and is associated with anxious and depressive symptoms. Children who spent more time on screens and who were in households with parents reporting higher stress levels had increased internalizing behaviours. Parent stress was positively associated with children's externalizing behaviours. Targeted family intervention plans focused on reducing parent stress and screen time use may aid in improving children's mental health during the ongoing pandemic.

Family resilience and neighborhood factors affect the association between digital media use and mental health among children: does sleep mediate the association?

The associations between digital media use and mental well-being among children and adolescents have been inconclusive. We examined (i) the associations between digital media use and mental health outcomes, anxiety, depression, and ADHD, (ii) whether family resilience and neighborhood factors attenuate the associations, and (iii) whether sleep mediates these associations. We used the National Survey of Children's Health data from 2019 to 2020. A total of 45,989 children's (6-17 years) data were analyzed in this study. Multivariate logistic regression was used to assess the associations between digital media use and anxiety, depression, and ADHD. Path models and Paramed command in STATA were used to test the role of sleep as a mediator of these associations. The prevalence of heavy digital media users (who spent 4 or more hours per day) among the analytic sample was 30.52%, whereas anxiety was 13.81%, depression was 5.93%, and ADHD was 12.41%. Children in the heavy media user group had 63% increased odds of anxiety (95% CI: 1.32-2.01) and 99% increased odds of depression (95% CI: 1.35-2.94) after adjusting for sociodemographic factors, compared to the children in light media user group (who spent < 2 h per day), and these relations were significant at 0.01 level. However, family resilience and community factors significantly attenuated the effect of digital media use on anxiety and depression. Sleep did not mediate the associations between digital media use and anxiety or depression.   Conclusions: Family resilience and neighborhood factors protect against the harmful effects of digital media use. Further research is needed to examine the relationships of media contents, the presence of electronic devices in bedrooms, and sleep quality with mental health. What is Known: • Spending long hours on digital media may adversely affect children and adolescents' health and development. However, the mediating role of sleep in the association between digital media use and mental health outcomes is inconclusive. What is New: • Digital media use has detrimental effects on anxiety and depression. However, family resilience and neighborhood factors attenuated the association. The study highlights the importance of positive family functioning and neighborhood conditions reducing the harmful effects of digital media use.

Bidirectional associations of sleep and discretionary screen time in adults: Longitudinal analysis of the UK biobank

The direction of the association between discretionary screen time (DST) and sleep in the adult population is largely unknown. We examined the bidirectional associations of DST and sleep patterns in a longitudinal sample of adults in the general population. A total of 31,361 UK Biobank study participants (52% female, 56.1 ± 7.5 years) had two repeated measurements of discretionary screen time (TV viewing and leisure-time computer use) and self-reported sleep patterns (five sleep health characteristics) between 2012 and 2018 (follow-up period of 6.9 ± 2.2 years). We categorised daily DST into three groups (low, <3 h/day; medium, 3-4 h/day; and high, >4 h/day), and calculated a sleep pattern composite score comprising morning chronotype, adequate sleep duration (7-8 h/day), never or rare insomnia, never or rare snoring, and infrequent daytime sleepiness. The overall sleep pattern was categorised into three groups (healthy: ≥ 4; intermediate: 2-3; and poor: ≤ 1 healthy sleep characteristic). Multiple logistic regression analyses were applied to assess associations between DST and sleep with adjustments for potential confounders. Participants with either an intermediate (OR: 1.40; 95% CI: 1.15, 1.71) or a poor (OR: 1.16; 95% CI: 1.10, 1.24) sleep pattern at baseline showed higher odds for high DST at follow-up, compared with those with a healthy baseline sleep pattern. Participants with medium (OR: 1.40; 95% CI: 1.14, 1.71) or high DST (OR: 1.62; 95% CI: 1.30, 2.00) at baseline showed higher odds for poor sleep at follow-up, compared with participants with a low DST. In conclusion, our findings provide consistent evidence that a high DST at baseline is associated with poor sleep over a nearly 7 year follow-up period, and vice versa.

Understanding Sleep Regulation in Normal and Pathological Conditions, and Why It Matters

Sleep occupies a peculiar place in our lives and in science, being both eminently familiar and profoundly enigmatic. Historically, philosophers, scientists and artists questioned the meaning and purpose of sleep. If Shakespeare's verses from MacBeth depicting "Sleep that soothes away all our worries" and "relieves the weary laborer and heals hurt minds" perfectly epitomize the alleviating benefits of sleep, it is only during the last two decades that the growing understanding of the sophisticated sleep regulatory mechanisms allows us to glimpse putative biological functions of sleep. Sleep control brings into play various brain-wide processes occurring at the molecular, cellular, circuit, and system levels, some of them overlapping with a number of disease-signaling pathways. Pathogenic processes, including mood disorders (e.g., major depression) and neurodegenerative illnesses such Huntington's or Alzheimer's diseases, can therefore affect sleep-modulating networks which disrupt the sleep-wake architecture, whereas sleep disturbances may also trigger various brain disorders. In this review, we describe the mechanisms underlying sleep regulation and the main hypotheses drawn about its functions. Comprehending sleep physiological orchestration and functions could ultimately help deliver better treatments for people living with neurodegenerative diseases.

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

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 (M_age 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.

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

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, M_age = 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.

