%0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e59869 %T Problematic Digital Technology Use Measures in Children Aged 0 to 6 Years: Scoping Review %A Selak,Špela %A Horvat,Janja %A Žmavc,Mark %+ National Institute of Public Health, Trubarjeva cesta 2, Ljubjana, 1000, Slovenia, 386 1 620 36 45, spela.selak@nijz.si %K scoping review %K measures %K problematic digital technology use %K children %K early childhood %K mobile phone %D 2025 %7 18.3.2025 %9 Review %J JMIR Ment Health %G English %X Background: In the interest of accurately assessing the effects of digital technology use in early childhood, researchers and experts have emphasized the need to conceptualize and measure children’s digital technology use beyond screen time. Researchers have argued that many patterns of early digital technology use could be problematic, resulting in the emerging need to list and examine their measures. Objective: We aimed to review existing empirical literature that is using measures for problematic digital technology use in preschool children with the end goal of identifying a set of reliable and valid measures, predicting negative outcomes for children’s health, development, or well-being. Methods: We conducted a scoping review across the Web of Science, PubMed, and Google Scholar databases to identify peer-reviewed publications that were published from January 2012 to December 2023, were written in the English language, described an empirical study, and included a measure of problematic digital technology use beyond exposure (ie, screen time) in children aged 0 to 6 years. Results: The search yielded 95 empirical studies, in which 18 composite measures of problematic use and 23 measures of specific problematic use aspects were found. Existing composite measures conceptualize problematic use as either a group of risky behaviors or as a group of symptoms of a presumed underlying disorder, with the latter being more common. Looking at their conceptual background and psychometric properties, existing composite measures fall short of reliably assessing all the crucial aspects of problematic digital technology use in early childhood. Therefore, the benefits and shortcomings of single-aspect problematic digital technology use measures are evaluated and discussed. Conclusions: On the basis of current research, early exposure to digital technologies, device use before sleep, and solitary device use represent measures that have been consistently associated with negative outcomes for children. In addition, potential measures of problematic use include device use during meals, device use for emotional regulation, device multitasking, and technoference, warranting further research. Public health benefits of defining problematic digital technology use as a group of risky behaviors rather than a group of addiction symptoms are discussed. %M 40100254 %R 10.2196/59869 %U https://mental.jmir.org/2025/1/e59869 %U https://doi.org/10.2196/59869 %U http://www.ncbi.nlm.nih.gov/pubmed/40100254 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e57962 %T Nationwide Trends in Screen Time and Associated Risk Factors by Family Structures Among Adolescents, 2008-2022: Nationwide Cross-Sectional Study %A Kim,Seokjun %A Jo,Hyesu %A Son,Yejun %A Shin,Min Kyung %A Lee,Kyeongmin %A Park,Jaeyu %A Lee,Hayeon %A Smith,Lee %A Dragioti,Elena %A Fond,Guillaume %A Boyer,Laurent %A López Sánchez,Guillermo F %A Tully,Mark A %A Rahmati,Masoud %A Pizzol,Damiano %A Woo,Selin %A Yon,Dong Keon %+ , Department of Medicine, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea, 82 269352476, yonkkang@gmail.com %K adolescents %K family type %K pandemic %K screen time %K South Korea %K sedentary activity %K risk factor %K mobile phone %D 2025 %7 10.3.2025 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Although understanding long-term trends in adolescent screen time and the influence of family structure is essential, there is a lack of research addressing these issues comprehensively. Objective: This study aimed to conduct comprehensive investigations into adolescent screen time before and during the COVID-19 pandemic, with a particular focus on family structures. Methods: This study used nationwide, large-scale data from the Korea Youth Risk Behavior Web-Based Survey from South Korea. We aimed to indicate the changes in adolescent screen time over 15 years from 2008 to 2022. Weighted linear regression was used to analyze annual trends in screen time before and during the pandemic, and stratified analyses were conducted to examine associated risk factors across different family structures. Results: This study used data from a total of 836,972 individuals (n=403,456, 48.2% women), with an age range of 12-18 years. The analysis revealed an overall increase in screen time prepandemic (β=8.06, 95% CI 7.74-8.39), with a notable increase observed at the onset of the pandemic (β=162.06, 95% CI 159.49-164.64). Among diverse family structures, the orphanage group showed the most substantial increase in screen time during the pandemic (βdiff=221.90, 95% CI 159.62-284.17). Risk factors associated with screen time during the pandemic varied by family structure. Notably, the nuclear family group presented distinct screen time–related risk factors, including grade, region of residence, physical activity frequency, sadness and despair, and the highest education level of parents. Conclusions: There has been a notable increase in average screen time among adolescents since the onset of the pandemic, with the orphanage group exhibiting a pronounced trend. The risk factors associated with screen time during the pandemic varied for each family structure. Findings from this study suggest that the implementation of individualized measures tailored to each family structure should be adopted to effectively address the increased issue of adolescent screen time since the pandemic. %M 40063937 %R 10.2196/57962 %U https://publichealth.jmir.org/2025/1/e57962 %U https://doi.org/10.2196/57962 %U http://www.ncbi.nlm.nih.gov/pubmed/40063937 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e59215 %T Novel Profiles of Family Media Use: Latent Profile Analysis %A Hamp,Nicole %A Radesky,Jenny %A Weeks,Heidi M %A Miller,Alison L %A Kaciroti,Niko %K preschool %K child %K digital media %K mobile media %K media use %K latent profile analysis %K computer use %K LPA %K technology use %K survey %K questionnaire %K pediatrics %D 2025 %7 6.3.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Over the past 3 decades, digital and screen media have evolved from broadcast, stationary platforms to a complex environment of interactive, omnipresent, mobile media. Thus, clinical guidance centered around unidimensional concepts such as “screen time” must be modernized to help families navigate the intricate digital ecosystems of readily available entertainment and information. Objective: This study aimed to identify and examine distinct latent profiles of media use in families with young children. We hypothesized that latent profile analysis (LPA) would identify different media use profiles characterized by more heavy, reactive, individual, and permissive media use and more intentional, regulated, or shared uses of media. Methods: We analyzed data from 398 preschool-aged children. English-speaking parents were recruited through community settings. Participants completed surveys regarding several aspects of family media use, such as child device use or activities, parent concerns and attitudes, limit setting and mediation, parent media use, and technology interference, examined in an LPA. The number of latent media profiles was determined using Bayesian Information Criteria. Parents also completed validated scales of parenting stress, depression symptoms, parenting style, child behavior, child sleep, and household disorganization. Multivariable logistic regression was used to examine parent, child, and household predictors of group membership. Results: The LPA yielded 2 distinct groups that differed in the duration of media used by parents and children, to calm children or help them fall asleep. Statistically significant differences between groups included: families in group 1 (n=236, which we termed social-emotional drivers) had parents who preferred interactions via text or email to in-person (P=.01) and were more likely to use media to calm their children (P=.03); in contrast, families in group 2 (n=162, intentional media) used more task-oriented media, like audio and nongame apps (P=.01), had more concerns about effects of media on child language development (P=.04), and used more media restrictions (P=.01). In regression models, female sex of the parent respondent, greater number of siblings, and later child sleep midpoint independently predicted group 1 membership. Conclusions: Findings suggest divergent family media use patterns that can be categorized into 2 main media user groups: those using media to buffer social situations or regulate emotions and those planning mobile device use around functional purposes and concerns around media exposure. Profiles were associated with household size and child sleep. More research is needed to examine the impact of social and emotional uses of media on child outcomes. %R 10.2196/59215 %U https://pediatrics.jmir.org/2025/1/e59215 %U https://doi.org/10.2196/59215 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65343 %T Association of Screen Content With Early Development Among Preschoolers in Shanghai: 7-Day Monitoring Study With Auto Intelligent Technology %A Chen,Hao %A Sun,Yi %A Luo,Sha %A Ma,Yingyan %A Li,Chenshu %A Xiao,Yingcheng %A Zhang,Yimeng %A Lin,Senlin %A Jia,Yingnan %+ Preventive Medicine and Health Education Department, School of Public Health, Fudan University, No 138 Yixueyuan Road, Shanghai, 200032, China, 86 13764665540, jyn@fudan.edu.cn %K types of screen content %K screen time %K intelligent technology %K early development %K preschool %D 2025 %7 5.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: It is unclear how exposure to different types of screen content is associated with early development among preschool children. Objective: This study aims to precisely evaluate the screen exposure time across different content types and to explore the associations with the Ages and Stages Questionnaire, Third Edition (ASQ-3) score and 5 capacity domains in children aged 34.5-66 months. Methods: This monitoring study used intelligent technology to collect data on the 7-day screen time and the time spent viewing each content type. The participants were 2 groups of Shanghai kindergarten kids. The data were collected between March 2023 and July 2023. Screen exposure data (total daily time and time for each type of content) were collected from children aged between 34.5 and 66 months. A self-designed questionnaire and the Healthy Screen Viewing for Children intelligent technology app were used to assess screen exposure to all media and tablets. The ASQ-3 was used to assess early development in children aged 34.5-66 months. Results: In the 535-child sample, the results of linear regression analysis indicated that both screen time of more than 60 minutes and exposure to smartphones and tablets were negatively associated with ASQ-3 score. Among 365 participants with data collected by the Healthy Screen Viewing for Children app, median regression showed that the median total ASQ-3 score was negatively associated with screen time for noneducational content (β=–.055; 95% CI –0.148 to –0.006; P=.03), screen time for both educational and noneducational content (β=–.042; 95% CI –0.081 to –0.007; P=.001), and fast-paced content (β=–.034; 95% CI –0.062 to –0.011; P=.049). The median gross motor score was negatively associated with screen time for parental guidance-13–rated content (β=–.015; 95% CI –0.022 to 0.009; P=.03), educational and noneducational content (β=–.018, 95% CI –0.038 to –0.001; P=.02), static content (β=–.022; 95% CI –0.050 to 0.007; P=.02). This study also revealed that the median fine motor score was negatively associated with screen time for guidance–rated content (β=–.032, 95% CI –0.057 to –0.003; P=.006), parental guidance (PG) rated content (β=–.020; 95% CI –0.036 to –0.007; P=.004), noneducational content (β=–.026; 95% CI –0.067 to –0.003; P=.01), both educational and noneducational content (β=–.020; 95% CI –0.034 to –0.001; P<.001), fast-paced content (β=–.022; 95% CI –0.033 to –0.014; P<.001), static content (β=–.034; 95% CI –0.050 to 0.018; P<.001), animated content (β=–.038; 95% CI –0.069 to –0.001; P=.004), and screen use during the daytime (β=–.026; 95% CI –0.043 to 0.005; P=.005). Conclusions: The results indicated that the time spent viewing noneducational, static, fast-paced, and animated content was negatively associated with early development among preschool children. Limiting screen time in relevant aspects is recommended. %M 40053802 %R 10.2196/65343 %U https://www.jmir.org/2025/1/e65343 %U https://doi.org/10.2196/65343 %U http://www.ncbi.nlm.nih.gov/pubmed/40053802 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e57636 %T Parental Technoference and Child Problematic Media Use: Meta-Analysis %A Zhang,Jinghui %A Zhang,Qing %A Xiao,Bowen %A Cao,Yuxuan %A Chen,Yu %A Li,Yan %+ , Shanghai Institute of Early Childhood Education, Shanghai Normal University, 100 Guilin Road, Xuhui District, Shanghai, 200234, China, 86 18939892301, liyan@shnu.edu.cn %K parental technoference %K child %K problematic media use %K meta-analysis %K children %K youth %K adolescents %K phubbing %K screen distraction %K systematic reviews %K interventions %K mental health %K digital health %D 2025 %7 22.1.2025 %9 Review %J J Med Internet Res %G English %X Background: Parental technoference, the interruption of parent-child interactions by technology, has been associated with negative outcomes in children’s media use. However, the magnitude of this relationship and its moderating factors remain unclear. Objective: This study aims to systematically examine the relationship between parental technoference and child problematic media use, as well as to identify moderating factors such as age, parental technoference group, study design, and type of problematic media use. