Different aspects of electronic media use, symptoms and neurocognitive outcomes of children and adolescents in the rural Western Cape region of South Africa

Association of screen-based sedentary behavior with executive function in school-aged children: A functional near-infrared spectroscopy study

Screen-based sedentary behavior (SSB) is a significant risk factor for the health of school-aged children, and guidelines recommend limiting SSB to 2 hr per day. This study aimed to examine association and potential mechanisms between SSB and executive function (EF) by comparing Stroop performance and frontal hemodynamic responses between children with and without excessive SSB. A total of 70 children aged 10 to 15 years were recruited and divided into two groups: excessive screen time (≥2 hr/day; n = 35; ES group) and normal screen time (<2 hr/day; n = 35; NS group). The Chinese version of the Adolescent Sedentary Activities Questionnaire was used to assess SSB, whereas EF was evaluated using the Stroop task. The frontal hemodynamic responses during the Stroop task were measured using functional near-infrared spectroscopy. The results indicated that the ES group had lower accuracy, longer reaction times, and greater activation in the bilateral dorsolateral prefrontal cortex (DLPFC) and left pre-supplementary motor area (Pre-SMA) compared with the NS group. Furthermore, significant correlations were observed between Stroop performance and cortical activation in the left DLPFC and Pre-SMA. These findings demonstrate that excessive SSB is associated with poor EF, which may be explained by a decrease in neural efficiency of the left DLPFC and Pre-SMA.

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

OBJECTIVE

The aim of this study was to summarize the evidence regarding screen use as a contributing factor in pediatric headache and migraine.

BACKGROUND

Screen exposure is often reported as a headache trigger, though there is no current consensus in terms of how screen type, duration, or frequency influences pediatric headache and the associated burden of disease.

METHODS

A systematic search in PubMed, Scopus, Cochrane Library, ProQuest Health and Medical Database, and Google Scholar was performed through November 2022 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. All English-language articles of pediatric patients aged ≤18 years evaluating screen use in relation to headache were included.

RESULTS

A total of 48 studies were included. Nearly all studies were cross-sectional and represented international samples. The strongest association between screen use and headache found was for duration of use, and computer use emerged as the most common device type related to headache. While there were mixed findings related to screen use and specific headache diagnosis, migraine appeared to confer a higher risk. Across studies, there were insufficient data to assess the impact of screen use on headache frequency or headache-related disability. Several studies demonstrated changes in screen use and headache patterns related to the COVID-19 pandemic and computer vision syndrome was commonly reported.

CONCLUSIONS

While there is preliminary evidence supporting possible associations between screen use and pediatric headache, there are several limitations in the present review including a lack of prospective and randomized controlled trials to better demonstrate causal relationships as well as methodological limitations with significant variability in how both headache and screen use are defined and measured. Future studies including real-time screen use and device monitoring are needed to better understand the influence of screen use behaviors on pediatric headache and to help further define best-use guidelines around these technologies.

The association between real-life markers of phone use and cognitive performance, health-related quality of life and sleep

INTRODUCTION

The real-life short-term implications of electromagnetic fields (RF-EMF) on cognitive performance and health-related quality of life have not been well studied. The SPUTNIC study (Study Panel on Upcoming Technologies to study Non-Ionizing radiation and Cognition) aimed to investigate possible correlations between mobile phone radiation and human health, including cognition, health-related quality of life and sleep.

METHODS

Adult participants tracked various daily markers of RF-EMF exposures (cordless calls, mobile calls, and mobile screen time 4 h prior to each assessment) as well as three health outcomes over ten study days: 1) cognitive performance, 2) health-related quality of life (HRQoL), and 3) sleep duration and quality. Cognitive performance was measured through six "game-like" tests, assessing verbal and visuo-spatial performance repeatedly. HRQoL was assessed as fatigue, mood and stress on a Likert-scale (1-10). Sleep duration and efficiency was measured using activity trackers. We fitted mixed models with random intercepts per participant on cognitive, HRQoL and sleep scores. Possible time-varying confounders were assessed at daily intervals by questionnaire and used for model adjustment.

RESULTS

A total of 121 participants ultimately took part in the SPUTNIC study, including 63 from Besancon and 58 from Basel. Self-reported wireless phone use and screen time were sporadically associated with visuo-spatial and verbal cognitive performance, compatible with chance findings. We found a small but robust significant increase in stress 0.03 (0.00-0.06; on a 1-10 Likert-scale) in relation to a 10-min increase in mobile phone screen time. Sleep duration and quality were not associated with either cordless or mobile phone calls, or with screen time.