School and non-school day screen time profiles and their differences in health and educational indicators in adolescents

Sedentary behavior and screen-based devices in particular have been negatively associated with a wide range of health and educational indicators. However, few have examined these relationships separately for school days and non-school days, and none have used a person-centered approach. This study aimed to identify school and non-school day screen time profiles, as well as examine possible differences in health indicators (physical fitness, fatness, physical activity, sleep duration, and Mediterranean diet) and academic performance. This study involved the participation of 1573 Spanish adolescents aged 12-16 years (54.73% girls). Academic performance was measured through grades in Mathematics, Language, English, and Physical Education. Physical fitness was measured through a battery of tests (cardiorespiratory fitness was measured using the 20 m shuttle run test, and muscular strength with both handgrip and standing long jump tests), while fatness (skinfold thicknesses) was assessed with calipers. Finally, physical activity, screen time, sleep duration, and adherence to the Mediterranean diet were measured using self-reported questionnaires. Hierarchical cluster analyses based on square Euclidian distances and Ward's method were performed based on daily minutes of screen time recorded on school and non-school days. We identified four clusters labeled and described as: (1) "High-high": highest screen time on school and non-school days; (2) "High-low": high screen time on school days and low screen time on non-school days; (3) "Low-high": low screen time on school days and high screen time on non-school days; (4) "Low-low": lowest screen time on school and non-school days. Adolescents who belonged to the "High-high" profile had worse health-related behaviors (i.e., physical activity, sleep duration, and adherence to Mediterranean diet) and academic performance than most other profiles, while adolescents who belonged to "Low-low" profile showed the opposite pattern. Adolescents in the "Low-high" profile had a higher sleep duration on school days and better academic performance than those in the "High-low" profile. No differences in body fat, cardiorespiratory fitness, and muscular strength were found between the four different profiles. The results suggest that adolescents who accumulated a large amount of screen time on school and non-school days reported worse health-related behaviors and academic performance. Moreover, adolescents who had high screen time on school days reported only a short sleep duration on school days and worse academic performance than on non-school days. Conducting interventions to reduce screen time in these four profiles, particularly in the groups of students with more screen time on school days, becomes essential to improving adolescents' healthy lifestyles and academic performance.

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

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, and 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; M_age = 14.23, SD_age = 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 replicates the findings from similar studies with children and adolescents from South Korea, Spain, Turkey, and the United States. Accordingly, the present study provides further support of the transcultural validity of the sluggish cognitive tempo construct.

Police stops and adolescent sleep problems: findings from the UK millennium cohort study

Youth-police contact has been shown to undermine various facets of adolescent health and well-being. The present study extends this body of research by assessing the association between police stops and sleep problems among a large, representative sample of adolescent in the UK (N = 11,200). The findings reveal youth-police contact was associated with all facets of sleep examined, including shorter sleep durations, longer sleep latency, and frequent mid-sleep awakenings. Ancillary analyses of a subsample of youth using daily time-use diaries (TUDs) largely corroborate these findings in the case of short sleep durations. Additionally, the odds of experiencing multiple sleep problems were greatest among youth who were arrested/taken into custody, but significant nonetheless even in the absence of arrest. These findings indicate the need for strategies and interventions among both public health practitioners and law enforcement that mitigate the adverse repercussions of police stops for adolescent sleep health.

Body image and health-related behaviors among fitspirit participants

Background

Body image variables such as body size perception (BSP) and body size dissatisfaction (BSD) can influence health-related behaviors. However, few studies have investigated these body image variables in adolescent girls participating in a physical activity intervention. Therefore, the study objectives were to examine the 1) associations between health-related behaviors (physical activity, screen-time, eating habits and sleep duration) and BSP and BSD among girls participating in FitSpirit, a physical activity intervention for girls; and 2) influence of weight control practices on the association between health-related behaviors and BSP and BSD.

Methods

This cross-sectional study assessed a sample of 545 adolescent girls (mean age: 15.0±1.5 years) from 240 schools. Body mass index, health-related behaviors, perceived actual body size and desired body size variables were self-reported and collected via an online questionnaire at the end of the FitSpirit intervention. A negative BSP score [perceived actual body size – calculated BMI z-score] indicates an underestimation of body size. A positive BSD score [perceived actual body size – desired body size] indicates a desire to reduce body size. A multiple linear regression analysis examined the effects of age, zBMI and health behaviors on BSP and BSD. A second multiple linear regression analysis examined the independent associations between BSP and BSD by weight control practice. The linear relationships between BSP and BSD were evaluated with Pearson’s correlations.

Results

Underestimation and dissatisfaction of body size are more prevalent in participants living with overweight/obesity. Screen-time and sleep duration were independently associated with BSP score (Beta=0.02; P<0.05 and Beta=-0.07; P<0.05, respectively), whereas only screen-time was associated with the BSD score (Beta=0.07; P<0.001). Physical activity was independently associated with the BSP score only in participants trying to control (maintain) their weight (Beta=-0.18; P<0.05).

Conclusions

Body size overestimation and dissatisfaction are associated with health-related behaviors, specifically with more screen-time and less optimal sleeping habits. Physical activity level does not appear to be associated with body image in girls engaged in a physical activity intervention and who want to lose or gain weight. Health promotion interventions could include screen-time and sleep components as they may influence body image.

The impact of adolescent's daily electronic media use on sleep: Insights from adolescent's and their mother's point of view

Several studies demonstrated that electronic media use (EMU) is negatively associated with sleep in adolescents. Most studies however are cross-sectional, self- or parents reports, and not distinguishing between different EMU types. Therefore, this study aimed to examine associations between adolescent's EMU and sleep reported by adolescents and from their mothers' perspective in a dyadic ambulatory assessment design. One hundred and five mother-adolescent dyads reported for 14 consecutive days adolescent's EMU for different EMU types and sleep duration. Mothers reported less EMU in the evening and more sleep of their adolescents than adolescents themselves. Multilevel analyses revealed that at the between- and within-person level, EMU in the evening was negatively associated with sleep. Different EMU types differed in effect sizes of associations with sleep. No effects were found for watching TV/DVD/video, whereas for gaming at the between- and within-person level, negative associations with sleep duration were found. For PC/tablet and smartphone use in the evening significant between-person association with sleep duration for adolescent's self-reports and from mother's point of view was found. It is important to investigate adolescent's EMU on a daily basis, from a dyadic perspective, and for different EMU types separately.