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive literature search was conducted up to August 2024 across multiple databases, including Web of Science, EBSCO, ProQuest, PubMed, PsycINFO, and China National Knowledge Infrastructure, using predefined search strings. A total of 53 studies with a total of 60,555 participants (mean age of 13.84, SD 1.18 years) were included. Inclusion criteria comprised studies involving children under the age of 22 years, assessing the association between parental technoference and child problematic media use with valid measures, and reporting necessary statistical data. Exclusion criteria included studies focusing on other child outcomes, having sample sizes <30, or being case reports or review papers. The risk of bias was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A random-effects meta-analysis was performed using R (version 4.2.1; R Foundation for Statistical Computing) with the meta and metafor packages to evaluate the association and conduct moderator analyses. Results: The meta-analysis identified a significant positive association between parental technoference and child problematic media use (r=0.296, 95% CI 0.259-0.331). Moderator analyses revealed that both parental technoference group (P<.001) and study design (P=.008) significantly influenced this relationship. Specifically, the association was stronger when both parents engaged in technoference compared to when only 1 parent did, and in cross-sectional studies compared to longitudinal studies. Age, gender, publication status, and type of problematic media use did not significantly moderate the relationship (all P>.05). Conclusions: This meta-analysis provides robust evidence of the association between parental technoference and child problematic media use. The findings highlight the need for family-based interventions and underscore the importance of longitudinal research to understand the temporal dynamics of this relationship better. Trial Registration: PROSPERO CRD42023471997; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=471997 %M 39841982 %R 10.2196/57636 %U https://www.jmir.org/2025/1/e57636 %U https://doi.org/10.2196/57636 %U http://www.ncbi.nlm.nih.gov/pubmed/39841982 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e59441 %T Reciprocal Relationship Between Self-Control Belief and Gaming Disorder in Children and Adolescents: Longitudinal Survey Study %A Zhu,Shimin %A Qi,Di %K growth mindset %K gaming disorder %K cross-lagged panel model %K children %K self-control %K adolescents %D 2025 %7 15.1.2025 %9 %J JMIR Serious Games %G English %X Background: Children and adolescents are often at the crossroads of leisure gaming and excessive gaming. It is essential to identify the modifiable psychosocial factors influencing gaming disorder development. The lay theories of self-control (ie, the beliefs about whether self-control can be improved, also called self-control mindsets) may interplay with self-control and gaming disorder and serve as a promising influential factor for gaming disorder. Objective: This study aims to answer the research questions “Does believing one’s self-control is unchangeable predict more severe gaming disorder symptoms later?” and “Does the severity of gaming disorder symptoms prospectively predict self-control mindsets?” with a 1-year, 2-wave, school-based longitudinal survey. Methods: A total of 3264 students (338 in grades 4‐5 and 2926 in grades 7‐10) from 15 schools in Hong Kong participated in the classroom surveys. We used cross-lagged panel models to examine the direction of the longitudinal association between self-control mindsets and gaming disorder. Results: A bidirectional relationship was found between self-control mindsets and gaming disorder symptom severity (the cross-lagged path from mindsets to gaming disorder: regression coefficients [b] with 95% CI [0.070, 0.020-0.12o, P=.006]; and from gaming disorder to mindsets: b with 95% CI [0.11, 0.060-0.160, P<.001]). Subgroup analyses of boy and girl participants revealed that more growth mindsets regarding self-control predicted less severe gaming disorder symptoms in girls (b=0.12, 95% CI 0.053-0.190, P=.001) but not in boys (b=0.025, 95% CI –0.050 to 0.100, P=.51), while more severe gaming disorder symptoms predicted a more fixed mindset of self-control in both boys (b=0.15, 95% CI 0.069-0.230, P<.001) and girls (b=0.098, 95% CI 0.031-0.170, P=.004) after 1 year. Conclusions: Our findings demonstrated the negative impact of gaming disorder on one’s self-control malleability beliefs and implied that promoting a growth mindset regarding self-control might be a promising strategy for gaming disorder prevention and early intervention, especially for girls. %R 10.2196/59441 %U https://games.jmir.org/2025/1/e59441 %U https://doi.org/10.2196/59441 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e62943 %T Supervised and Unsupervised Screen Time and Its Association With Physical, Mental, and Social Health of School-Going Children in Dhaka, Bangladesh: Cross-Sectional Study %A Kakon,Shahria Hafiz %A Soron,Tanjir Rashid %A Hossain,Mohammad Sharif %A Haque,Rashidul %A Tofail,Fahmida %K screen time %K parental supervision %K Strength and Difficulties Questionnaire %K Spencer Children Anxiety Scale %K Pittsburgh Sleep Quality Scale %K children %K sleep quality %K headache %K behavioral problems %D 2025 %7 14.1.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Children’s screen time has substantially increased worldwide, including in Bangladesh, especially since the pandemic, which is raising concern about its potential adverse effects on their physical, mental, and social health. Parental supervision may play a crucial role in mitigating these negative impacts. However, there is a lack of empirical evidence assessing the relationship between parental screen time supervision and health outcomes among school children in Dhaka, Bangladesh. Objective: We aimed to explore the association between supervised and unsupervised screen time on the physical, mental, and social health of school-going children in Dhaka, Bangladesh. Methods: We conducted a cross-sectional descriptive study between July 2022 and June 2024. A total of 420 children, aged 6‐14 years, were enrolled via the stratified random sampling method across three English medium and three Bangla medium schools in Dhaka. Data were collected through a semistructured questionnaire; anthropometry measurements; and the Bangla-validated Strength and Difficulties Questionnaire (SDQ), Pittsburgh Sleep Quality Index (PSQI) Scale, and Spencer Children Anxiety Scale (SCAS). Results: A total of 234 out of 420 students (56%) used digital screen devices without parental supervision. We did not find a substantial difference in the duration of the daily mean use of digital devices among the supervised students (4.5 hours, SD 2.2 hours) and the unsupervised students (4.6 hours, SD 2.4 hours). According to the type of school, English medium school children had a mean higher screen time (5.46 hours, SD 2.32 hours) compared to Bangla medium school children (3.67 hours, SD 2.00 hours). Headache was significantly higher among the unsupervised digital screen users compared to those who used digital screens with parental supervision (175/336 students, 52.1% versus 161/336 students, 47.9%; P<.003). Moreover, students who used digital screens without parental supervision had poor quality of sleep. Behavioral problems such as conduct issues (119/420 students, 28.3%) and peer difficulties (121/420 students, 28.8%) were observed among the participants. However, when comparing supervised and unsupervised students, we found no statistically significant differences in the prevalence of these issues. Conclusions: The findings of the study showed that the lack of screen time supervision is associated with negative health effects in children. The roles of various stakeholders, including schools, parents, policy makers, and students themselves, are crucial in developing effective guidelines for managing screen use among students. Further research is needed to demonstrate causal mechanisms; identify the best interventions; and determine the role of mediators and moderators in households, surroundings, and schools. %R 10.2196/62943 %U https://pediatrics.jmir.org/2025/1/e62943 %U https://doi.org/10.2196/62943 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59968 %T Prevention and Health Promotion Interventions for Young People in the Context of Digital Well-Being: Rapid Systematic Review %A Colder Carras,Michelle %A Aljuboori,Dahlia %A Shi,Jing %A Date,Mayank %A Karkoub,Fatima %A García Ortiz,Karla %A Abreha,Fasika Molla %A Thrul,Johannes %+ Carras Colder Carras, 3375 Ellicott Center Dr Unit 1675, Ellicott City, MD, 21043, United States, 1 410 412 0797, michelle@carrasandco.com %K digital well-being %K internet addiction %K gaming disorder %K social media %K screen time %K prevention %K children %K adolescents %K mobile phone %K PRISMA %D 2024 %7 18.12.2024 %9 Review %J J Med Internet Res %G English %X Background: Increasing digital technology and media use among young people has raised concerns about problematic use and negative consequences. The formal recognition of a technology addiction (eg, gaming disorder) requires an understanding of the landscape of interventions designed to prevent this disorder and related technology addictions. Objective: We conducted a rapid systematic review to investigate the current evidence on approaches to prevent problematic technology use and promote digital well-being, defined as the healthy use of digital media and technology and the absence of problems resulting from excessive use. Methods: We used a pragmatic and rapid approach to systematically review and synthesize recent literature with a focus on contextual factors that can aid in understanding translatability, making trade-offs appropriate for rapid reviews per the Cochrane Collaboration guidelines. We searched multiple databases, including gray literature, for primary studies and systematic reviews of prevention interventions targeting children, adolescents, and youth. We extracted data on study characteristics, quality, and translatability and synthesized evidence through narrative description and vote counting of controlled trials. Data are openly available on our Open Science Framework website. Results: We found 6416 citations, of which 41 (0.64%) were eligible for inclusion (6 reviews and 35 primary studies of 33 interventions). Most interventions (26/33, 79%) combined intervention approaches and included an education component. Synthesis through vote counting showed benefits for all forms of digital well-being. Both included meta-analyses reported small positive effects on reductions of screen time. However, study reporting was overall lacking, impairing the ability to draw conclusions. Conclusions: As digital technology use increases, interventions to prevent problematic technology use and promote digital well-being continue to proliferate. Understanding context factors that influence healthy technology use and understanding the limitations of the current evidence are vital for informing future research. This review demonstrates positive findings for the effectiveness of prevention interventions and describes factors that may contribute to translation and implementation. Future research would benefit from following appropriate reporting guidelines, reporting both the benefits and harms of interventions, and including greater detail on factors informing translation. Trial Registration: PROSPERO CRD42023444387; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=444387 %M 39693138 %R 10.2196/59968 %U https://www.jmir.org/2024/1/e59968 %U https://doi.org/10.2196/59968 %U http://www.ncbi.nlm.nih.gov/pubmed/39693138 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59585 %T Ten Myths About the Effect of Social Media Use on Well-Being %A Hall,Jeffrey A %+ Department of Communication Studies, University of Kansas, Bailey Hall, 1440 Jayhawk Boulevard, Lawrence, KS, 66045, United States, 1 7858641082, hallj@ku.edu %K social media %K well-being %K health promotion %K depressive disorder %K depression %K anxiety %K adolescent %K mental health %D 2024 %7 25.11.2024 %9 Viewpoint %J J Med Internet Res %G English %X This viewpoint reviews the empirical evidence regarding the association between social media use and well-being, including life satisfaction and affective well-being, and the association between social media use and ill-being, including loneliness, anxiety, and depressive symptomology. To frame this discussion, this viewpoint will present 10 widely believed myths about social media, each drawn from popular discourse on the topic. In rebuttal, this viewpoint will offer a warranted claim supported by the research. The goal is to bring popular beliefs into dialogue with state-of-the-art quantitative social scientific evidence. It is the intention of this viewpoint to provide a more accurate and nuanced claim to challenge each myth. This viewpoint will bring attention to the importance of using rigorous scientific evidence to inform public debates about social media use and well-being, especially among adolescents and young adults. %M 39586087 %R 10.2196/59585 %U https://www.jmir.org/2024/1/e59585 %U https://doi.org/10.2196/59585 %U http://www.ncbi.nlm.nih.gov/pubmed/39586087 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52478 %T Cognitive Mechanisms Between Psychosocial Resources and the Behavioral Intention of Professional Help-Seeking for Internet Gaming Disorder Among Chinese Adolescent Gamers: Cross-Sectional Mediation Study %A Yu,Yanqiu %A Ng,Joyce Hoi-Yuk %A Li,Ji-bin %A Zhang,Jianxin %A Lau,Joseph T F %K professional help-seeking %K behavioral intention %K internet gaming disorder %K IGD %K perception %K China %K mental health %K psychosocial resource %K secondary school %K gamer %K cross-sectional survey %D 2024 %7 14.11.