Objectives To systematically examine the evidence of harms and benefits relating to time spent on screens for children and young people’s (CYP) health and well-being, to inform policy. Methods Systematic review of reviews undertaken to answer the question ‘What is the evidence for health and well-being effects of screentime in children and adolescents (CYP)?’ Electronic databases were searched for systematic reviews in February 2018. Eligible reviews reported associations between time on screens (screentime; any type) and any health/well-being outcome in CYP. Quality of reviews was assessed and strength of evidence across reviews evaluated. Results 13 reviews were identified (1 high quality, 9 medium and 3 low quality). 6 addressed body composition; 3 diet/energy intake; 7 mental health; 4 cardiovascular risk; 4 for fitness; 3 for sleep; 1 pain; 1 asthma. We found moderately strong evidence for associations between screentime and greater obesity/adiposity and higher depressive symptoms; moderate evidence for an association between screentime and higher energy intake, less healthy diet quality and poorer quality of life. There was weak evidence for associations of screentime with behaviour problems, anxiety, hyperactivity and inattention, poorer self-esteem, poorer well-being and poorer psychosocial health, metabolic syndrome, poorer cardiorespiratory fitness, poorer cognitive development and lower educational attainments and poor sleep outcomes. There was no or insufficient evidence for an association of screentime with eating disorders or suicidal ideation, individual cardiovascular risk factors, asthma prevalence or pain. Evidence for threshold effects was weak. We found weak evidence that small amounts of daily screen use is not harmful and may have some benefits. Conclusions There is evidence that higher levels of screentime is associated with a variety of health harms for CYP, with evidence strongest for adiposity, unhealthy diet, depressive symptoms and quality of life. Evidence to guide policy on safe CYP screentime exposure is limited. PROSPERO registration number CRD42018089483.

https://bmjopen.bmj.com/content/bmjopen/9/1/e023191.full.pdf

Effects of screentime on the health and well-being of children and adolescents: a systematic review of reviews

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

/pdf/association-between-portable-screen-based-media-device-2nsk8v467b.pdf

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

The Centers for Disease Control and Prevention (CDC) in the United States has declared insufficient sleep a "public health problem." Indeed, according to a recent CDC study, more than a third of American adults are not getting enough sleep on a regular basis. However, insufficient sleep is not exclusively a US problem, and equally concerns other industrialised countries such as the United Kingdom, Japan, Germany, or Canada. According to some evidence, the proportion of people sleeping less than the recommended hours of sleep is rising and associated with lifestyle factors related to a modern 24/7 society, such as psychosocial stress, alcohol consumption, smoking, lack of physical activity and excessive electronic media use, among others. This is alarming as insufficient sleep has been found to be associated with a range of negative health and social outcomes, including success at school and in the labour market. Over the last few decades, for example, there has been growing evidence suggesting a strong association between short sleep duration and elevated mortality risks. Given the potential adverse effects of insufficient sleep on health, well-being and productivity, the consequences of sleep-deprivation have far-reaching economic consequences. Hence, in order to raise awareness of the scale of insufficient sleep as a public-health issue, comparative quantitative figures need to be provided for policy- and decision-makers, as well as recommendations and potential solutions that can help tackling the problem.

/pdf/why-sleep-matters-the-economic-costs-of-insufficient-sleep-a-1a8mgsfz8r.pdf

Why Sleep Matters-The Economic Costs of Insufficient Sleep: A Cross-Country Comparative Analysis.

Obesity is one of the best-documented outcomes of screen media exposure. Many observational studies find relationships between screen media exposure and increased risks of obesity. Randomized controlled trials of reducing screen time in community settings have reduced weight gain in children, demonstrating a cause and effect relationship. Current evidence suggests that screen media exposure leads to obesity in children and adolescents through increased eating while viewing; exposure to high-calorie, low-nutrient food and beverage marketing that influences children’s preferences, purchase requests, consumption habits; and reduced sleep duration. Some evidence also suggests promise for using interactive media to improve eating and physical activity behaviors to prevent or reduce obesity. Future interdisciplinary research is needed to examine the effects of newer mobile and other digital media exposures on obesity; to examine the effectiveness of additional interventions to mitigate the adverse effects of media exposures on obesity and possible moderators and mediators of intervention effects; to effectively use digital media interventions to prevent and reduce obesity; and to uncover the mechanisms underlying the causal relationships and interactions between obesity-related outcomes and media content, characteristics, and context.

Screen Media Exposure and Obesity in Children and Adolescents.

Objective
To test the independent and interactive associations of physical activity (PA) and screen time (ST) with self-reported mental health and sleep quality among Chinese college students.

/pdf/low-physical-activity-and-high-screen-time-can-increase-the-2ubeubqj9f.pdf

Low Physical Activity and High Screen Time Can Increase the Risks of Mental Health Problems and Poor Sleep Quality among Chinese College Students

Screen time and sleep among school-aged children and adolescents: A systematic literature review

Interactive vs passive screen time and nighttime sleep duration among school-aged children

Seafood intake and blood cadmium in a cohort of adult avid seafood consumers.

Narcolepsy, first described in the 1880s, is characterized by excessive daytime sleepiness and commonly seen along with cataplexy, or episodic weakness, which occurs in 60–80 % of patients with narcolepsy. Symptoms of narcolepsy vary in their nature and severity and most commonly include (1) sleep paralysis, (2) hypersomnia, (3) disturbed nocturnal sleep, (4) abnormal rapid eye movement sleep, and (5) hypnagogic (at the onset of sleep) or hypnopompic (on awakening) hallucinations. Since there is not a uniform standard for the diagnosis of narcolepsy, assessing epidemiologic estimates of narcolepsy is challenging. Current estimates indicate prevalence rates of about 19–56 per 100,000 people in Europe and the USA, with some geographic areas of the world being much lower (e.g., Israel) and other areas being much higher (e.g., Japan). Age of onset for narcolepsy typically occurs in the second decade of life; however, diagnosis can occur 10–16 years later on average. Some studies indicate that narcolepsy is more common among men than women. There are few lifestyle characteristics associated with narcolepsy, yet environmental factors, such as violence and family stressors, have been suggested as possible triggers for the manifestation of narcolepsy. Narcolepsy is more common among first-degree relatives, but does not follow normal inheritance patterns with concordance among monozygotic twins being only 25–31 %. Other studies have shown an association between narcolepsy and the HLA DQB1*602 gene. Through better epidemiological research, the scientific and medical community can improve our collective understanding of its causes and increase awareness, early recognition, and treatment of narcolepsy.

Stanford Guan

Papers

Screen time and sleep among school-aged children and adolescents: A systematic literature review

Interactive vs passive screen time and nighttime sleep duration among school-aged children

Seafood intake and blood cadmium in a cohort of adult avid seafood consumers.

Epidemiology of Narcolepsy