Chronotype, circadian rhythm, and psychiatric disorders: Recent evidence and potential mechanisms

The circadian rhythm is crucial for physiological and behavioral functions. Chronotype, which represents individual preferences for activity and performance, is associated with human health issues, particularly psychiatric disorders. This narrative review, which focuses on the relationship between chronotype and mental disorders, provides an insight into the potential mechanism. Recent evidence indicates that (1) the evening chronotype is a risk factor for depressive disorders and substance use disorders, whereas the morning chronotype is a protective factor. (2) Evening chronotype individuals with bipolar disorder tend to have more severe symptoms and comorbidities. (3) The evening chronotype is only related to anxiety symptoms. (4) The relationship between chronotype and schizophrenia remains unclear, despite increasing evidence on their link. (5) The evening chronotype is significantly associated with eating disorders, with the majority of studies have focused on binge eating disorders. Furthermore, the underlying mechanisms or influence factors are described in detail, including clock genes, brain characteristics, neuroendocrinology, the light/dark cycle, social factors, psychological factors, and sleep disorders. These findings provide the latest evidence on chronotypes and psychiatric disorders and serve as a valuable reference for researchers.

The Association of Internet Use Intensity and Lifestyle Behaviors During the COVID-19 Pandemic: A Cross-Sectional Study in Chinese Adults

The COVID-19 pandemic substantially increased the intensity of internet use in humans, which has made public opinion around health and public perceptions of it more vital, and this phenomenon has had a significant impact on human lifestyle behavior. This study used cross-sectional data during the COVID-19 pandemic to explore how internet use intensity influenced lifestyle behaviors among adults, and compared the differences between samples of different ages. The findings showed that the internet use intensity among adults increased the probability of physical activity, staying up late, and high-quality eating behaviors, and that they had a statistically significant positive association. Such associations were also found in independent younger, middle-aged, and older samples. However, the internet use intensity elevated the probability of body weight gain only in the independent samples of younger, middle-aged, and older adults. Besides, internet use intensity was able to increase the probability of smoking & drinking only among the younger sample. Notably, the effect of internet use intensity on lifestyle behaviors, including body weight gain, physical activity, staying up late, and a high-quality diet, was strongest among the elderly, followed by the middle-aged, and weakest among the younger. In the process of rural and urban governance regarding citizens' health, public health agencies should remind citizens to spend a reasonable amount of time on internet use to reduce the probability of unhealthy lifestyle behaviors and improve their physical health.

Brain structural covariation linked to screen media activity and externalizing behaviors in children

Background and Aims

Screen media activity (SMA) may impact neurodevelopment in youth. Cross-sectionally, SMA has been linked to brain structural patterns including cortical thinning in children. However, it remains unclear whether specific brain structural co-variation patterns are related to SMA and other clinically relevant measures such as psychopathology, cognition and sleep in children.

Methods

Adolescent Brain Cognitive Development (ABCD) participants with useable baseline structural imaging (N = 10,691; 5,107 girls) were analyzed. We first used the Joint and Individual Variation Explained (JIVE) approach to identify cortical and subcortical covariation pattern(s) among a set of 221 brain features (i.e., surface area, thickness, or cortical and subcortical gray matter (GM) volumes). Then, the identified structural covariation pattern was used as a predictor in linear mixed-effect models to investigate its associations with SMA, psychopathology, and cognitive and sleep measures.

Results

A thalamus-prefrontal cortex (PFC)-brainstem structural co-variation pattern (circuit) was identified. The pattern suggests brainstem and bilateral thalamus proper GM volumes covary more strongly with GM volume and/or surface area in bilateral superior frontal gyral, rostral middle frontal, inferior parietal, and inferior temporal regions. This covariation pattern highly resembled one previously linked to alcohol use initiation prior to adulthood and was consistent in girls and boys. Subsequent regression analyses showed that this co-variation pattern associated with SMA (β = 0.107, P = 0.002) and externalizing psychopathology (β = 0.117, P = 0.002), respectively.

Discussion and Conclusions

Findings linking SMA-related structural covariation to externalizing psychopathology in youth resonate with prior studies of alcohol-use initiation and suggest a potential neurodevelopmental mechanism underlying addiction vulnerability.

Cyberbullying involvement and short sleep duration among adolescents

BACKGROUND

Research has shown that cyberbullying victimization is associated with short sleep duration among adolescents; however, the association between cyberbullying perpetration and sleep duration is unclear. Furthermore, little is known about the factors that could moderate these associations. Thus, the objectives of this study were to investigate the associations of cyberbullying victimization, perpetration, or both with short sleep duration among adolescents, and to test whether age, sex, and adherence to the screen time recommendations (≤2 hours/day) moderate these associations.

METHODS

Data on 6834 adolescents aged 11-20 years were derived from a representative cross-sectional study of middle and high school students across Ontario, Canada. Short sleep duration was self-reported and defined as sleeping less than the age-appropriate sleep duration recommendations. Multivariable logistic regression models were adjusted for important covariates. Adjusted odds ratios (AOR) and their 95% confidence intervals (CI) are reported.