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Internet gaming disorder (IGD) is a global public health concern for adolescents due to its potential severe negative consequences. Professional help-seeking is important for early screening, diagnosis, and treatment of IGD. However, research on the factors associated with professional help-seeking for IGD as well as relevant mediation mechanisms among adolescents is limited. Objective: Based on the stress coping theory, the conservation of resource theory, and behavioral change theories, this study investigated the prevalence and factors influencing the behavioral intention of professional help-seeking for internet gaming disorder (BI-PHSIGD). The research also explored the underlying mechanisms, including psychosocial resources like resilience and social support, perceived resource loss due to reduced gaming time, and self-efficacy, in professional help-seeking among adolescent internet gamers. Methods: A cross-sectional survey was conducted among secondary school students who were internet gamers in 2 Chinese cities from October 2019 to January 2020. Data from the full sample (N=1526) and a subsample of 256 IGD cases (according to the 9-item DSM-5 [Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition] IGD Checklist) were analyzed. Multivariate logistic regression analysis was conducted to examine the factors of BI-PHSIGD, while structural equation modeling was performed to test the proposed mediation mechanisms. Results: The prevalence of BI-PHSIGD was 54.3% (829/1526) in the full sample and 40.6% (104/256) in the IGD subsample (vs 708/1239, 57.1% among non-IGD cases). In the full sample, psychosocial resources of resilience (adjusted odds ratio [aOR] 1.03, 95% CI 1.02-1.05) and social support (aOR 1.03, 95% CI 1.02-1.04) as well as self-efficacy in professional help-seeking (aOR 1.64, 95% CI 1.49-1.81) were positively associated with BI-PHSIGD, while perceived resource loss due to reduced gaming time was negatively associated with BI-PHSIGD (aOR 0.97, 95% CI 0.96-0.98); the positive association between psychosocial resources and BI-PHSIGD was fully mediated via 2 single-mediator indirect paths (via self-efficacy in professional help-seeking alone: effect size=53.4%; indirect effect/total effect=0.10/0.19 and via perceived resource loss due to reduced gaming time alone: effect size=17.8%; indirect effect/total effect=0.03/0.19) and one 2-mediator serial indirect path (first via perceived resource loss due to reduced gaming time then via self-efficacy in professional help-seeking: effect size=4.7%; indirect effect/total effect=0.009/0.19). In the IGD subgroup, a full mediation via self-efficacy in professional help-seeking alone but not the other 2 indirect paths was statistically significant. Conclusions: Many adolescent internet gamers, especially those with IGD, were unwilling to seek professional help; as a result, early treatment is often difficult to achieve. To increase BI-PHSIGD, enhancing psychosocial resources such as resilience and social support, perceived resource loss due to reduced gaming time, and self-efficacy in professional help-seeking may be effective. Future longitudinal and intervention studies are needed to confirm and extend the findings. %R 10.2196/52478 %U https://publichealth.jmir.org/2024/1/e52478 %U https://doi.org/10.2196/52478 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e51833 %T Study to Evaluate the Comparative Efficacy of Medhya Rasayana (Pharmacological) Versus Nonpharmacological Interventions in Management of Gadget Addiction in Children: Protocol for Parallel, Triple-Arm, Randomized Clinical Trial %A Yewale,Prasad %A Rathi,Renu %A Mate,Swapnali %+ Mahatma Gandhi Ayurved College Hospital and Research Centre, Datta Meghe Institute of Higher Education and Research (Deemed to be University) Sawangi Meghe, Maharashtra, Wardha, 442001, India, 91 9096165511, prasad.kaumarbhritya@dmiher.edu.in %K addiction %K Ayurveda %K gadget addiction %K children %K Kaumarbhritya %K Medhya Rasayana %K yoga %K complementary and alternative medicine %D 2024 %7 11.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Gadget addiction is a common behavioral problem among children. It is known to hamper social and academic life as well as adversely affect the lives of children. Ayurveda offers many therapeutic modalities and Ayurvedic medicines that can be used in the management of gadget addiction in children. The purpose of this study is to evaluate and compare the effectiveness of nonpharmacological therapies and the pharmaceutical intervention Medhya Rasayana in treating childhood gadget addiction. Objective: This study aims to provide a detailed description of the study methodology that will be used to compare the efficacy of nonpharmacological versus pharmaceutical interventions in the treatment of children’s gadget addiction. Methods: A randomized, parallel, triple-arm interventional study will be conducted on diagnosed participants of gadget addiction with an age group of 6- to 16-year-old children, which will be selected and equally distributed in 2 groups. Group P will be given Medhya Rasayana (pharmacological intervention), group N will be nonpharmacological Ayurveda intervention, and group C (cognitive behavioral therapy) will be an external group. The Study duration is 180 days with assessment at baseline, midpoint, and endpoint Appropriate statistical techniques, such as ANOVA and regression analysis, will be used to examine the data and evaluate the efficacy of the 3 groups’ interventions. We will perform subgroup analysis according to initial addiction severity, gender, and age. Primary outcome measures include a reduction in gadget addiction and changes in the psychosocial well-being of participants. Standardized questionnaires and instruments will be used to collect data. Results: In December 2023, the randomized controlled study got underway. Since participants may begin at any time, our goal is for everyone to be finished by December 2024. Conclusions: This research will provide crucial new information about the relative effectiveness of Ayurveda nonpharmacological therapies and Medhya Rasayana in treating children’s gadget addiction. The results will guide evidence-based treatments aimed at reducing the negative impact of excessive gadget use on this susceptible population’s psychosocial development. In the end, the findings are meant to help policy makers and medical professionals create sensible plans to deal with the rising issue of childhood gadget addiction. International Registered Report Identifier (IRRID): PRR1-10.2196/51833 %M 39527798 %R 10.2196/51833 %U https://www.researchprotocols.org/2024/1/e51833 %U https://doi.org/10.2196/51833 %U http://www.ncbi.nlm.nih.gov/pubmed/39527798 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e58127 %T Mobile Apps for the Personal Safety of At-Risk Children and Youth: Scoping Review %A Bowen-Forbes,Camille %A Khondaker,Tilovatul %A Stafinski,Tania %A Hadizadeh,Maliheh %A Menon,Devidas %+ Health Technology and Policy Unit, School of Public Health, Edmonton Clinic Health Academy, 11405 St 87 Avenue NW, Edmonton, AB, T6G 1C9, Canada, 1 587 712 2086, bowenfor@ualberta.ca %K children %K youth %K personal safety apps %K smartphones %K mobile apps %K violence %K bullying %K suicide prevention %K youth support %K homeless support %K mobile phone %D 2024 %7 5.11.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Personal safety is a widespread public health issue that affects people of all demographics. There is a growing interest in the use of mobile apps for enhancing personal safety, particularly for children and youth at risk, who are among the most vulnerable groups in society. Objective: This study aims to explore what is known about the use of mobile apps for personal safety among children and youth identified to be “at risk.” Methods: A scoping review following published methodological guidelines was conducted. In total, 5 databases (Scopus, SocINDEX, PsycINFO, Compendex, and Inspec Archive) were searched for relevant scholarly articles published between January 2005 and October 2023. The gray literature was searched using Google and Google Scholar search engines. The results were reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. For summarizing the features and users’ experiences of the apps, a published framework for evaluating the quality of mobile health apps for youth was used. Results: A total of 1986 articles were identified, and 41 (2.1%) were included in the review. Nine personal safety apps were captured and categorized into 4 groups based on the goals of the apps, as follows: dating and sexual violence prevention (n=4, 44% of apps), bullying and school violence prevention (n=2, 22% of apps), self-harm and suicide prevention (n=2, 22% of apps), and homeless youth support (n=1, 11% of apps). Of the 41 articles, 25 (61%) provided data solely on app descriptions and features, while the remaining 16 (39%) articles provided data on app evaluations and descriptions. Outcomes focused on app engagement, users’ experiences, and effectiveness. Four articles reported on app use, 3 (75%) of which reported relatively high app use. Data on users’ experience were obtained from 13 studies. In general, participants found the app features to be easy to use and useful as educational resources and personal safety tools. Most of the views were positive. Negative perceptions included redundancy of app features and a lack of usefulness. Five apps were evaluated for effectiveness (n=2, 40% dating and sexual violence prevention; n=2, 40% self-harm and suicide prevention; and n=1, 20% bullying and school violence prevention) and were all associated with a statistically significant reduction (P=.001 to .048) in harm or risk to participants at the 95% CI. Conclusions: Although many personal safety apps are available, few studies have specifically evaluated those designed for youth. However, the evidence suggests that mobile safety apps generally appear to be beneficial for reducing harm to at-risk children and youth without any associated adverse events. Recommendations for future research have been made to strengthen the evidence and increase the availability of effective personal safety apps for children and youth. %M 39499918 %R 10.2196/58127 %U https://mhealth.jmir.org/2024/1/e58127 %U https://doi.org/10.2196/58127 %U http://www.ncbi.nlm.nih.gov/pubmed/39499918 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59490 %T Interaction Effects Between Low Self-Control and Meaning in Life on Internet Gaming Disorder Symptoms and Functioning in Chinese Adolescents: Cross-Sectional Latent Moderated Structural Equation Modeling Study %A Fong,Ted CT %A Cui,Kunjie %A Yip,Paul SF %+ Research Institute of Social Development, Southwestern University of Finance and Economics, No. 555 Liutai Road, Wenjiang District, Chengdu, 611100, China, 86 17512828565, cuikunjie@swufe.edu.cn %K Chinese %K impulsivity %K interaction effects %K internet gaming disorder %K latent moderation %K meaning in life %K self-control %K temper %D 2024 %7 4.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet gaming disorder (IGD) is an emerging behavioral addiction with mental health implications among adolescents. Low self-control is an established risk factor of IGD. Few studies have, however, examined the moderating role of meaning in life (MIL) on the relationships between low self-control and IGD symptoms and functioning. Objective: This study aimed to examine the effects of low self-control and MIL and their interaction effects on IGD symptoms and family and school functioning in a structural equation model. Methods: A sample of 2064 adolescents (967, 46.9% male; mean age 14.6 years) was recruited by multistage cluster random sampling from 5 middle schools in Sichuan, China, in 2022. The participants completed a self-report questionnaire with validated measures on low self-control, presence of MIL, search for MIL, IGD symptoms, school commitment, and family functioning. Construct validity, measurement invariance, and structural invariance of the measures were evaluated by confirmatory factor analysis across sex. Structural equation modeling was conducted to examine the indirect effects of low self-control and MIL on family and school functioning through IGD symptoms. Latent moderated structural equation modeling was performed to examine the interaction effects between low self-control and MIL on IGD symptoms, school commitment, and family functioning. Results: All scales showed satisfactory model fit and scalar measurement invariance by sex. Males showed significantly greater IGD symptoms and lower levels of self-control (Cohen d=0.25-1.20, P<.001) than females. IGD symptoms were significantly and positively associated with impulsivity (β=.20, P=.01), temper (β=.25, P<.001), and search for meaning (β=.11, P=.048) and significantly and negatively associated with presence of meaning (β=–.21, P<.001). Presence of MIL and impulsivity showed a significant and negative interaction effect (β=–.11, SE .05; P=.03) on IGD symptoms. The positive effect of impulsivity on IGD symptoms was stronger among adolescents with low presence of MIL than those with high presence of MIL. Temper showed significant and positive interaction effects with presence of MIL (β=.08, SE .04; P=.03) and search for MIL (β=.08, SE .04; P=.04) on family functioning. The negative effects of temper on family functioning were stronger among adolescents with low levels of MIL than among those with high levels of MIL. Conclusions: This study provides the first findings on the interaction effects between low self-control and presence of MIL and search for MIL on IGD symptoms and functioning among a large sample of adolescents in rural China. The results have implications for targeted interventions to help male adolescents with lower self-control and presence of meaning. %M 39496163 %R 10.2196/59490 %U https://www.jmir.org/2024/1/e59490 %U https://doi.org/10.2196/59490 %U http://www.ncbi.nlm.nih.gov/pubmed/39496163 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56387 %T Family-Centered Treatment Program for Problematic Gaming and Excessive Screen Use in a Clinical Child and Youth Population (FAME): Protocol for a Feasibility Pilot Mixed Method Study %A Werner,Marie %A Kapetanovic,Sabina %A Claesdotter-Knutsson,Emma %+ Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, BOX 117, Lund, 22100, Sweden, 46 724685697, marie.werner@skane.se %K gaming %K family program %K family intervention %K pilot study, %K adolescent %K problematic gaming %K excessive screen time %K children %K screen use %K child-parent relationship %K motivational interviewing %D 2024 %7 8.