Understanding screen use in children and adolescents

Understanding screen use in children and adolescents

Background: Electronic screens(e.g., TVs, computers, smartphones)are ubiquitous in modern society, occupying a large part of children and adolescents’ daily discretionary time. This has drawn concern on the impact of excessive ‘screen time’ on young people’s health, especially with many exceeding recreational screen time guidelines of ≤2 hours per day. Evidence suggests that screen time can be detrimental to child and adolescent health. However, relatively little is known about the extent, nature, and contexts of contemporary screen engagement in this population. The aims of this research thesis were threefold: (i) to synthesize the descriptive epidemiology of screen-based devices among youth, incorporating newer forms of screens, and their contribution towards health-related screen time guidelines(Study 1); (ii) to examine the longitudinal trends of various screen-based behaviours in adolescents(Study 2); and (iii) to explore the nature and contextual environment of contemporary screen engagement in adolescents(Study 3 and 4).

Methods: Study 1comprised a systematic scoping review of surveillance studies (k=130) to describe the descriptive epidemiology of screen-based devices, including screen time prevalence and average usage. Study 2 included a secondary analysis of a large prospective cohort (n=2179adolescents) to examine the longitudinal trends of various screen-based behaviours and determine any differences in sex and screen domain. The final two studies of this PhD comprised two phases: (i) a qualitative study involving semi-structured individual interviews (n=16) to explore the nature of contemporary screen engagement(Study 3)and direct observation via automated wearable cameras (n=10) to categorise the type and context of screen-based behaviours (Study 4).

Results: The scoping review(Study 1) indicated that a high proportion of children and adolescents (52.3%) exceeded public health screen time guidelines of ≤2 hours per day. However, there was limited information for the time-use of contemporary screen-based devices, such as smartphones and tablets. The secondary analysis(Study 2) showed longitudinal increases in screen time (+84.5 minutes/day) over four years, with increases most pronounced in contemporary forms of digital media, such as social networking and online communication. This prospective analysis also showed that increases also differed by sex and screen time domain, with boys spending increased time playing electronic games, while girls reported larger increases in TV viewing, computer use, and time spent social networking and communicating online. Based on the interview study (Study 3), multiscreening and binge watching were identified as emerging patterns of screen use and ascertained important social functions of screen time. Through wearable camera images (Study 4),it was apparent that the majority of screen time occurred in the home environment and in solitary. However, it was likely a number of social interactions occurred through online interfaces such as social media and interactive gaming platforms.

Conclusions: This thesis provides new insights into contemporary screen engagement among children and adolescents, including information on newer devices that was previously lacking. Important differences in screen use were found according to adolescent sex and screen time domain. The (social) benefits of contemporary screen use were evident, although several psychological, physical, and behavioural concerns were also acknowledged.
Findings can be used to inform future interventions designed to manage screen use for health gains where appropriate. This PhD contributes to the literature by providing a greater understanding of screen use in children and adolescents, including the utilization of novel measures to identify the context and nature in which screen time occurs in this population.