RESULTS

Cyberbullying victimization (AOR = 1.60, 95% CI = 1.37-1.86), perpetration (AOR = 1.44, 95% CI = 1.16-1.79), or both perpetration and victimization (AOR = 1.71, 95% CI = 1.27-2.30) was associated with greater odds of short sleep duration. Results further indicated that younger students who were not cyberbullied had a lower probability of short sleep duration, but there was no difference in the probability of short sleep duration between being cyberbullied or not among older adolescents. Sex and screen time did not moderate any of the associations between cyberbullying involvement and short sleep duration.

CONCLUSION

Involvement in cyberbullying as either a victim, a perpetrator, or both is associated with short sleep duration among adolescents. Strategies that can help to eliminate cyberbullying are needed in public health.

Use of digital screens by adolescents and association on sleep quality: a systematic review

This study aimed to analyze the influence of digital screen use on adolescents’ quality of sleep. This systematic review was recorded on PROSPERO (CRD42020203403) and conducted according to PRISMA guidelines. Studies covering adolescents from 10 to 19 years were included without language or publication restrictions which answered the following guiding question: “Does the use of digital screen influence adolescents’ quality sleep?”. Article search included the following databases: (MEDLINE/PubMed), LILACS, SciELO, Scopus, EMBASE, Web of Science, IBECS, Cochrane Library, ClinicalTrials.gov, and Open Gray. The following descriptors were used: “Sleep Quality”, “Screen Time”, and “Adolescent”. The Newcastle-Ottawa Scale (NOS) assessed the methodological quality of the cohort studies, and a modified NOS was used to assess the cross-sectional ones. In total, 2,268 articles were retrieved, of which 2,059 were selected for title and abstract reading, after duplicates were deleted. After this stage, 47 articles were selected for full reading, resulting in the 23 articles which compose this review. Excessive use of digital screens was associated with worse and shorter sleep, showing, as its main consequences, night awakenings, long sleep latency, and daytime sleepiness. The use of mobile phones before bedtime was associated with poor quality of sleep among adolescents. Our evaluation of the methodological quality of the chosen studies found seven to be poor and 16, moderate.

The Relationship Between Digital Activity and Bedtime, Sleep Duration, and Sleep Quality in Chinese Working Youth

PURPOSE

The study aims to examine whether and how digital activities influence sleep issues among working Chinese youth.

METHODS

This study used data from the China Family Panel Studies (CFPS) a Chinese population-based survey, and employed the multilevel ordinal logistic regression model (MOLRM) to test the associations between digital engagement (whether to engage in digital activity, frequency, and duration) and sleep issues (bedtime, sleep duration, and quality) among Chinese working youth. Additionally, the restricted cubic spline model (RCSM) was adopted to fit the MOLRM to evaluate the nonlinear relationship between digital activity duration and sleep quality, and thus determine the optimal range of digital activity duration.

RESULTS

The analysis included 7849 working young adults. The digital usage rate was 84.11%. Digital use was not significantly associated with average, workday, or free-day sleep duration, after controlling for all potential confounders. However, most digital activity indicators could significantly predict bedtime and sleep quality. Furthermore, the RCSM indicated a non-linear relationship pattern between digital activity duration and sleep quality, with a weekly peak point of 25 h. Age significantly moderated the relationship between digital activity, sleep duration and bedtime. Younger youth who used digital media more frequently and for a longer time tended to sleep later and had shorter sleep duration than older youth.

CONCLUSION

Digital usage significantly predicted later bedtime among Chinese working youth; however, it was not linked with sleep duration on workdays or free days. In parallel, a nonlinear correlation between digital activity duration and sleep quality indicated that appropriate digital activity duration (less than 25 h weekly) may contribute to good sleep quality.

Social media use, sleep, and psychopathology in psychiatrically hospitalized adolescents

Sleep disruption among adolescents represents a major public health concern, and social media use may play an important role in affecting sleep and subsequent mental health. While prior studies of youth sleep and mental health have often focused on social media use frequency and duration, adolescents' emotional experiences related to social media have been underexplored, particularly among clinically acute populations. This study offers a preliminary investigation of associations among negative emotional experiences using social media, sleep disturbance, and clinical symptom severity in a sample of psychiatrically hospitalized youth. A sample of 243 adolescents (Mage = 15.34) completed self-report measures at a single time point. Measures assessed social media use, including frequency and duration, subjective experiences of use, and emotional responses to use, as well as sleep disturbance and clinical symptom severity, including suicidal ideation, internalizing symptoms, and attention problems. Results revealed that more frequent negative emotional responses to social media use were linked to greater sleep disturbance and higher clinical symptom severity. Furthermore, sleep disturbance mediated the relation between negative emotional responses to social media and clinical symptom severity. While gender differences were revealed in characteristics of social media use, sleep disturbance, and clinical outcomes, the associations among these constructs did not vary across gender groups. Overall, these findings highlight sleep disturbance as a potential mechanism through which negative emotional experiences on social media may impact clinical symptoms in psychiatrically vulnerable youth.

Linear and nonlinear associations between the sleep environment, presleep conditions, and sleep in adolescence: moderation by race and socioeconomic status

OBJECTIVE/BACKGROUND

The role of the sleep environment and presleep conditions that may influence adolescents' sleep are understudied. The aims of the current study were to examine linear and nonlinear associations between the sleep environment and presleep conditions and adolescents' daytime sleepiness and sleep/wake problems.

METHOD

Participants included 313 adolescents (M_age = 17.39 years, SD = 10.38 months; 51.4% girls, 48.6% boys; 59.1% White/European American, 40.3% Black/African American) from a wide range of socioeconomic backgrounds living in the southeastern United States. Adolescents completed surveys assessing the sleep environment (eg, light, bedding), four presleep conditions (ie, general worries, family concerns, arousal, somatic complaints), and sleep (daytime sleepiness, sleep/wake problems).