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Screen time among children and adolescents has increased dramatically, raising concerns about its impact on development and mental health. While research highlights both potential benefits and risks, excessive use has been linked to issues like anxiety, depression, and gaming addiction. Despite growing concern, effective interventions are scarce. Recognizing the importance of family dynamics in child development, we propose a family-centered program to address problematic gaming and excessive screen use in a clinical population. By involving both children and parents, we aim to create a more comprehensive approach to prevention and treatment. Objective: This study aims to determine the possibility of distributing and evaluating a family-centered group program for problematic gaming and excessive screen use (FAME) in a clinical child and adolescent psychiatry (CAP) population. We will monitor the recruitment rate; track the retention and attendance rates of both parents and children; and assess whether each session’s objectives are met, the content is delivered within the allotted time, and the necessary resources (eg, facilitators and materials) are available. Additionally, we will gather qualitative and quantitative feedback from participants through postprogram surveys and individual interviews with both children and parents. Methods: A total of 10 families with ongoing contact with CAP in Skåne, Sweden, will be recruited and offered participation in a family-centered group program targeting children aged 10-18 years with reported difficulties regarding screen gaming or screen use. The intervention to be tested is a newly developed, family-centered, psychoeducational, cognitive behavioral therapy–based intervention addressing both positive and negative aspects of screen use; setting boundaries; the connection between thoughts, feelings, and behaviors; conflict triggers; and sleep hygiene. The primary goal of the pilot study is to test the feasibility of the program, as well as recruitment and the analysis of participants’ experiences with the program. Results: A total of 11 children and their parents were enrolled during first quarter of 2024. A 4-session pilot was delivered in first quarter of 2024, and the first results are expected in the third quarter of 2024. Conclusions: The overarching goal of this pilot study is to determine the possibility of distributing and evaluating a family-centered group program for problematic gaming and excessive screen use (FAME) in a clinical CAP population. The insights gained from this study will guide our future research, which will focus on conducting a larger-scale evaluation of the intervention’s impact on family screen time conflicts and inform future strategies for the implementation of family-centered interventions in child and youth clinics. Trial Registration: ClinicalTrials.gov NCT06098807; https://clinicaltrials.gov/study/NCT06098807 International Registered Report Identifier (IRRID): DERR1-10.2196/56387 %M 39378066 %R 10.2196/56387 %U https://www.researchprotocols.org/2024/1/e56387 %U https://doi.org/10.2196/56387 %U http://www.ncbi.nlm.nih.gov/pubmed/39378066 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53101 %T Dose-Response Associations of Internet Use Time and Internet Addiction With Depressive Symptoms Among Chinese Children and Adolescents: Cross-Sectional Study %A Li,Juanjuan %A Sun,Weidi %A Luo,Zeyu %A Liu,Yi %A Huang,Xuanyin %A Jiang,Denan %A Li,Shuting %A Meng,Jia %A Gu,Fang %A Zhang,Ronghua %A Song,Peige %K internet use %K internet addiction %K depression %K children %K adolescents %K China %K depressive symptoms %D 2024 %7 23.9.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Children’s lives are increasingly mediated by digital technologies, yet evidence regarding the associations between internet use and depression is far from comprehensive and remains unclear. Objective: This study aimed to investigate the dose-response association between internet use, including use time and addiction behaviors, and depressive symptoms among children and adolescents in Zhejiang Province. Methods: Data were collected from a school-based health survey China Common Disease and Risk Factor Surveillance Among Students, encompassing 21,336 students in Zhejiang Province. The daily internet use time, internet addiction (IA) behaviors, and depressive symptoms were assessed with questionnaires. Logistic regression models were used to explore the associations of internet use time and IA behaviors with depressive symptoms among children and adolescents. Restricted cubic spline curves were used to determine the dose-response associations. Results: A total of 6225 (29.2%) students had depressive symptoms. Compared to those reporting no internet use, boys using the internet for >2 hours/day (odds ratio [OR] 1.53, 95% CI 1.34‐1.74) and girls using internet for 1.1‐2 hours/day (OR 1.22, 95% CI 1.06‐1.39) and >2 hours/day (OR 1.70, 95% CI 1.50‐1.93) were at higher risks of depressive symptoms. A significant J-shaped association was identified between internet use time and depressive symptoms among children and adolescents, especially in boys and primary school students (nonlinear P values were .006, .003, and <.001, respectively). Increased IA behaviors were associated with a higher odd of depressive symptoms (1 IA behavior: OR 2.01, 95% CI 1.83‐2.21; 2 IA behaviors: 2.91, 95% CI 2.57‐3.29; and ≥3 IA behaviors: 4.72, 95% CI 4.26‐5.22). A positive nonlinear association between the number of IA behaviors and depressive symptoms was found in total population, girls, and primary school students (nonlinear P values were .02, .002, .007, respectively). Conclusions: Findings suggested that excessive internet use time and IA behaviors were significantly associated with an increased risk of depressive symptoms, highlighting the importance of interventions to regulate and educate about adequate internet use during childhood and adolescence. %R 10.2196/53101 %U https://publichealth.jmir.org/2024/1/e53101 %U https://doi.org/10.2196/53101 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52670 %T Factors Associated With the Use of Digital Technology Among Youth in Zimbabwe: Findings From a Cross-Sectional Population-Based Survey %A Martin,Kevin %A Peh,Rachel Wei Chun %A Tembo,Mandikudza %A Mavodza,Constancia Vimbayi %A Doyle,Aoife M %A Dziva Chikwari,Chido %A Dauya,Ethel %A Bandason,Tsitsi %A Azizi,Steven %A Simms,Victoria %A Ferrand,Rashida A %+ Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 2076368636, kevin.martin@lshtm.ac.uk %K Zimbabwe %K youth %K digital technology %K household wealth %D 2024 %7 23.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Globally, the increasing use of digital technologies such as mobile phones and the internet has allowed for the development of innovative mobile health interventions, particularly for reaching and engaging with youth. However, there is a risk that using such technologies may exclude those who lack access to them. Objective: In this study, we investigated the sociodemographic factors associated with mobile phone ownership, internet use, and social media use among youth in Zimbabwe. Methods: A population-based prevalence survey was conducted in 24 urban and periurban communities across 3 provinces of Zimbabwe (Harare, Mashonaland East, and Bulawayo). Youths aged 18 to 24 years resident in randomly selected households in the study communities completed an interviewer-administered questionnaire. The primary outcomes were mobile phone ownership and current internet and social media use. A household wealth indicator was developed using principal components analysis, based on household asset ownership. Multivariable logistic regression was used to investigate the factors associated with each primary outcome. Age, sex, and province were considered a priori confounders. Household wealth, marital status, education level, employment status, time lived at current address, and HIV status were included in the final multivariable model if there was an age-, sex-, and province-adjusted association with a primary outcome on univariable analysis at a significance level of P<.10. Results: Of the 17,636 participants assessed for the primary outcome, 16,370 (92.82%) had access to a mobile phone, and 15,454 (87.63%) owned a mobile phone. Among participants with access to a mobile phone, 58.61% (9594/16,370) and 57.79% (9460/16,370), respectively, used internet and social media at least weekly. Older age (adjusted odds ratio [aOR] 1.76, 95% CI 1.55-2.00), increasing wealth (ranging from aOR 1.85, 95% CI 1.58-2.16, for wealth quintile 2 to aOR 3.80, 95% CI 3.00-4.80, for wealth quintile 5, with quintile 1 as reference), and higher education level (secondary: aOR 1.96, 95% CI 1.60-2.39; tertiary: aOR 8.36, 95% CI 5.29-13.20) were associated with mobile phone ownership. Older age, male sex, increasing wealth, having never been married, higher education level, being in education or formal employment, and having lived at the same address for ≥2 years were associated with higher levels of internet and social media use. Conclusions: While mobile phone ownership was near-universal, over one-third of youths in urban and periurban settings did not have access to the internet and social media. Access to the internet and social media use were strongly associated with household wealth and education level. Mobile health interventions must ensure that they do not amplify existing inequalities in access to health care. Such interventions must be accompanied by alternative strategies to engage and enroll individuals without internet or social media access to prevent the exclusion of young people by sex and socioeconomic status. %M 39312390 %R 10.2196/52670 %U https://www.jmir.org/2024/1/e52670 %U https://doi.org/10.2196/52670 %U http://www.ncbi.nlm.nih.gov/pubmed/39312390 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52978 %T COVID-19–Related Social Isolation, Self-Control, and Internet Gaming Disorder Among Chinese University Students: Cross-Sectional Survey %A Guo,Yufang %A Yue,Fangyan %A Lu,Xiangyu %A Sun,Fengye %A Pan,Meixing %A Jia,Yannan %+ School of Nursing and Rehabilitation, Shandong University, 44 Wen Hua Xi Road, Jinan, 250012, China, 86 15269163352, cdguoyufang@163.com %K COVID-19 pandemic %K internet gaming disorder %K self-control %K social isolation %K university students %K game %K gaming %K games %K addict %K addictive %K addiction %K addictions %K university %K universities %K college %K colleges %K postsecondary %K higher education %K student %K students %K China %K Chinese %K isolation %K isolated %K self-compassion %K mental health %K association %K associations %K correlation %K causal %K correlated %K correlations %D 2024 %7 10.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet gaming disorder among university students has become a great concern for university counsellors worldwide since the COVID-19 pandemic. The factors influencing the development of internet gaming disorder in students during the COVID-19 pandemic could be different from those before the pandemic. Objective: This study aims to explore the associations among social isolation, self-control, and internet gaming disorder in Chinese university students and to examine whether self-control mediates the positive effects of social isolation on internet gaming disorder. Methods: A cross-sectional survey was employed to collect data from university students in Shandong province of China from April to September 2022. The Isolation subscale of the Self-Compassion Scale, Self-Control Scale, and Internet Gaming Disorder Scale were used to assess the social isolation, self-control, and internet gaming disorder among university students, respectively. Models 4 and 5 of PROCESS software were used to analyze the mediating role of self-control and the moderating role of gender on the association between social isolation and internet gaming disorder. Results: A total of 479 students were recruited from 6 universities located in 3 different regions of Shandong, China. Students had low levels of internet gaming disorder and moderate levels of social isolation and self-control, with mean scores of 8.94 (SD 9.06), 12.04 (SD 3.53), and 57.15 (SD 8.44), respectively. Social isolation was positively correlated with internet gaming disorder (r=0.217; P<.001), and self-control was negatively correlated with social isolation (r=–0.355; P<.001) and internet gaming disorder (r=–0.260; P<.001). Self-control played a mediating role in the association between social isolation and internet gaming disorder (β=–.185, 95% CI –.295 to –.087). The effects of social isolation on internet gaming disorder among female students were lower than those among male students. Conclusions: Self-control was a mediator in the association between social isolation and internet gaming disorder. Moreover, gender played a moderating role in the association between social isolation and internet gaming disorder. This study highlights the need to alleviate the development of internet gaming disorder among students during a pandemic, especially that of male students. Effective interventions that lessen social isolation and promote self-control should be developed. %M 39255486 %R 10.2196/52978 %U https://www.jmir.org/2024/1/e52978 %U https://doi.org/10.2196/52978 %U http://www.ncbi.nlm.nih.gov/pubmed/39255486 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e63692 %T The Effect of Prebedtime Behaviors on Sleep Duration and Quality in Children: Protocol for a Randomized Crossover Trial %A Jackson,Rosie %A Gu,Chao %A Haszard,Jillian %A Meredith-Jones,Kim %A Galland,Barbara %A Camp,Justine %A Brown,Deirdre %A Taylor,Rachael %+ Department of Medicine, University of Otago, Otago Medical School – Dunedin Campus, PO Box 56, Dunedin, 9054, New Zealand, 64 21479556, rachael.taylor@otago.ac.nz %K screen time %K digital device %K diet %K physical activity %K objective measurement %K wearable camera %K sleep %K mobile phone %D 2024 %7 20.