DISCUSSION

The study did not find associations between short-term RF-EMF markers and cognitive performance, HRQoL, or sleep duration and quality. The most consistent finding was increased stress in relation to more screen time, but no association with cordless or mobile phone call time.

Modelling of daily radiofrequency electromagnetic field dose for a prospective adolescent cohort

INTRODUCTION

Radiofrequency electromagnetic fields originate from a variety of wireless communication sources operating near and far from the body, making it challenging to quantify daily absorbed dose. In the framework of the prospective cohort SCAMP (Study of Cognition, Adolescents and Mobile Phones), we aimed to characterize RF-EMF dose over a 2-year period.

METHODS

The SCAMP cohort included 6605 children from greater London, UK at baseline (age 12.1 years; 2014-2016) and 5194 at follow-up (age 14.2; 2016-2018). We estimated the daily dose of RF-EMF to eight tissues including the whole body and whole brain, using dosimetric algorithms for the specific absorption rate transfer into the body. We considered RF-EMF dose from 12 common usage scenarios such as mobile phone calls or data transmission. We evaluated the association between sociodemographic factors (gender, ethnicity, phone ownership and socio-economic status), and the dose change between baseline and follow-up.

RESULTS

Whole body dose was estimated at an average of 170 mJ/kg/day at baseline and 178 mJ/kg/day at follow-up. Among the eight tissues considered, the right temporal lobe received the highest daily dose (baseline 1150 mJ/kg/day, follow-up 1520 mJ/kg/day). Estimated daily dose [mJ/kg/day] increased between baseline and follow-up for head and brain related tissues, but remained stable for the whole body and heart. Doses estimated at baseline and follow-up showed low correlation among the 3384 children who completed both assessments. Asian ethnicity (compared to white) and owning a bar phone or no phone (as opposed to a smartphone) were associated with lower estimated whole-body and whole-brain RF-EMF dose, while black ethnicity, a moderate/low socio-economic status (compared to high), and increasing age (at baseline) were associated with higher estimated RF-EMF dose.

CONCLUSION

This study describes the first longitudinal exposure assessment for children in a critical period of development. Dose estimations will be used in further epidemiological analyses for the SCAMP study.

Headache in Children and Adolescents: The Association between Screen Time and Headache within a Clinical Headache Population

BACKGROUND

More than half of children and adolescents have experienced headache within the last 3 months. Several risk factors for headache have been identified, including obesity and lack of sleep. The association between screen time and headache in children and adolescents is sparsely investigated. The aim of this study was to assess this association and evaluate if it varied according to headache diagnosis.

METHOD

This cross-sectional study was performed at the tertiary pediatric outpatient clinic for headache at Herlev University Hospital. A total of 139 participants who answered a questionnaire on lifestyle factors and their daily living were included. Diagnoses of migraine and tension-type headache (TTH) were made according to the International Classification of Headache Disorders-3. Children with both migraine and TTH were allocated to a mixed headache group. We differentiated between total, leisure, and school-related screen time.

RESULTS

The mean age was 13.20 ± 3.38 years and 53.2% were girls. Note that 25.2% were diagnosed with migraine without aura, 23.0% migraine with aura, 28.1% TTH, 15.8% mixed headache, and 7.9% had an unclassified headache diagnosis at the time of inclusion. There was no statistically significant difference in screen time across the five headache groups. An association between screen time and headache frequency was found in children with migraine with aura.

CONCLUSION

In this study, we investigated the association between screen time and headache in children and adolescents. More screen time was associated with more frequent headaches in children with migraine with aura. Future prospective studies are needed to determine the causality of this association.

Access to mass media and teenage pregnancy among adolescents in Zambia: a national cross-sectional survey

OBJECTIVE

Teenage pregnancies and childbirths are associated with negative health outcomes. Access to health information enables adolescents to make appropriate decisions. However, the relationship between access to health information through mass media and teenage pregnancy has not received much attention in existing literature. We therefore examined the association between access to mass media and teenage pregnancy in Zambia.

DESIGN

Cross-sectional.

SETTING

Zambia.

PARTICIPANTS

Weighted sample of 3000 adolescents aged 15-19 years.

OUTCOME MEASURE

Teenage pregnancy that included adolescents who were currently pregnant or had had an abortion or had given birth in the last 5 years preceding the survey.