RESULTS

Sleep environment disruptions and worse presleep conditions were positively associated with sleepiness and sleep/wake problems in a linear fashion. Nonlinear associations emerged such that levels of sleepiness increased rapidly between low and average levels of the sleep environment and two presleep conditions (worries, arousal); the slope leveled off between average and high levels. Moreover, linear effects of environmental disruptions, family concerns, somatic complaints, and presleep arousal on sleep/wake problems were moderated by race and/or SES, indicating that positive associations between some presleep conditions and sleep/wake problems were more pronounced for Black and lower SES youth.

CONCLUSIONS

Results support the importance of the sleep environment and multiple presleep conditions and assessments of both linear and nonlinear effects for a better understanding of factors that may contribute to sleep. Additionally, results indicate the sleep environment and some presleep conditions may be more consequential for disadvantaged youth.

Adolescents' physical activity and sedentary behaviour in Indonesia during the COVID-19 pandemic: a qualitative study of mothers' perspectives

BACKGROUND

Socio-behavioural adaptations during the COVID-19 pandemic may have significantly affected adolescents' lifestyle. This study aimed to explore possible reasons affecting changes in physical activity and sedentary behaviour in Indonesian adolescents during the pandemic based on mothers' perspectives.

METHODS

We recruited parents (n = 20) from the Yogyakarta region of Indonesia (July-August 2020) using purposive and snowball sampling. Individual interviews were audio-recorded, transcribed verbatim and anonymised. Data were imported into NVivo software for a reflexive thematic analysis.

RESULTS

The interviews lasted between 38 and 113 min (M = 65 min). Participants' age ranged between 36 and 54 years (M = 42.6 years). Participants' children ranged in age from 12 to 15 years (M = 13.7 years, female: 9, male: 11). Themes related to changes in physical activity during the pandemic were 1) self-determination and enjoyment, 2) supports from others, and 3) physical activity facilities and equipment. Themes related to changes in sedentary behaviour during the pandemic included 1) educational demands, 2) psychological effects due to the pandemic, 3) devices and internet availability, 4) parental control, and 5) social facilitators.

CONCLUSIONS

During the pandemic, mothers perceived their children to be less active and using more screen-based devices, either for educational or recreational purposes, compared to before. The present themes might be useful when developing interventions and policies promoting physical activity and reducing sedentary behaviour in adolescents. Interventions could, for example, consider increasing parents' and adolescents' awareness on current activity guidelines, providing education on healthier recreational screen time, and involving parents, peers, and teachers. Increasing the accessibility of physical activity facilities and equipment, making use of adolescents' favourite program and social media for interventions, and providing activities that are fun and enjoyable may also important.

Is There a Dose-Response Relationship between Acute Physical Activity and Sleep Length? A Longitudinal Study with Children and Adolescents Living in Sweden

A declining physical activity (PA) and sleep in children and adolescents have been observed during the previous decades. PA could benefit sleep, but the findings are mixed. The aim of the present study was to examine if there is a dose-response relationship between time spent in acute moderate and vigorous physical activity (MVPA) and sleep length in children and adolescents. Additional aims were to examine if the sleep length is higher for children and adolescents who conduct at least an average of 60 min in MVPA/day and to study differences between sex and school years. The study population consists of 262 participants in school year 5 (aged 11 years), 7 (aged 13 years), and 9 (aged 15 years). Accelerometers measured MVPA while sleep diaries measured sleep length. A linear and longitudinal mixed effect linear regression was conducted to study the primary aim. The secondary aims were studied with linear regressions. Included confounders were sex, school year, school stress, screen time, menstruation onset, family household economy, and health status. A stratified regression for sex and school year was conducted. The linear regression showed no statistically significant findings in the crude or adjusted model. The stratified linear regression found a significant positive association for girls but a negative association for school year 5. No associations were found in the longitudinal regression or when comparing sleep length for participants that did and did not spend an average of at least 60 min in MVPA/day. A dose-response relationship was found in the stratified linear regression, implying a possible weak association. The statistically non-significant differences between participants that did and did not spend an average of at least 60 min in MVPA/day implies that spending an average of at least 60 min in MVPA/day may not be associated with a higher mean sleep length.

Longitudinal association between movement behaviours and depressive symptoms among adolescents using compositional data analysis

BACKGROUND

Research examining the associations between movement behaviours and mental health indicators within a compositional framework are sparse and limited by their cross-sectional study design. This study has three objectives. First, to describe the change in movement behaviour composition over time. Second, to explore the association between change in movement behaviour composition and change in depressive symptoms. Third, to explore how reallocations of time between movement behaviours are associated with changes in depressive symptoms.

METHODS

Longitudinal data of 14,620 students in grades 9-12 (mean age: 14.9 years) attending secondary schools in Canada (Ontario, British Columbia, Alberta, Quebec) were obtained from two waves (2017/18, 2018/19) of the COMPASS study. Moderate-to-vigorous physical activity (MVPA), recreational screen time, and sleep duration were self-reported. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (Revised)-10 (CESD-R-10). Compositional data analyses using pivot coordinates and compositional isotemporal substitution for longitudinal data were used to analyse the data. Analyses accounted for school clustering, were stratified by gender and age (< or ≥ 15 years), and were adjusted for race/ethnicity, body mass index z-score, baseline movement behaviour composition, and baseline depressive symptoms.