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: It is recommended that children should avoid eating dinner, being physically active, or using screens in the hour before bed to ensure good sleep health. However, the evidence base behind these guidelines is weak and limited to cross-sectional studies using questionnaires. Objective: The aim of this randomized crossover trial was to use objective measures to experimentally determine whether recommendations to improve sleep by banning electronic media, physical activity, or food intake in the hour before bed, impact sleep quantity and quality in the youth. Methods: After a baseline week to assess usual behavior, 72 children (10-14.9 years old) will be randomized to four conditions, which are (1) avoid all 3 behaviors, (2) use screens for at least 30 minutes, (3) be physically active for at least 30 minutes, and (4) eat a large meal, during the hour before bed on days 5 to 7 of weeks 2 to 5. Families can choose which days of the week they undertake the intervention, but they must be the same days for each intervention week. Guidance on how to undertake each intervention will be provided. Interventions will only be undertaken during the school term to avoid known changes in sleep during school holidays. Intervention adherence and shuteye latency (time from getting into bed until attempting sleep) will be measured by wearable and stationary PatrolEyes video cameras (StuntCams). Sleep (total sleep time, sleep onset, and wake after sleep onset) will be measured using actigraphy (baseline, days 5 to 7 of each intervention week). Mixed effects regression models with a random effect for participants will be used to estimate mean differences (95% CI) for conditions 2 to 4 compared with condition 1. Results: Recruitment started in March 2024, and is anticipated to finish in April 2025. Following data analysis, we expect that results will be available later in 2026. Conclusions: Using objective measures, we will be able to establish if causal relationships exist between prebedtime behaviors and sleep in children. Such information is critical to ensure appropriate and achievable sleep guidelines. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12624000206527; https://tinyurl.com/3kcjmfnj International Registered Report Identifier (IRRID): DERR1-10.2196/63692 %M 39163119 %R 10.2196/63692 %U https://www.researchprotocols.org/2024/1/e63692 %U https://doi.org/10.2196/63692 %U http://www.ncbi.nlm.nih.gov/pubmed/39163119 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e39707 %T Screen Use Time and Its Association With Mental Health Issues in Young Adults in India: Protocol for a Cross-Sectional Study %A Deshpande,Swasti %A Sachdev,Ashmeet %A Maharana,Anwesha %A Zadey,Siddhesh %A Dharmadhikari,Surabhi P %A Ghate,Swati %A Godatwar,Pawankumar %A Ojha,Nisha Kumari %A Sharma,Sanjeev %+ Association for Socially Applicable Research, D2 Sai Heritage, New D P Road, Aundh, Pune, 411007, India, 91 9196999557, sidzadey@asarforindia.org %K mental health %K India %K screen use %K computer use %K screen time %K depression %K stress %K anxiety %K low- and middle-income country %K LMIC %K questionnaire %K survey %K instrument %K young adult %K mental well-being %K cross sectional %K internet use %K phone use %K young adults %D 2024 %7 16.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Screen use time has increased in the past decade owing to the increased availability and accessibility of digital devices and the internet. Several studies have shown an association between increased screen use time and mental health issues such as anxiety and depression. However, studies in the young adult population—a demographic with high screen use—and in low- and middle-income country settings are limited. Objective: This protocol describes a study that aims to measure self-reported screen use times and patterns in young adults (18-24 y) in India and assess if increased screen use time is associated with poorer mental well-being. Methods: This protocol describes a cross-sectional study of a pan-India, web-based convenience sample of young adults (18-24 y) with access to digital devices with a screen and a minimum of secondary school education. Participants will be recruited through people in the professional networks of the investigators, which includes pediatricians. The survey will also be distributed via the social media pages of our organization (X [X Corp], Instagram [Meta], Facebook [Meta], etc). Sociodemographic details will be collected through a questionnaire designed by the authors; screen use time and patterns will be assessed using an adaptation of the Screen Time Questionnaire to include data on different apps and websites used on digital devices; and mental health parameters will be gauged using the Warwick-Edinburgh Mental Well-Being Scale, Generalized Anxiety Disorder Scale, Perceived Stress Scale, and Patient Health Questionnaire. For statistical analysis, we will consider the following variables: (1) the primary independent variable is screen use time; (2) other independent variables include age, gender, residence: rural or urban, educational qualifications, employment status, stress associated with familial financial status, average sleep time, number of people living in a house or rooms in that house, BMI, substance use, and past psychiatric history; and (3) dependent variables include mental well-being, depression, anxiety, and perceived stress. To quantify the association between screen use time and mental health, we will perform a Bayesian multivariate multiple regression analysis that models the possibility of multiple alternative hypotheses while accounting for relevant sociodemographic covariables. Results: The survey instrument has been designed, and feedback has been obtained from the domain experts and members of our organization whose profile is similar to the potential study participants. The final data received after this study has been conducted will be analyzed and shared. As of January 2023, we have not yet initiated the data collection. Conclusions: Based on the findings of this study, we will be able to establish a correlation between device- and use-specific screen use time and various mental health parameters. This will provide a direction to develop screen use time and mental health guidelines among young adults. International Registered Report Identifier (IRRID): PRR1-10.2196/39707 %M 39012657 %R 10.2196/39707 %U https://www.researchprotocols.org/2024/1/e39707 %U https://doi.org/10.2196/39707 %U http://www.ncbi.nlm.nih.gov/pubmed/39012657 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e55364 %T Digital Interventions for Combating Internet Addiction in Young Children: Qualitative Study of Parent and Therapist Perspectives %A Theopilus,Yansen %A Al Mahmud,Abdullah %A Davis,Hilary %A Octavia,Johanna Renny %+ Centre for Design Innovation, Swinburne University of Technology, John St, Hawthorn, Melbourne, 3122, Australia, 61 39214383, aalmahmud@swin.edu.au %K addiction therapist %K children %K digital intervention %K internet addiction %K digital devices %K parents %K parental control %K mobile phone %D 2024 %7 26.4.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Internet addiction is an emerging mental health issue in this digital age. Nowadays, children start using the internet in early childhood, thus making them vulnerable to addictive use. Previous studies have reported that the risk of internet addiction tends to be higher in lower-income regions with lower quality of life, such as Indonesia. Indonesia has high risks and prevalence of internet addiction, including in children. Digital interventions have been developed as an option to combat internet addiction in children. However, little is known about what parents and therapists in Indonesia perceive about these types of interventions. Objective: This study aims to investigate the experiences, perceptions, and considerations of parents and therapists regarding digital interventions for combating internet addiction in young Indonesian children. Methods: This study used a qualitative exploratory approach through semistructured interviews. We involved 22 parents of children aged 7 to 11 years and 6 experienced internet addiction therapists for children. The interview data were transcribed and analyzed using thematic analysis. Results: Participants in this study recognized 3 existing digital interventions to combat internet addiction: Google Family Link, YouTube Kids, and Apple parental control. They perceived that digital interventions could be beneficial in continuously promoting healthy digital behavior in children and supporting parents in supervision. However, the existing interventions were not highly used due to limitations such as the apps’ functionality and usability, parental capability, parent-child relationships, cultural incompatibility, and data privacy. Conclusions: The findings suggest that digital interventions should focus not only on restricting and monitoring screen time but also on suggesting substitutive activities for children, developing children’s competencies to combat addictive behavior, improving digital literacy in children and parents, and supporting parental decision-making to promote healthy digital behavior in their children. Suggestions for future digital interventions are provided, such as making the existing features more usable and relatable, investigating gamification features to enhance parental motivation and capability in managing their children’s internet use, providing tailored or personalized content to suit users’ characteristics, and considering the provision of training and information about the use of interventions and privacy agreements. %M 38669672 %R 10.2196/55364 %U https://pediatrics.jmir.org/2024/1/e55364 %U https://doi.org/10.2196/55364 %U http://www.ncbi.nlm.nih.gov/pubmed/38669672 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40190 %T The Relationship Between Lockdowns and Video Game Playtime: Multilevel Time-Series Analysis Using Massive-Scale Data Telemetry %A Zendle,David %A Flick,Catherine %A Halgarth,Darel %A Ballou,Nick %A Cutting,Joe %A Drachen,Anders %+ Department of Computer Science, University of York, Heslington Way, York, YO10 5GH, United Kingdom, 44 1904320000, david.zendle@york.ac.uk %K COVID-19 %K lockdown policy %K disordered gaming %K big data %K playtime %K policy %K lockdown %K public health %K side effects %K pandemic %K video games %K playing %K gaming %K time %K disordered %D 2023 %7 8.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 led governments worldwide to enact a variety of containment and closure policies. Substantial attention has been directed toward the idea that these public health measures may have unanticipated negative side effects. One proposed effect relates to video games. There is a nascent evidence base suggesting that individuals played video games for longer and in a more disordered manner during lockdowns and school closures specifically. These increases are commonly framed as a potential health concern in relation to disordered gaming. However, the evidence base regarding changes in gaming during the COVID-19 pandemic is based on self-report and, thus, is susceptible to bias. Therefore, it is unclear what the true consequences of lockdowns were for gaming behavior worldwide. Objective: The primary objective of this study was to estimate whether any specific lockdown policy led to meaningful increases in the amount of time individuals spent playing video games. Methods: Rather than relying on self-report, we used >251 billion hours of raw gameplay telemetry data from 184 separate countries to assess the behavioral correlates of COVID-19–related policy decisions. A multilevel model estimated the impact of varying enforcement levels of 8 containment and closure policies on the amount of time that individual users spent in-game. Similar models estimated the impact of policy on overall playtime and the number of users within a country. Results: No lockdown policy can explain substantial variance in playtime per gamer. School closures were uniquely associated with meaningful increases in total playtime within a country (r2=0.048). However, this was associated with increases in the number of unique individuals playing games (r2=0.057) rather than increases in playtime per gamer (r2<0.001). Conclusions: Previous work using self-report data has suggested that important increases in heavy gaming may occur during pandemics because of containment and closure (“lockdown”) procedures. This study contrasts with the previous evidence base and finds no evidence of such a relationship. It suggests that significant further work is needed before increases in disordered or heavy gaming are considered when planning public health policies for pandemic preparedness. %M 37938889 %R 10.2196/40190 %U https://www.jmir.org/2023/1/e40190 %U https://doi.org/10.2196/40190 %U http://www.ncbi.nlm.nih.gov/pubmed/37938889 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e50984 %T Effect of Technology and Digital Media Use on Adolescent Health and Development: Protocol for a Multimethod Longitudinal Study %A Cascio,Christopher N %A Selkie,Ellen %A Moreno,Megan A %+ School of Journalism and Mass Communication, University of Wisconsin-Madison, 821 University Ave, 5115 Vilas Hall, Madison, WI, 53706, United States, 1 6082634898, chris.n.cascio@wisc.edu %K social media %K adolescents %K teenagers %K health %K well-being %K risk behavior %K brain %K functional magnetic resonance imaging %K fMRI %K mobile phone %D 2023 %7 13.