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

      systematic-review
      Author(s): ,
      Publication date (Electronic):
      Journal: BMJ Open
      Publisher: BMJ Publishing Group
      Keywords: screentime, chil health, obesity, mental health

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          Abstract

          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.

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          Most cited references14

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          The associations between sedentary behaviour and mental health among adolescents: a systematic review

          Erin Hoare, Karen Milton, Charlie Foster … (2016)
          Background With technological developments and modernised sedentary lifestyles has come an increase in diseases associated with inactivity such as obesity and other non-communicable diseases. Emerging evidence suggests that time spent sedentary may also interact with mental health. This systematic review examined the associations between sedentary behaviour and mental health problems among adolescents. Methods This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and applied a quality assessment tool for quantitative studies to identity best available evidence. Following stringent search strategy of the databases; Cumulative Index to Nursing and Allied Health Literature, Global Health, Health Source: Nursing and Academic Edition, MEDLINE, PsychARTICLES and PsycINFO, we identified 32 articles eligible for review. Results All studies reported leisure screen time among adolescents, and two thirds of identified studies examined depressive symptomatology. Other mental health measures were; anxiety symptoms, self-esteem, suicide ideation, loneliness, stress, and psychological distress. Strong consistent evidence was found for the relationship between both depressive symptomatology and psychological distress, and time spent using screens for leisure. Moderate evidence supported the relationship between low self-esteem and screen use. Poorer mental health status was found among adolescents using screen time more than 2–3 h per day, and gender differences exist. Essential information was missing for quality of evidence including heterogeneity in mental health and screen time-based measures, and self-report data collection methods. Conclusions The findings are of particular significance given the global public health concern of lifestyle-attributed diseases and the possibility for novel approaches to mental health. Future research should examine the psychological impact of reducing time spent using screens for leisure among adolescents, whilst accounting for possible confounding factors such as physical activity and dietary behaviours. It is critical that the reciprocal relationship between lifestyle behaviours and mental health is represented in both the psychiatric and public health forum. Electronic supplementary material The online version of this article (doi:10.1186/s12966-016-0432-4) contains supplementary material, which is available to authorized users.
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            A Large-Scale Test of the Goldilocks Hypothesis

            Andrew K. Przybylski, Netta Weinstein (2016)
            Although the time adolescents spend with digital technologies has sparked widespread concerns that their use might be negatively associated with mental well-being, these potential deleterious influences have not been rigorously studied. Using a preregistered plan for analyzing data collected from a representative sample of English adolescents ( n = 120,115), we obtained evidence that the links between digital-screen time and mental well-being are described by quadratic functions. Further, our results showed that these links vary as a function of when digital technologies are used (i.e., weekday vs. weekend), suggesting that a full understanding of the impact of these recreational activities will require examining their functionality among other daily pursuits. Overall, the evidence indicated that moderate use of digital technology is not intrinsically harmful and may be advantageous in a connected world. The findings inform recommendations for limiting adolescents' technology use and provide a template for conducting rigorous investigations into the relations between digital technology and children's and adolescents' health.
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              The health indicators associated with screen-based sedentary behavior among adolescent girls: a systematic review.

              Ronald Plotnikoff, Anna L Barnett, Ronald C Plotnikoff … (2013)
              Evidence suggests sitting time is independently associated with a range of health issues in adults, yet the relationship between sedentary behavior and health indicators in young people is less clear. Age-related increases in sedentary behavior are well-documented; the behavioral patterns of adolescent girls are of particular concern. More than one third of adolescent girls' sedentary behavior time is accumulated through use of recreational screen-based behaviors. The objective of this review was to investigate the association between recreational screen-based sedentary behavior and the physical, behavioral, and psychosocial health indicators for adolescent girls. A secondary objective was to identify studies that have adjusted sedentary behavior indicators for physical activity. A structured electronic search of all publication years (through December 2011) was conducted to identify studies in: CINAHL, Communications and Mass Media Complete, ERIC, MEDLINE with Full Text, PsycINFO, and SPORTDiscus with Full Text. Included publications were observational and interventional studies involving adolescent girls (12-18 years) that examined associations between screen-based, sedentary behavior and health indicators (physical, psychosocial, and/or behavioral). The search identified 33 studies that evaluated health indicators of screen-based sedentary behaviors among adolescent girls. Strong evidence for a positive association between screen-based sedentary behavior and weight status was found. A positive association was observed between screen-time and sleep problems, musculoskeletal pain and depression. Negative associations were identified between screen time and physical activity/fitness, screen time and psychological well-being, and screen time and social support. The relationship between screen-based sedentary behavior and diet quality was inconclusive. Less than half of the studies adjusted sedentary behavior indicators for physical activity. Screen-based sedentary behavior is associated with a range of adverse health consequences, but additional longitudinal studies are needed to better understand the health impacts. In addition, screen-time guidelines for youth should be regularly revised and updated to reflect rapid technological changes. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2019
                Publication date (Electronic): 3 January 2019
                Volume: 9
                Issue: 1
                Electronic Location Identifier: e023191
                Affiliations
                [1] departmentPopulation, policy and practice research programme , UCL Institute of Child Health , London, UK
                Author notes
                [Correspondence to ] Dr Russell M Viner; r.viner@ 123456ucl.ac.uk
                Author information
                http://orcid.org/0000-0003-3047-2247
                Article
                Publisher ID: bmjopen-2018-023191
                DOI: 10.1136/bmjopen-2018-023191
                PMC ID: 6326346
                PubMed ID: 30606703
                SO-VID: 20a3c0dc-871d-4456-a439-4ebc5f2da1ad
                Copyright © © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date received : 25 March 2018
                Date revision received : 11 October 2018
                Date accepted : 26 November 2018
                Categories
                Subject: Paediatrics
                Subject: Research
                Subject: 1506
                Subject: 1719
                Subject: 1334
                Custom metadata
                special-feature unlocked

                ScienceOpen disciplines: Medicine
                Keywords: screentime,chil health,obesity,mental health
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: screentime, chil health, obesity, mental health

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