RESULTS

There were significant differences in movement behaviour composition over time across all subgroups. For example, the relative contributions of MVPA and sleep duration to the movement behaviour composition decreased over time while screen time increased among younger boys and girls and older girls. Increasing sleep duration relative to the remaining behaviours (i.e. screen time and MVPA) was associated with lower depressive symptoms among all subgroups. Increasing screen time relative to the remaining behaviours (i.e. MVPA and sleep duration) was associated with higher depressive symptoms among all subgroups. Increasing MVPA relative to the remaining behaviours (i.e. screen time and sleep duration) was associated with lower depressive symptoms in older girls only. Isotemporal substitution estimates indicated that decreasing screen time by 60 minutes/day and replacing that time with 60 minutes of additional sleep is associated with the largest change in depressive symptoms across all subgroups.

CONCLUSIONS

Findings from this prospective analysis suggest that increased sleep duration and reduced screen time are important determinants of lower depressive symptoms among adolescents.

Relationship between Sleep Problems and Self-Injury: A Systematic Review

Objective/Background: Previous studies suggested that sleep problems were related to non-suicidal self-injury. The current systematic review investigated more thoroughly this relationship.Methods: PubMED and Embase databases were searched. The keywords were "self-injury" OR "self-harm" OR "non-suicidal self-injury" OR "self-injurious behavior" OR "self-destructive behavior" OR "self-mutilation" AND "sleep problem" OR "sleep disturbance" OR insomnia OR nightmare OR "poor sleep quality" or "sleep disorders." A total of 16 studies were included in the present review.Results: The pattern of results indicated that sleep problems such as short sleep duration, sleep disturbances, and poor sleep quality were associated with non-suicidal self-injury. Additionally, emotional dysregulation, depression, and post-traumatic stress disorder appeared to mediate this relationship. Above all adolescents and young adults with sleep disruptions were at higher risk of non-suicidal self-injury.Conclusions:g Interventions to improve sleep quality and sleep duration might concomitantly decrease the risk of non-suicidal self-injury.

Sex differences in the factors associated with sleep duration in university students: A cross-sectional study

BACKGROUND

Insufficient sleep duration among university students was commonly associated with many detrimental effects. University students experience substantial environmental and psychological changes. Female and male university students may differ in many spheres. However, most research on sleep duration of university students is based on an aggregate sample rather than digging the sex-specific profiles. The objective of this study is to examine potential sex differences in the correlates of sleep duration and explore the underlying mechanism of correlations.

METHODS

This is a large-scale university-based mental health survey, which was conducted in university students in Qinghai Province in Northwest China in December 2019. A multi-stage logistic regression was separately fitted by sex to examine the factors associated with short sleep duration in university students.

RESULTS

A total of 5,552 university students with an average sleep duration of 6.88 h (SD = 1.04) were included, among which 35.0% of the participants may currently be sleeping less than the optimal duration. Female students (6.84 h, SD = 1.00) slept shorter than males (6.94 h, SD = 1.09). The only parallel between sexes was that both female and male students with 3-5 times weekly breakfast were less likely to have short sleep duration. Adjusting for depressive symptoms in the following step eliminated the association between anxiety symptoms and short sleep duration in the model for female students. Female-specific associated factors with short sleep duration were age, grade, academic pressure, weekly physical exercise, depressive symptoms. Male-specific characteristics were current smoking tobacco cigarette, self-perceived health, duration of daily Internet use.

CONCLUSION

Characteristic profiles of sleep duration differed between female and male university students; only a few male-specific factors were identified. Psychological guidance and education courses as well as other interventions to improve university students' sleep and related health should be designed and implemented based on sex differences.

The Canadian 24-Hour Movement Guidelines and Psychological Distress among Adolescents: Les Directives canadiennes en matière de mouvement sur 24 heures et la détresse psychologique chez les adolescents

OBJECTIVE

The Canadian 24-Hour Movement Guidelines for Children and Youth recommend at least 60 minutes of physical activity per day, 2 hours or less of recreational screen time per day, and 9 to 11 hours of sleep per night for 5 to 13 years old and 8 to 10 hours per night for 14 to 17 years old. This study examined the association between meeting these guidelines and psychological distress among adolescents.

METHODS

The present cross-sectional sample included 6,364 students aged 11 to 20 years from the 2017 Ontario Student Drug Use and Health Survey. This provincially representative school-based survey is based on a 2-stage cluster design. A confirmatory factor analysis (CFA) was first conducted to confirm the factor structure of the K6, and structural equation modeling adjusted for age, sex, ethnoracial background, subjective socioeconomic status, and body mass index z-score was used to investigate the association between meeting the 24-Hour Movement Guidelines and K6 factors among adolescents.

RESULTS

The CFA demonstrated that a 2-factor model (representing anxiety and depressive symptoms) of the K6 fit the data well. The anxiety and depression items demonstrated a composite reliability (Cronbach's α) of 0.86 and 0.83, respectively, indicating a high level of internal consistency. Compared to meeting none of the recommendations, meeting all 3 movement behavior recommendations was associated with lower anxiety (β = -0.076; P = 0.028) and depressive symptoms (β = -0.067; P = 0.028). Meeting the screen time + sleep duration recommendations had the strongest association with anxiety (β = -0.157; P < 0.001) and depressive symptoms (β = -0.139; P < 0.001), followed by meeting the sleep duration recommendation only for both anxiety (β = -0.135; P < 0.001) and depressive symptoms (β = -0.106; P < 0.001).

CONCLUSIONS

Meeting the 24-Hour Movement Guidelines was associated with lower anxiety and depressive symptoms among adolescents, and these associations appear mainly driven by meeting the sleep duration recommendation.