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Technology and digital media (TDM) use is integral to modern adolescence; adolescents have been labeled as “digital natives,” since they have had exposure to digital technology for their entire lives. Previous evidence has illustrated TDM’s connections with adolescent risk behaviors such as increased alcohol use and social media exposure, as well as relationships with adolescent well-being such as improved socioemotional health and social media connections with peers. Although several recent review articles have described both the benefits and risks of technology use, most individual studies adopt a singular risk-centered approach. In addition, reviews suggest that little evidence exists on the potential mediating and moderating factors between TDM use and well-being and health outcomes, which limits our understanding of what influences the outcomes of interest. Therefore, there is an urgent need to fill these gaps. Objective: This protocol addresses the need to understand how TDM exposure and use affect multiple developmental domains and health outcomes. We address the fragmented nature of previous research, the common focus on single behaviors or conditions, and the typical narrow lens on risks. Our approach further aligns with reviews that called for studies identifying and investigating the factors that moderate the relationships between social media and health behaviors and outcomes. Methods: We will address our objective by longitudinally examining over a 2-year period a common set of adolescent participants (N=400, aged 13-15 years) across 3 studies that adopt a multimethodological approach. Study 1 will use TDM to understand the mechanisms behind adolescent health and risk behaviors. Study 2 will use functional magnetic resonance imaging to understand how positive and negative TDM experiences relate to mental and behavioral health in a subsample of 150 adolescents. Study 3 will use a mixed methods design to evaluate self- and other-generated TDM content as the predictors of socioemotional well-being in sexual and gender minority and non–sexual and gender minority adolescents. Results: Recruitment is ongoing, and the initial results from the first wave of recruitment are expected in 2024. Conclusions: This integrated approach to longitudinal data collection from a shared adolescent participant pool will lead to novel analyses and findings, allowing for the examination of the health and well-being risks and benefits associated with TDM use and factors that moderate these relationships. The findings from this study will advance conceptual models and inform new interventions to improve adolescent health. International Registered Report Identifier (IRRID): DERR1-10.2196/50984 %M 37703071 %R 10.2196/50984 %U https://www.researchprotocols.org/2023/1/e50984 %U https://doi.org/10.2196/50984 %U http://www.ncbi.nlm.nih.gov/pubmed/37703071 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e44920 %T Prospective Association Between Video and Computer Game Use During Adolescence and Incidence of Metabolic Health Risks: Secondary Data Analysis %A Lebby,Stephanie R %A Shyam,Sangeetha %A Ramadas,Amutha %A Bohm,Andrew R %A Hill,Julia C %A Fortuna,Karen L %A Zoltick,Stephanie R %+ Department of Psychiatry, Geisel School of Medicine at Dartmouth, 1 Medical Center Drive, Lebanon, NH, 03756, United States, 1 603 722 5727, Karen.L.Fortuna@dartmouth.edu %K video games %K obesity %K pediatrics %K computer games %K portable device %K teenager %K adolescents %K health data %K BMI %K diabetes %K high blood pressure %K high cholesterol %K metabolic disorder %D 2023 %7 6.7.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Video and computer games are popular activities, with 72% of adolescents aged 13 to 17 years reporting video game use on either a computer, game console, or portable device. Despite high levels of video and computer game use in adolescence, relatively little scientific literature exists examining the association and effects of video and computer games on adolescents. Objective: The objective of this study was to examine the prevalence of video and computer game use among US adolescents and rates of positive screens for obesity, diabetes, high blood pressure (BP), and high cholesterol. Methods: A secondary data analysis was conducted using the National Longitudinal Study of Adolescent to Adult Health (Add Health) data, including adolescents aged 12 to 19 years between 1994 and 2018. Results: Respondents (n=4190) who played the most video and computer games had a significantly (P=.02) higher BMI and were more likely to self-report having at least one of the evaluated metabolic disorders: obesity (BMI >30 kg/m2), diabetes, high BP (BP >140/90), and high cholesterol (>240). With increased video or computer game use, there was a statistically significant increase in high BP rates in each quartile, with those with more frequent use also having higher rates of high BP. A similar trend was observed for diabetes, though the association did not reach statistical significance. No significant association was observed between video or computer game use and diagnoses of dyslipidemia, eating disorders, or depression. Conclusions: Frequency of video and computer game use is associated with obesity, diabetes, high BP, and high cholesterol in adolescents aged 12 to 19 years. Adolescents who play the most video and computer games have a significantly higher BMI. They are more likely to have at least one of the evaluated metabolic disorders: diabetes, high BP, or high cholesterol. Public health interventions designed to target modifiable disease states through health promotion and self-management may support the health of adolescents aged 12 to 19 years. Video and computer games can integrate health promotion interventions in gameplay. This is an important area for future research as video and computer games are integrated into the lives of adolescents. %M 37410530 %R 10.2196/44920 %U https://pediatrics.jmir.org/2023/1/e44920 %U https://doi.org/10.2196/44920 %U http://www.ncbi.nlm.nih.gov/pubmed/37410530 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e41480 %T Time Spent Gaming, Device Type, Addiction Scores, and Well-being of Adolescent English Gamers in the 2021 OxWell Survey: Latent Profile Analysis %A Skripkauskaite,Simona %A Fazel,Mina %A , %+ Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, OX2 6GG, United Kingdom, 44 01865 271444, simona.skripkauskaite@psych.ox.ac.uk %K gaming %K adolescents %K latent profile analysis %K mobile phone %K well-being %K mental ill-health %K mental health %K digital technology %D 2022 %7 18.11.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The shift in the last decades to screen-based and increasingly web-based gaming activity has raised concerns about its impact on the development of children and adolescents. Despite decades of research into gaming and related psychosocial effects, the question remains how best to identify what degree or context of gaming may be a cause for concern. Objective: This study aimed to classify adolescents into gamer profiles based on both gaming behaviors and well-being. Once we distinguished the different gamer profiles, we aimed to explore whether membership to a specific profile could be predicted based on a range of personal characteristics and experiences that could then help identify those at risk. Methods: We explored gaming and well-being in an adolescent school population (aged 12-18 years) in England as part of the 2021 OxWell student survey. Self-report measures of time spent playing games on computers or consoles, time spent playing games on mobile phones, the Game Addiction Scale, and the Warwick-Edinburgh Mental Well-being Scale were used to classify adolescent heavy gamers (playing games for at least 3.5 hours a day) using latent profile analysis. We used multinomial logistic regression analysis to predict the profile membership based on a range of personal characteristics and experiences. Results: In total, 12,725 participants answered the OxWell gaming questions. Almost one-third (3970/12,725, 31.2%) indicated that they play games for at least 3.5 hours a day. The correlation between time spent playing video games overall and well-being was not significant (P=.41). The latent profile analysis distinguished 6 profiles of adolescent heavy gamers: adaptive computer gamers (1747/3970, 44%); casual computer gamers (873/3970, 22%); casual phone gamers (595/3970, 15%); unknown device gamers (476/3970, 12%); maladaptive computer gamers (238/3970, 6%); and maladaptive phone gamers (79/3970, 2%). In comparison with adaptive computer gamers, maladaptive phone gamers were mostly female (odds ratio [OR] 0.08, 95% CI 0.03-0.21) and were more likely to have experienced abuse or neglect (OR 3.18, 95% CI 1.34-7.55). Maladaptive computer gamers, who reported gaming both on their mobile phones and on the computer, were mostly male and more likely to report anxiety (OR 2.25, 95% CI 1.23-4.12), aggressive behavior (OR 2.83, 95% CI 1.65-4.88), and web-based gambling (OR 2.18, 95% CI 1.24-3.81). Conclusions: A substantial number of adolescents are spending ≥3.5 hours gaming each day, with almost 1 in 10 (317/3970, 8%) reporting co-occurring gaming and well-being issues. Long hours gaming using mobile phones, particularly common in female gamers, may signal poorer functioning and indicate a need for additional support. Although increased time gaming might be changing how adolescents spend their free time and might thus have public health implications, it does not seem to relate to co-occurring well-being issues or mental ill-health for the majority of adolescent gamers. %M 36399378 %R 10.2196/41480 %U https://pediatrics.jmir.org/2022/4/e41480 %U https://doi.org/10.2196/41480 %U http://www.ncbi.nlm.nih.gov/pubmed/36399378 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 4 %P e33806 %T Parental Factors Associated With Internet Gaming Disorder Among First-Year High School Students: Longitudinal Study %A She,Rui %A Zhang,Youmin %A Yang,Xue %+ The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, 5/F, Ngan Shing Street, Shatin, Hong Kong, HKG, China, 852 2647 5108, sherryxueyang@cuhk.edu.hk %K internet gaming disorder %K adolescents %K parental factors %K longitudinal study %K parenting %K gaming %K gaming disorder %K health intervention %K treatment %K mental health %D 2022 %7 8.11.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Parents play central roles in adolescents’ socialization, behavioral development, and health, including the development of internet gaming disorder (IGD). However, longitudinal research on the parental predictors of adolescent IGD is limited. Objective: This study aimed to investigate the reciprocal associations between various parental factors and adolescent IGD using 2-wave cross-lagged models. Methods: A sample of 1200 year-one high school students in central China completed a baseline assessment in 2018 (mean age 15.6 years; 633/1200, 52.8% male) and a follow-up survey in 2019. IGD was measured using the 9-item DSM-5 IGD Symptoms checklist. Perceptions related to parental variables, including psychological control, parental abuse, parental support, and the parent-child relationship, were also collected from the adolescents. Results: Of all the participants, 12.4% (148/1200) and 11.7% (140/1200) were classified as having IGD at baseline (T1) and follow-up (T2), respectively. All 4 cross-lagged models fit the data well (range for the comparative fit index .91-.95; range for the standardized root mean square residual .05-.06). Parental support (β=–.06, P=.02) and parental abuse (β=.08, P=.002) at T1 predicted IGD symptoms at T2, while parental psychological control (β=.03, P=.25) and a positive relationship with parents (β=–.05, P=.07) at T1 had nonsignificant effects on IGD symptoms at T2, when controlling for background variables. In addition, IGD symptoms at T1 did not predict parental factors at T2. Conclusions: The findings suggest that parental factors may be significant predictors of adolescent IGD. Health interventions should consider involving parents to increase the effectiveness of treatment to prevent and reduce adolescent IGD. %M 36346660 %R 10.2196/33806 %U https://games.jmir.org/2022/4/e33806 %U https://doi.org/10.2196/33806 %U http://www.ncbi.nlm.nih.gov/pubmed/36346660 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e40704 %T Youth Perspectives on the Recommended Age of Mobile Phone Adoption: Survey Study %A Richter,Aliah %A Adkins,Victoria %A Selkie,Ellen %+ Child Health Evaluation and Research Center, University of Michigan, 300 N Ingalls St, Ann Arbor, MI, 48104, United States, 1 419 779 4111, vadkins@wisc.edu %K adolescent %K youth %K child %K mobile phone %K technology %K media %K phone use %K phone ownership %K parental guidance %K parenting %K cell phone %K smartphone %D 2022 %7 31.10.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Despite increasing prevalence of phone ownership in early adolescence, there is a deficit of evidence-based guidance on the appropriate time to provide youth their first phone. Objective: This survey study explored age recommendations for phone ownership among a diverse panel of youths, as their experiences are an important contribution to the development of ownership guidelines. Methods: Participants were recruited from MyVoice, a national panel of over 765 youth (14 to 24 years old) who respond to weekly SMS text message–based surveys. Questions were distributed between January 24 2018, and March 20, 2018. Inductive qualitative analysis was used to identify major themes among youths’ open-ended responses. Results: In all, 469 youth (mean age 18.8 years; female: 299/469, 63.8%; White race: 332/468, 70.8%) responded. On average, respondents obtained their first phone at 12.2 years of age. Most participants (325/459, 71.1%) stated they received their first phone out of necessity rather than for entertainment or social reasons. Youth recommended that early adolescents receive their first phone between 12 and 13 years of age primarily for reasons of necessity (146/448, 32.6%). Conclusions: According to the participants, phones supported safety and independence by allowing communication with parents and participation in activities. Youth-serving professionals and parents can incorporate these youth perspectives into shared decision-making about phone ownership among families. This can include discussions about essential features, safety, or phone use, as well as maturity and responsibility milestones, which were all key considerations reported by participants in the survey. %M 36315219 %R 10.2196/40704 %U https://pediatrics.jmir.org/2022/4/e40704 %U https://doi.org/10.2196/40704 %U http://www.ncbi.nlm.nih.gov/pubmed/36315219 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e39017 %T Objective Assessment of the Nature and Extent of Children’s Internet-Based World: Protocol for the Kids Online Aotearoa Study %A Gurtner,Marcus %A Smith,Moira %A Gage,Ryan %A Howey-Brown,Anna %A Wang,Xinyi %A Latavao,Tevita %A D Deng,Jeremiah %A P Zwanenburg,Sander %A Stanley,James %A Signal,Louise %+ Department of Public Health, University of Otago, 23 Mein Street Newtown, Wellington, 6021, New Zealand, 64 210541869, marcus.gurtner@otago.ac.nz %K public health %K child health %K internet %K policy %K methods %K child %K youth %K methodology %K student %K human-computer interaction %K digital health %K eHealth %K technology use %K computer use %K user experience %K perception %K attitude %K internet use %K screen time %K perceived behavior %K phone use %K social media %D 2022 %7 11.