RESULTS

Out of 3000 adolescents, 897 (29.9%, 95% CI: 28.1% to 31.3%) were pregnant or had ever been pregnant. Majority of the adolescents resided in rural areas (55.9%) and had secondary education (53.6%). Adolescents who had exposure to internet, newspapers or magazines, radio and television were 10.5%, 22.6%, 43.1% and 43.1%, respectively. Adolescents who had daily access to newspapers or magazines (adjusted OR (AOR): 0.33, 95% CI: 0.13 to 0.82) or using internet (AOR: 0.54, 95% CI: 0.30 to 0.95) were less likely to be pregnant or to have had a pregnancy compared with those with no access to newspapers and internet, respectively.

CONCLUSION

Our study suggests that internet use and reading of newspapers or magazines may trigger behavioural change as an effective approach to reducing teenage pregnancy. Behavioural change communicators can implement mass media campaigns using newspapers, magazines and the internet to publicise adolescent health messages that can encourage adolescents to adopt healthy behaviours and prevent teenage pregnancies.

Translation and Psychometric Testing of the Arabic Version of the Problematic Media Use Measure Short Form for Children

Background. There is growing concerns that excessive use of media among children will become problematic. Research on the management of children’s problematic use of media would be improved if screening tools are widely applied. Problematic Media Use Measure Short Form (PMUM-SF) was developed to screen problematic use of media among 4- to 11-year-old US children. Purpose. The study is aimed at developing and validating a cross-cultural version of the PMUM-SF for use in Arabic-talking parents of children from age 3 to 13 years. Design. Cross-cultural adaptation and cross-sectional psychometric testing study. Methods. Using the World Health Organization (WHO) framework for instrument translation and adaptation, the instrument was translated, back translated, pretested, and reviewed by a committee. The PMUM-SF was tested in 180 parents of children aging from 3 to 13 years. Results. The results demonstrated that the Arabic version of the PMUM-SF had high reliability (Cronbach’s alpha was 0.90); it has good convergent and predictive validity. The factor structure of the Arabic version of PMUM-SF was confirmed through exploratory and confirmatory factor analysis (comparative fit index $\left(\text{CFI}\right)=0.93$ ; goodness of fit index $\left(\text{GFI}\right)=0.90$ ; incremental fit index $\left(\text{IFI}\right)=0.93$ ). Conclusion. Because the Arabic version of the PMUM-SF seems to be reliable and valid in assessing problematic use of media of children in Arabic-speaking parents, the use of this translated version is recommended in future research.

Is Sedentary Behavior Associated With Executive Function in Children and Adolescents? A Systematic Review

Background

Prolonged time on sedentary behavior, especially screen-based sitting time, is associated with unfavorable health indicators in children and adolescents. However, the effects of sedentary behavior on cognitive function remain to be elucidated.

Objective

The purpose of this systematic review was to synthesize the evidence on the associations of sedentary behavior with executive function in children and adolescents.

Methods

Four electronic databases (i.e., PubMed, Web of Science, PsycINFO, and SPORTDiscus) were searched for studies examining the associations between sedentary behavior and executive function in children and adolescents. Study quality was assessed by the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

Results

A total of 1,151 records were initially identified through database searches and other searches. Twelve cross-sectional and four longitudinal studies met the inclusion criteria. Of the 16 studies, seven studies found significant negative associations between sedentary behavior and executive function, and two studies presented positive associations. Eight studies measured sedentary time using accelerometers and showed varied associations between objectively measured sedentary time and executive function. Nine studies measured screen-based sedentary behavior, of which five studies found negative associations of sedentary time with executive function.

Conclusion

The available evidence on the associations between sedentary behavior and executive function is not conclusive in children and adolescents. However, screen-based sedentary behavior may be negatively associated with executive function.

Maternal drinking behaviour and co-exposure from smoking during and after pregnancy in relation to the neurocognitive function of school-children in the rural Western Cape

BACKGROUND

Maternal substance use and its long-term effect on the neurocognitive functions of children is a global public health issue. Despite an increase in substance use in rural areas of low to middle-income countries, research is limited in these populations.

OBJECTIVE

We have therefore explored the effect of maternal drinking and smoking behaviors on the neurocognitive functioning of rural school children.