Sleep duration does not mediate the association between screen time and adolescent depression and anxiety: findings from the 2018 National Survey of Children's Health

OBJECTIVE/BACKGROUND

Adolescence is a crucial time period in which individuals are at high risk for depression and anxiety. Associations between screen time and adolescent depression and anxiety have been inconclusive. We examined 1) the associations of screen time with adolescent depression and anxiety and 2) whether sleep duration mediates these relationships.

METHODS

This study utilized data from the 2018 US. National Survey of Children's Health, a large cross-sectional population representative dataset with parent/caregiver responses. Multivariable logistic regression was used to estimate the associations between screen time and depression and anxiety in separate models. Path models were used to test the mediating role of sleep duration. Confounders, as sex, age, and sociodemographic variables were included in our adjusted models.

RESULTS

Data of 10,907 adolescents aged 13 to 17 were included in this study. The average screen time was 3.76 h daily. Compared to no screen time, adolescents who used over 4 h of screen time per day had higher odds of depression (OR = 2.23, 95% CI:1.27-3.91) and anxiety (OR = 1.85, 95% CI: 1.26-2.72). Sleep duration did not mediate the associations between screen time and depression and anxiety.

CONCLUSIONS

Further research is necessary to examine the associations of screen time content with depression and anxiety, as well as the effects of sleep quality in conjunction with sleep duration on the relationships of screen time and depression and anxiety.

Chronic sleep restriction triggers inadequate napping habits in adolescents: a population-based study

BACKGROUND

The prevalence of chronic sleep restriction during adolescence is a major public health issue. Napping has been adopted to alleviate sleep pressure complaints. However, it also has the potential to amplify sleep restriction due to a vicious cycle triggered by delayed sleep times. The aim of this study was to investigate sleep and napping habits in a sample of Brazilian adolescents.

METHODS

This study enrolled 1554 high school students and included the evaluation of sleep times, daytime sleepiness, sleep quality, and circadian preference. The students were asked about their napping routine, ie its frequency and duration per week.

RESULTS

The adolescent sleep recommendation was achieved by only 27.6% of the sample. Napping habit was reported by 58.1%, with 36.2% of nappers informing naps in 1-2 times per week. Prolonged naps were reported by 44.9% of nappers. Nappers had later median bedtime (23:30) and reduced time in bed (TIB) (median = 07:00 h) compared to non-nappers. The frequency of nappers who did not achieve satisfactory TIB was higher than non-nappers. In addition, nappers reported increased daytime sleepiness and poor sleep quality. Later bedtimes and reduced TIB were associated with longer nap duration. Increased sleepiness and poor sleep quality were linked to a higher nap frequency.

CONCLUSIONS

This exploratory survey demonstrated a severe sleep restriction faced by Brazilian adolescents. Napping can be an efficient strategy to counteract sleep restriction, but it needs to be adopted with caution due to the detrimental effects of frequent and prolonged naps on nocturnal sleep.

Lights Out: Examining Sleep in Children with Vision Impairment

Sleep is crucial for development across cognitive, physical, and social-emotional domains. Sleep quality and quantity impact domains of daytime functioning, attainment, and global development. Previous work has explored sleep profiles in typically developing children and children with developmental disorders such as Down syndrome and Williams Syndrome, yet there is a complete absence of published work regarding the sleep profiles of children with vision impairment aged 4–11 years. This is the first known study that examines the sleep profiles in children with vision impairment (n = 58) in comparison to 58 typically developing children (aged 4–11 years) in the UK. Sleep was measured using the Childhood Sleep Habits Questionnaire (CSHQ; parental report), actigraphy and sleep diaries. Results showed group differences in subjective CSHQ scores but not objective actigraphy measures. Surprisingly, the findings revealed disordered sleep (namely, poor sleep quantity) in both groups. Discordance between CSHQ and actigraphy measures could represent heightened awareness of sleeping problems in parents/caregivers of children with vision impairment. The implications of this study extend beyond group comparison, examining disordered sleep in ‘typically developing’ children, exploring the potential role of light perception and the importance of sleep quality and quantity in both groups.

24-h Movement Guidelines and Substance Use among Adolescents: A School-Based Cross-Sectional Study

Children and youth are recommended to achieve at least 60 min/day of moderate-to-vigorous physical activity, no more than 2 h/day of recreational screen time, and a sleep duration of 9–11 h/night for 11–13-year-olds or 8–10 h/night for 14–17-year-olds. Meeting the physical activity, screen time, and sleep duration recommendations have previously been associated with substance use among adolescents. However, previous research has mainly examined these factors individually rather than looking at how these indicators could concurrently relate to substance use in this age group. Therefore, this study examined the associations between meeting the 24-h movement guidelines for screen time, sleep duration, and physical activity (independent variables) with substance use outcomes including alcohol consumption, cannabis use, and cigarette smoking (dependent variables) among adolescents. Self-reported data from a cross-sectional and representative sample of 10,236 students (mean age = 15.1 years) in Ontario, Canada were analyzed. Logistic regression models stratified by gender were adjusted for potential confounders. Combinations of 24-h movement guidelines was differentially associated with substance use in boys and girls. Overall, findings showed that meeting 24-h movement guidelines is associated with lower odds of alcohol consumption, cannabis use, and cigarette smoking differentially with type of recommendation met and gender. Given that the associations between 24-h movement guidelines and substance use differ between boys and girls, future efforts should take this into consideration.