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Children under 18 years of age account for approximately 1 in 3 internet users worldwide. Largely unregulated, the internet-based world is evolving rapidly and becoming increasingly intrusive. There is a dearth of objective research globally on children’s real-time experiences of the internet-based world. Objective: This paper reports an objective methodology to study the nature and extent of children’s internet-based world, their engagement with it, and how this impacts their health and well-being. Methods: A total of 180 year 8 students from 12 schools will be recruited into the study within the Wellington region of Aotearoa, New Zealand. Children use Zoom video teleconferencing software to record real-time, screen-shared internet-based content, for 4 consecutive days. Data on demographics, health and well-being, and attitudes and perceived behaviors in relation to the internet-based world are collected. Phone screen-time balances are retrieved. Data collection commenced in June 2021 and is anticipated to be completed in 2023. Results: Recordings show children exploring diverse web-based settings and content, including personalized content curated by algorithms on platforms such as TikTok, YouTube, and Instagram. Preliminary analysis shows that the data can be used to study a wide range of topics. Behavioral Observation Research Interaction Software is being used to manually code recordings. Artificial Intelligence techniques are also being applied, including hashtag extraction, optical character recognition, as well as object, pattern, speech, and lyric recognition. Conclusions: This novel methodology reveals the unique internet-based experiences of children. It is underpinned by a commitment to ensuring that their rights are protected. It seeks to provide concrete evidence on internet usage in this group and to facilitate appropriate political and societal action to effectively regulate the internet-based world to prevent harm to children. International Registered Report Identifier (IRRID): DERR1-10.2196/39017 %M 36129809 %R 10.2196/39017 %U https://www.researchprotocols.org/2022/10/e39017 %U https://doi.org/10.2196/39017 %U http://www.ncbi.nlm.nih.gov/pubmed/36129809 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e35540 %T Digital Technology and Media Use by Adolescents: Latent Class Analysis %A Moreno,Megan A %A Binger,Kole %A Zhao,Qianqian %A Eickhoff,Jens %A Minich,Matt %A Uhls,Yalda Tehranian %+ University of Wisconsin-Madison, 2870 University Ave, Suite 200, Madison, WI, 53705, United States, 1 608 2632846, mamoreno@pediatrics.wisc.edu %K digital technology %K adolescents %K latent class analysis %K social media %K mobile phone %D 2022 %7 4.5.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Digital technology and media use is integral to adolescents’ lives and has been associated with both positive and negative health consequences. Previous studies have largely focused on understanding technology behaviors and outcomes within adolescent populations, which can promote assumptions about adolescent technology use as homogeneous. Furthermore, many studies on adolescent technology use have focused on risks and negative outcomes. To better understand adolescent digital technology use, we need new approaches that can assess distinct profiles within study populations and take a balanced approach to understanding the risks and benefits of digital technology use. Objective: The purpose of this study was to identify profiles of adolescent technology use within a large study population focusing on four evidence-based constructs: technology ownership and use, parental involvement, health outcomes, and well-being indicators. Methods: Adolescent-parent dyads were recruited for a cross-sectional web-based survey using the Qualtrics (Qualtrics International, Inc) platform and panels. Technology use measures included ownership of devices, social media use frequency, and the Adolescents’ Digital Technology Interactions and Importance scale. Parent involvement measures included household media rules, technology-related parenting practices, parent social media use frequency, and the parent-child relationship. Health outcome measures included physical activity, sleep, problematic internet use, and mental health assessments. Well-being indicators included mental wellness, communication, and empathy. We used latent class analysis (LCA) to identify distinct profile groups across the aforementioned 4 critical constructs. Results: Among the 3981 adolescent-parent dyads recruited, adolescent participants had a mean age of 15.0 (SD 1.43) years; a total of 46.3% (1842/3981) were female, 67.8% (2701/3981) were White, and 75% (2986/3981) lived in a household with an income above the poverty line. The LCA identified 2 discrete classes. Class 1 was made up of 62.8% (2501/3981) of the participants. Class 1 participants were more likely than Class 2 participants to report family-owned devices, have lower technology importance scores, have household technology rules often centered on content, have positive parent relationships and lower parent social media use, and report better health outcomes and well-being indicators. Conclusions: Findings from this national cross-sectional survey using LCA led to 2 distinct profile groups of adolescent media use and their association with technology use and parent involvement as well as health and well-being outcomes. The two classes included a larger Class 1 (Family-Engaged Adolescents) and a smaller Class 2 (At-Risk Adolescents). The findings of this study can inform interventions to reinforce positive technology use and family support. %M 35507401 %R 10.2196/35540 %U https://pediatrics.jmir.org/2022/2/e35540 %U https://doi.org/10.2196/35540 %U http://www.ncbi.nlm.nih.gov/pubmed/35507401 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e29102 %T Explaining Adherence to American Academy of Pediatrics Screen Time Recommendations With Caregiver Awareness and Parental Motivation Factors: Mixed Methods Study %A Lammers,Shea M %A Woods,Rebecca J %A Brotherson,Sean E %A Deal,James E %A Platt,Carrie Anne %+ Department of Human Development and Family Science, North Dakota State University, Department No 2615, P.O. Box 6050, Fargo, ND, 58108-6050, United States, 1 701 231 6143, sean.brotherson@ndsu.edu %K infancy %K screen time %K screen time recommendations %K mothers and infants %K American Academy of Pediatrics recommendations %K parental motivations %D 2022 %7 5.4.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: With the increasing integration of technology into society, it is advisable that researchers explore the effects of repeated digital media exposure on our most vulnerable population—infants. Excessive screen time during infancy has been linked to delays in language, literacy, and self-regulation. Objective: This study explores the awareness of and adherence to the American Academy of Pediatrics’ (AAP) recommendations related to avoiding screen time for infants younger than 2 years and the motivational factors associated with screen time exposure. Methods: A mixed methods survey design was used to gather responses from 178 mothers of infants younger than 2 years. The measures included infant screen time use and duration, maternal awareness of screen time use recommendations, and motivations related to screen time exposure. A variety of statistical procedures were used to explore associations between caregiver awareness of and adherence to AAP guidelines for screen time exposure, motivations related to screen time for infants, and the duration of infant screen time exposure. Results: The results indicated that 62.2% (111/178) of mothers were aware of the AAP screen time recommendations, but only 46.1% (82/178) could cite them accurately, and most mothers learned of them via the internet or from a medical professional. Mothers who were aware of the guidelines allowed significantly less screen time for infants than those who were unaware (P=.03). In addition, parents who adhered to the AAP guidelines reported significantly less infant screen time per day than those who did not adhere (P<.001). Among mothers who reported not adhering to the guidelines, the greatest motivation for allowing screen time was perceived educational benefits. Less educated mothers rated an infant’s relaxation as a motivational factor in allowing screen time significantly higher than more highly educated mothers (P=.048). The regression analysis indicated that none of the parental motivation factors predicted daily infant screen time. Conclusions: These results indicate 2 key approaches to improving adherence to screen time recommendations. First, the awareness of the AAP recommendations needs to be increased, which tends to improve adherence. Second, the myth that screen time can be educational for infants needs to be dispelled. %M 35380541 %R 10.2196/29102 %U https://pediatrics.jmir.org/2022/2/e29102 %U https://doi.org/10.2196/29102 %U http://www.ncbi.nlm.nih.gov/pubmed/35380541 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e33569 %T An Objective System for Quantitative Assessment of Television Viewing Among Children (Family Level Assessment of Screen Use in the Home-Television): System Development Study %A Vadathya,Anil Kumar %A Musaad,Salma %A Beltran,Alicia %A Perez,Oriana %A Meister,Leo %A Baranowski,Tom %A Hughes,Sheryl O %A Mendoza,Jason A %A Sabharwal,Ashutosh %A Veeraraghavan,Ashok %A O'Connor,Teresia %+ Agricultural Research Service, US Department of Agriculture, Children’s Nutrition Research Center, Baylor College of Medicine, 1100 Bates Street, Houston, TX, 77030, United States, 1 7137986782, teresiao@bcm.edu %K television %K screen media %K digital media %K measurement %K child %K gaze %K machine learning %K mobile phone %D 2022 %7 24.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Television viewing among children is associated with developmental and health outcomes, yet measurement techniques for television viewing are prone to errors, biases, or both. Objective: This study aims to develop a system to objectively and passively measure children’s television viewing time. Methods: The Family Level Assessment of Screen Use in the Home-Television (FLASH-TV) system includes three sequential algorithms applied to video data collected in front of a television screen: face detection, face verification, and gaze estimation. A total of 21 families of diverse race and ethnicity were enrolled in 1 of 4 design studies to train the algorithms and provide proof of concept testing for the integrated FLASH-TV system. Video data were collected from each family in a laboratory mimicking a living room or in the child’s home. Staff coded the video data for the target child as the gold standard. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each algorithm, as compared with the gold standard. Prevalence and biased adjusted κ scores and an intraclass correlation using a generalized linear mixed model compared FLASH-TV’s estimation of television viewing duration to the gold standard. Results: FLASH-TV demonstrated high sensitivity for detecting faces (95.5%-97.9%) and performed well on face verification when the child’s gaze was on the television. Each of the metrics for estimating the child’s gaze on the screen was moderate to good (range: 55.1% negative predictive value to 91.2% specificity). When combining the 3 sequential steps, FLASH-TV estimation of the child’s screen viewing was overall good, with an intraclass correlation for an overall time watching television of 0.725 across conditions. Conclusions: FLASH-TV offers a critical step forward in improving the assessment of children’s television viewing. %M 35323113 %R 10.2196/33569 %U https://pediatrics.jmir.org/2022/1/e33569 %U https://doi.org/10.2196/33569 %U http://www.ncbi.nlm.nih.gov/pubmed/35323113 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e28208 %T Using Wearable Cameras to Categorize the Type and Context of Screen-Based Behaviors Among Adolescents: Observational Study %A Thomas,George %A Bennie,Jason A %A De Cocker,Katrien %A Dwi Andriyani,Fitria %A Booker,Bridget %A Biddle,Stuart J H %+ School of Allied Health, Curtin University, 208 Kent Street, Bentley, 6102, Australia, 61 473195605, george.thomas@curtin.edu.au %K adolescent %K screen time %K smartphone %K television %D 2022 %7 21.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Automated wearable cameras present a new opportunity to accurately assess human behavior. However, this technology is seldom used in the study of adolescent’s screen exposure, and the field is reliant on poor-quality self-report data. Objective: This study aimed to examine adolescents’ screen exposure by categorizing the type and context of behaviors using automated wearable cameras. Methods: Adolescents (mean age 15.4 years, SD 1.6 years; n=10) wore a camera for 3 school evenings and 1 weekend day. The camera captured an image every 10 seconds. Fieldwork was completed between February and March 2020, and data were analyzed in August 2020. Images were date and time stamped, and coded for screen type, content, and context. Results: Data representing 71,396 images were analyzed. Overall, 74.0% (52,842/71,396) of images contained screens and 16.8% (11,976/71,396) of images contained multiple screens. Most screen exposures involved television sets (25,950/71,396, 36.3%), smartphones (20,851/71,396, 29.2%), and laptop computers (15,309/71,396, 21.4%). The context of screen use differed by device type, although most screen exposures occurred at home (62,455/64,856, 96.3%) and with solitary engagement (54,430/64,856, 83.9%). The immediate after-school period saw high laptop computer use (4785/15,950, 30.0%), while smartphone use (2059/5320, 38.7%) peaked during prebedtime hours. Weekend screen exposure was high, with smartphone use (1070/1927, 55.5%) peaking in the early morning period and fluctuating throughout the day. Conclusions: There was evidence for high screen use during the after-school and weekend period, mostly through solitary engagement, and within the home environment. The findings may inform the basis of larger studies aimed at examining screen exposure in free-living conditions. %M 35311672 %R 10.2196/28208 %U https://pediatrics.jmir.org/2022/1/e28208 %U https://doi.org/10.2196/28208 %U http://www.ncbi.nlm.nih.gov/pubmed/35311672 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e30778 %T Influence of Forced Online Distance Education During the COVID-19 Pandemic on the Perceived Stress of Postsecondary Students: Cross-sectional Study %A Šorgo,Andrej %A Crnkovič,Nuša %A Gabrovec,Branko %A Cesar,Katarina %A Selak,Špela %+ National Institute of Public Health, Trubarjeva cesta 2, Ljubljana, 1000, Slovenia, 386 1 620 36 45, spela.selak@nijz.si %K online study %K stress %K COVID-19 %K postsecondary students %K pandemic %K epidemiology %K educational institutions %K online education %K pedagogy %K mental health %D 2022 %7 15.