METHOD

A cross-sectional analysis on the determinants of current, past and gestational maternal alcohol use and gestational smoking on child neurocognitive functions was conducted on school-children (N = 482), embedded within the child health agricultural cohort (CapSA) study across seven schools in rural Western Cape, South Africa. Standardised neurocognitive assessment tools included the Cambridge Automated Neuropsychological Battery (CANTAB) and the KIDSCREEN-10 to measure health-related quality of life via a child questionnaire. Maternal smoking and drinking behaviour were captured using a parent/guardian questionnaire.

RESULTS

Of the 482 parents/guardians who completed the survey, 29 % reported current drinking 27 % reported past drinking and 10 % reported maternal gestational drinking, while 31 % reported gestational smoking. Significant associations were observed between past and current maternal drinking and child's reduced rapid visual processing accuracy in attention [β:-0.03; 95 % confidence interval (CI): -0.05;-0.004] and between maternal drinking during pregnancy and reduced child's spatial working memory (β: -0.59; CI: -1.02; -0.15). Heavy (>5 cigarettes per day) gestational smoking was associated with lowered child's learning in memory (β:-1.69; 95 % CI: -3.05; -0.33) and lower health-related quality of life (β: -3.41; CI: -6.64; -0.17). The odds of a child repeating a grade were 1.69 (CI: 2.81-1.02) for those exposed to maternal gestational smoking and 1.68 (CI: 3.31-0.85) for those exposed to maternal gestational drinking compared to those who were not exposed.

CONCLUSION

The consistent negative associations across all four maternal substance use proxies, six neurocognitive health outcomes and one health symptom is suggestive of adverse health effects, warranting longitudinal follow-up. Health policies to eliminate gestational substance use are recommended.

High cellphone use associated with greater risk of depression among young women aged 15-24 years in Soweto and Durban, South Africa

BACKGROUND

The ubiquity of cellular phone (cellphone) use in young people's daily lives has emerged as a priority area of concern for youth mental health.

OBJECTIVE

This study measured the prevalence of depression and its association with high cellphone use among youth in Soweto and Durban, South Africa.

METHODS

We analysed cross-sectional, baseline survey data among youth aged 16-24 who participated in a dual-site cohort study, 'AYAZAZI', conducted from 2014 to 2017. The primary outcome was depression using the 10-item Center for Epidemiologic Studies Depression Scale, with a score of ≥ 10 indicating probable depression. Cellphone use was measured via self-reported average number of hours of active use, with 'high cellphone use' defined as daily usage of ≥ 8. Multivariable logistic regression models assessed the independent relationship between high cellphone use and probable depression, adjusting for potential confounders.

RESULTS

Of 425 participants with a median age of 19 years (IQR = 18-21), 59.5% were young women. Overall, 43.3% had probable depression, with a higher prevalence among women (49.0% vs. 34.9%, P = .004). Nearly all (94.6%) owned a cellphone. About one-third (29.5%) reported spending ≥ 8 hours per day using their cellphone (39.3% of women vs. 14.9% of men, P < .001). In the overall adjusted model, youth reporting high daily cellphone use had higher odds of probable depression (aOR: 1.83, 95% CI: 1.16-2.90). In gender-stratified models, high daily cellphone use was associated with probable depression among women (aOR: 2.51, 95% CI: 1.47-4.31), but not among men (aOR: 0.87, 95% CI: 0.35-2.16).

CONCLUSIONS

Among a cohort of South African youth, we found a high prevalence of probable depression and high cellphone use (30%). The findings indicate a need for intersectoral initiatives focused on meaningful mental health support for South African youth to support positive growth and development.

Association of activities related to pesticide exposure on headache severity and neurodevelopment of school-children in the rural agricultural farmlands of the Western Cape of South Africa

OBJECTIVE

Children and adolescents living in agricultural areas are likely to be exposed to mixtures of pesticides during their daily activities, which may impair their neurodevelopment. We investigated various such activities in relation to headache severity and neurodevelopment of school-children living in rural agricultural areas in the Western Cape of South Africa.

METHOD

We used baseline date from 1001 school-children of the Child Health Agricultural Pesticide Cohort Study in South Africa (CapSA) aged 9-16 from seven schools and three agriculture areas in the Western Cape. Questionnaires were administrated to assess activities related to pesticide exposure and health symptoms addressing four types of activities: 1) child farm activities related to pesticide handling, 2) eating crops directly from the field, 3) contact with surface water around the field, and 4) seen and smelt pesticide spraying activities. Neurocognitive performance across three domains of attention, memory and processing speed were assessed by means of an iPad-based cognitive assessment tool, Cambridge Automated NeuroPsychological Battery (CANTAB). Headache severity was enquired using a standard Headache Impact Test (HIT-6) tool. Cross-sectional regression analysis was performed.