Effect of COVID-19-Related Home Confinement on Sleep Quality, Screen Time and Physical Activity in Tunisian Boys and Girls: A Survey

COVID-19 home confinement has led to a stressful situation for children around the world and affected their lifestyle. The present study aimed to investigate the effect of these restrictions on sleep quality, screen time (ST) and physical activity (PA) in Tunisian children with a special focus on gender differences. An online survey was launched in April 2020. Questions were presented in a differential format, with expected responses related to "before" and "during" confinement. Participants (52 boys and 48 girls, age: 8.66 ± 3.3 years) responded to the Pittsburgh Sleep Quality Index (PSQI), the digital media use, and the Ricci and Gagnon sedentary behavior questionnaires. Findings revealed that COVID19 home confinement had a negative effect on all the considered parameters (p < 0.05). Significant effects of gender were found on sleep disturbances (p = 0.016, np2 = 0.05), subjective sleep quality (p < 0.01, np2 = 0.07), global score of PSQI (p = 0.01, np2 = 0.01) and nocturnal and global screen time (p < 0.001, np2 = 0.09) with poorer sleep and higher screen time in girls compared to boys during home confinement. A significant correlation was shown between Global ST and PSQI score (r = 0.39, p < 0.001). Programs of PA for children and sensitization campaigns against the use of screens have been deemed urgent with special focus oriented to girls.

Screen exposure exacerbates ADHD symptoms indirectly through increased sleep disturbance

OBJECTIVES

The aim of this study was twofold. First, to confirm the deleterious aspect of evening screen exposure in school-aged children, in particular the effect of screens in the bedroom. Second, to explore the three-way association between degree of screen exposure, sleep disturbance, and ADHD symptoms. Solid evidence exists on the link between sleep disturbance and ADHD symptoms, and screen exposure and sleep disturbance. However, no studies have formally assessed the impact of screen exposure on ADHD symptoms in children, as a function of sleep disturbance.

METHODS

Parents of 374 French children (201 girls, 173 boys, mean age of 10.8 ± 2.8 years old) completed the Sleep Disturbance Scale for Children (SDSC), the Attention-Deficit/Hyperactivity Disorder (ADHD) Rating Scale, and a questionnaire about their children's screen habits (total hours in the morning, afternoon, and evening per day). Correlational analyses between evening screen exposure, sleep quality and behavioral problems were conducted. Then, formal mediation analyses were run in order to quantify the relationship between variables.

RESULTS

School-aged children with screens in their bedrooms demonstrated more sleep and behavioral problems. Evening TV exposure was associated with higher SDSC and ADHD scores. Furthermore, the Structural Equation Modelling approach confirmed that evening screen exposure is directly associated with more disrupted sleep, which in turn is directly associated with behavioral problems.

CONCLUSIONS

These findings encourage families to avoid putting screens in their children's bedrooms, and limit evening screen exposure. They furthermore demonstrate the importance of taking into account screen exposure time (morning, afternoon, evening) and location (bedroom or elsewhere) in future studies.

Sleep Quality and Duration in European Adolescents (The AdolesHealth Study): A Cross-Sectional, Quantitative Study

Sleep is a vital element of adolescents' overall health; it influences their body and mind and thus affects their quality of life. Adequate sleep quality and duration are essential for maintaining optimal metabolic health and lowering the risk of developing several medical conditions, such as cardiovascular disease. The current study aimed to assess the perceived sleep quality and duration of 1717 European adolescents from three different European countries (Spain, Iceland and Estonia) aged 13- to 16-years (900 boys, 817 girls) using the Pittsburgh Sleep Quality Index (PSQI). A multivariate analysis of variance (MANOVA) was performed to examine differences between groups and two-factor analysis of variance (ANOVA) was used to analyze city and age differences. The probability of having poor sleep quality and duration was calculated by Odd-Ratio (OR). Our study found poor sleep quality in 44% of the boys and 53% of the girls, whereas 68% and 69%, respectively did not get the recommended hours of sleep (i.e., 8-10 h). No difference was found between adolescents from Estonia, Iceland and Spain regarding sleep duration. In contrast, Spanish and Estonian adolescents reported higher probabilities of having poor sleep quality. Finally, girls had a significantly higher probability of poor sleep quality than boys.

Prosocial television and prosocial toddlers: A multi-method, longitudinal investigation

How screen use might affect early childhood outcomes is an important question for parents, but existing research is patchy. In particular, screen time is often examined in relation to sleep and aggression, but much less is known about its links with prosocial behaviour. To address this gap, we conducted semi-structured observations and interviews / questionnaires with both mothers and fathers in a sample of 195 (predominantly affluent and educated) British families tracked across three time-points, when the first-born child was 14-, 24-, and 36-months old. We also applied an objective coding scheme to assess the relative frequency of prosocial behaviour in the programmes and films children were watching at age 24-months. While our results showed no overall associations between prosocial behaviour and either screen time or screen content, there were interaction effects. Specifically, children whose favourite programmes were slow-paced and rich in prosocial content were particularly likely to show developmental gains in sharing. We discuss these findings in terms of their implications for parents, researchers, and policy makers.

Screen Time and Executive Function in Toddlerhood: A Longitudinal Study

Technology is pervasive in homes with young children. Emerging evidence that electronic screen-based media use has adverse effects on executive functions may help explain negative relations between media use and early academic skills. However, longitudinal investigations are needed to test this idea. In a sample of 193 British toddlers tracked from age 2 to 3 years, we test concurrent and predictive relations between screen use and children’s executive function. We find no concurrent association between screen use and executive function; however, screen time at age 2 is negatively associated with the development of executive functions in toddlerhood from age 2 to 3, controlling for a range of covariates including verbal ability. Implications for parenting, education, and pediatric recommendations are discussed.