RESULTS

About 50% of the cohort report to have ever been engaged in activities related to pesticide exposure including farm activities, eating crops directly from the field and leisure activities. Headache severity score was consistently increased in relation to pesticide-related farm activities (score increase of 1.99; 95% CI: 0.86, 3.12), eating crops (1.52; 0.41, 2.67) and leisure activities of playing, swimming or bathing in nearby water (1.25; 0.18, 2.33). For neurocognitive outcomes, an overall negative trend with pesticide exposure-related activities was observed. Among others, involvement in pesticide-related farm activities was associated with a lower multi-tasking accuracy score (-2.74; -5.19, -0.29), while lower strategy in spatial working memory (-0.29; -0.56; -0.03) and lower paired associated learning (-0.88; -1.60, -0.17) was observed for those who pick crops off the field compared to those who do not pick crops off the field. Eating fruits directly from the vineyard or orchard was associated with a lower motor screening speed (-0.06; -0.11, -0.01) and lower rapid visual processing accuracy score (-0.02; -0.03, 0.00).

CONCLUSIONS

Children who indicate activities related to pesticide exposure may be at higher risk for developing headaches and lower cognitive performance in the domains of attention, memory and processing speed. However, self-reported data and cross-sectional design are a limitation. Future research in CapSA will consider pesticide exposure estimations via urinary biomarkers and longitudinal assessment of cognitive functions.

Impact of Technology Use on Behavior and Sleep Scores in Preschool Children in Saudi Arabia

Background: Pre-school children use digital devices both at home and in kindergarten for communication. However, such technologies can also be used for creativity learning and entertainment. Technology usage might exert a negative impact on the psychosocial development of pre-school children, thus necessitating parental monitoring. Previous studies have recommended early intervention for pre-school children by decreasing the duration of digital devices, spending more time with the family, and participation in motor activities to avoid the ill effects of technology. Aim: To investigate the impact of digital device use on the behavioral and sleep scores of preschool children as perceived by parents in Saudi Arabia (SA). Method: This cross-sectional study was conducted across two regions in SA. It was ethically approved by the ethical review board of Imam Abdulrahman Bin Faisal University. The participants were randomly selected from well-baby hospital records, surveyed and interviewed to obtain data for the following measures: demographic data, technology usage, sleep disturbance scale, and behavior scale. Children with special needs or comorbidities were excluded from the study. Descriptive and multivariate regression analysis were done. Results: We recruited 288 children. Most did not attend schools (63.2%), 22.6% were in kindergarten, and 14.2% were in nursery schools. Smart phones were the most commonly used device by the children (42.4%). Most used the technology for 2-3 h/days (34%). Cartoons were the most commonly sought content (42%). The behavior scores for children aged 18-36 months showed a mean value of 5.1, 3.7, and 4.6 for surgency, negative affect, and effortful control, respectively. Children aged 3-5 years showed a mean value of 4.3, 4, and 4.7 for surgency, negative affect, and effortful control, respectively. Sleep disturbance scores for all children showed a mean value of 12.4, 3.5, 3.8, 8, 7.3, and 2.7 on disorders of initiating and maintaining sleep, sleep-breathing disorders, disorders of arousal, sleep-wake transition disorders, disorders of excessive somnolence, and sleep hyperhidrosis, respectively. The mean total sleep score was 37. Multivariate regression analysis showed significant positive relationship between surgency and three factors namely family income of 10,000-15,000 SR (t = 1.924, p = 0.045), fathers' bachelor's degrees (t = 2.416, p = 0.16), and owning a video game device (t = 2.826, p = 0.005<0.05). Negative affect was significantly associated with fathers' diploma level of education (t = 2.042, p = 0.042). Negative significant relationship between effortful control and fathers' secondary level of education (t = -2.053, p = 0.041). There was a significant negative relationship between effortful control and owning a TV and video game device (t = -2.35, -2.855, p = 0.043, 0.005<0.05, respectively). A significant positive relationship was found between child's sleeping score (worse sleep) and watching technology between 3 and 5 h (t = 2.01, p = 0.045), and mothers' unemployment status (t = 2.468, p = 0.014). Conclusion: In conclusion, technology use is associated with a negative impact on children sleep and behavior. Owning a digital device, using tablets, screen viewing for more than 3-5 h, and watching movies were significantly associated with negative child's behavior and sleep.