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: One of the most significant changes in the majority of postsecondary educational institutions was the closure of those institutions and the shift of educational activities to online distance learning formats as a result of the COVID-19 pandemic. Closure combined with forced online distance education (FODE) was a cure with many side effects, 1 of them being the effect on students’ mental health and, more specifically, levels of stress. Due to the novelty of the situation, there have been no studies so far designed to link satisfaction with online study, feelings toward the study obligations, and stress among students. Objective: The aim of the study is to assess the perceived stress of Slovenian postsecondary students in order to identify the online study–related factors affecting or acting as a covariate during the COVID-19 lockdown. Methods: Data collection was conducted through a self-reported survey as part of a large cross-sectional study based on data collected from postsecondary students from a number of higher educational institutions. The random sample consisted of 4455 individuals. The Perceived Stress Scale (PSS-4), Satisfaction with Online Study Scale (SAT-5), and Feelings Towards Study Obligations Scale (FETSOS) were used to assess the constructs and the relations observed within the study. Results: The results indicate that more than half of all respondents reported high levels of stress. The difference in the reported levels of perceived stress between genders were statistically significant (N=4454, F2=56.719, P<.001, Cohen d=0.35). Overall, the results suggest that a decline in the motivation to study, the quality of internet and mobile connections, and the presence of distracting factors in the study space were the 3 main factors related to the students’ negative emotions as associated with the timeliness, performance, and quality of the study obligations. Furthermore, the results show that the level of satisfaction with online study affected stress such that the higher the satisfaction, the lower the stress. Moreover, the more positive feelings connected with the timeliness, performance, and quality of the study obligations that the students felt, the more satisfaction they reported with online study and, thus indirectly, lower stress and less negative feelings. Conclusions: The findings of this study call for implementing structures and measures targeted at stress reduction, working conditions, and pedagogy with regard to FODE. %M 35171098 %R 10.2196/30778 %U https://www.jmir.org/2022/3/e30778 %U https://doi.org/10.2196/30778 %U http://www.ncbi.nlm.nih.gov/pubmed/35171098 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e35984 %T Researching the Links Between Smartphone Behavior and Adolescent Well-being With the FUTURE-WP4 (Modeling the Future: Understanding the Impact of Technology on Adolescent’s Well-being Work Package 4) Project: Protocol for an Ecological Momentary Assessment Study %A Elavsky,Steriani %A Blahošová,Jana %A Lebedíková,Michaela %A Tkaczyk,Michał %A Tancos,Martin %A Plhák,Jaromír %A Sotolář,Ondřej %A Smahel,David %+ Faculty of Informatics, Masaryk University, Botanická 68A, Brno, 60200, Czech Republic, 420 549491814, elavsky@fi.muni.cz %K well-being %K adolescents %K smartphones %K intensive data %K ecological momentary assessment %D 2022 %7 8.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smartphone ownership has increased among teens within the last decade, with up to 89% of adolescents owning a smartphone and engaging daily with the online world through it. Although the results of recent meta-analyses suggest that engaging digital technology plays only a small role in adolescent well-being, parents, professionals, and policymakers remain concerned about the impact that the instant connectivity of smartphones has on adolescent well-being. Objective: Herein, we introduce the protocol of a research study investigating the associations between adolescent smartphone use and different facets of well-being (social, physical, and psychological), with the aim to apply innovative methods to address the limitations of existing empirical studies. Methods: This 12-month prospective study of adolescents uses a repeated measurement-burst design with the ecological momentary assessment methodology. Adolescents (N=203; age range 13-17 years) complete baseline assessments through online questionnaires, four 14-day intensive data collection bursts, and an online questionnaire at the end of the study. As part of the 4 measurement bursts, adolescent smartphone behavior is assessed objectively by passive data collection of smartphone data logs and through self-reports in short questionnaires administered via a custom-built Android app. Results: The protocol describes the study objectives, research tools (including the development of the Android app and specialized software), and process (including pilot studies, the main study, and targets for machine learning approaches). Two of the 203 enrolled participants provided no data during the first data collection burst of the main study. Preliminary analyses of the data from the first data collection burst indicated an acceptable level of compliance (72.25%) with the daily questionnaires. The design of the study will allow for the assessment of both within- and between-person variabilities in smartphone behavior, as well as short-term variation and long-term change in smartphone behavior and how it impacts the indicators of social, physical, and psychological well-being. Conclusions: The innovative methods applied in this study (objective smartphone logs, ecological momentary assessment, and machine learning) will allow for a more nuanced assessment of the links between smartphone use and well-being, informing strategies to help adolescents navigate the online world more constructively in terms of the development of their physical, social, and psychological well-being. International Registered Report Identifier (IRRID): DERR1-10.2196/35984 %M 35258467 %R 10.2196/35984 %U https://www.researchprotocols.org/2022/3/e35984 %U https://doi.org/10.2196/35984 %U http://www.ncbi.nlm.nih.gov/pubmed/35258467 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e33376 %T Investigating Adolescents’ Video Gaming and Gambling Activities, and Their Relationship With Behavioral, Emotional, and Social Difficulties: Protocol for a Multi-Informant Study %A Cena,Loredana %A Rota,Matteo %A Trainini,Alice %A Zecca,Sara %A Bonetti Zappa,Sofia %A Tralli,Nella %A Stefana,Alberto %+ Department of Brain and Behavioural Sciences, University of Pavia, Via Bassi, 21, Pavia, 27100, Italy, 39 3381131304, alberto.stefana@gmail.com %K adolescents %K gaming disorder %K gambling disorder %K pathological video gaming %K pathological gambling %D 2022 %7 25.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Growing empirical evidence suggests that adolescents have a relatively greater propensity to develop problematic video gaming or gambling habits. Objective: The main objectives of this study are to estimate the prevalence of potential pathological gambling and video game use among adolescent students and to evaluate their risk factors. Methods: This is a cross-sectional multi-informant study based on an online survey. It will include a sample of adolescents attending secondary schools located in Brescia, northern Italy, their schoolteachers, and parents. The survey includes extensive data on adolescents’ (1) demographic, social, economic, and environmental characteristics; (2) behavioral, emotional, and social problems and adaptive functioning; (3) emotional and social loneliness; (4) perception of the reasons to use social networks; (5) video game habits and pathological use of video gaming; and (6) gambling behaviors. Results: This protocol was approved by the Institutional Ethics Board of the Spedali Civili of Brescia (Italy). We expect to collect data from 793 or more adolescent students, as determined by our sample size calculation. Conclusions: This multisite project will make a substantial contribution to (1) the implementation of a system for identifying pathological gambling and pathological video game use among adolescents, allowing for interventions aimed at improving adolescents’ financial, emotional, and social well-being; and (2) the identification of distinct profiles of gamblers and pathological video gamers that will contribute to setting up effective targeted prevention measures. Understanding the causes and impact of gambling and pathological video gaming on adolescents is a public health issue. International Registered Report Identifier (IRRID): DERR1-10.2196/33376 %M 35212638 %R 10.2196/33376 %U https://www.researchprotocols.org/2022/2/e33376 %U https://doi.org/10.2196/33376 %U http://www.ncbi.nlm.nih.gov/pubmed/35212638 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e33059 %T Gaming Activity and Possible Changes in Gaming Behavior Among Young People During the COVID-19 Pandemic: Cross-sectional Online Survey Study %A Claesdotter-Knutsson,Emma %A André,Frida %A Håkansson,Anders %+ Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Barav. 1, Lund, 22185, Sweden, 46 768871765, emma.claesdotter-knutsson@med.lu.se %K COVID-19 pandemic %K gaming %K screen time %K psychological distress %D 2022 %7 25.1.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Young people’s daily lives and social interactions changed remarkably during the COVID-19 pandemic as schools and cinemas closed, leisure activities were cancelled, and gatherings were regulated. Questions have been raised by the media, schools, policy makers, and research communities about the effect on young people’s online behaviors. Objective: This cross-sectional study aimed to study self-reported changes in gaming, focusing on a younger section of the population during the COVID-19 pandemic in Sweden. We also wanted to look at potential risk factors behind problematic gaming during the pandemic, including gaming patterns, gambling behavior, psychological distress, certain sociodemographic characteristics, health factors, and school situation. Methods: This was an anonymous online survey study of web panel participants in Sweden (n=1501) to study changes in gaming behaviors during the COVID-19 pandemic. Self-reported increases in gaming were analyzed in logistic regression analyses against sociodemographic and health factors. Results: Within the study population that reported changes in gaming activity, we found significant differences in age, employment status, disposable income, whether they ever played on loot boxes, time spent at home, school attendance, psychological distress, and gambling and gaming problems, as well as significant differences in changes in alcohol consumption and exercise habits. When examining the 16–24-year-old age group who reported changes in gaming activity, we found significant differences within the group in disposable income, time at home, and school attendance. When examining the 25–39-year-old age group who reported changes in gaming activity, we found significant differences within the group in employment status, disposable income, time spent at home, whether the respondents were studying, school attendance level, psychological distress, and gaming problems, as well as significant differences in changes in alcohol consumption and exercise habits. Psychological distress (all age groups analyzed together; 25–39-year-old age group), drinking less alcohol (all age groups analyzed together), spending more time at home (all age groups analyzed together), gaming problems, and exercising less (25–39-year-old age group) were positively correlated with a self-reported increase in gaming activity. Being employed (25–39-year-old age group) and being over 40 years of age (all age groups analyzed together) were negatively correlated with increased gaming. We found no significant correlations in the 16–24-year-old age group. Conclusions: Those who reported increased gaming during the COVID-19 pandemic were more likely to be 16 years to 39 years old. In the age group of 25 years to 39 years old, the increase was associated with psychological distress, reporting less exercise, and being unemployed. COVID-19 may present as a risk factor of increased online gaming in a small but vulnerable group. More research and preferably longitudinal studies are needed in the field of gaming and effects of the COVID-19 pandemic. %M 34817386 %R 10.2196/33059 %U https://games.jmir.org/2022/1/e33059 %U https://doi.org/10.2196/33059 %U http://www.ncbi.nlm.nih.gov/pubmed/34817386 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e27852 %T Understanding Adolescents’ Perceptions and Aspirations Towards Their Relationship With Personal Technology: Survey Study %A Jee,Muhammad %A Khan,Alsa %A Nazneen,Nazneen %+ Twinbits, 1201 Big Falls Dr, Flower Mound, TX, 75028, United States, 1 214 972 8988, muhammadjee1@gmail.com %K adolescents’ perceptions %K personal technology %K technology relationship %K adolescents as technology users %K adolescents as technology bystanders %D 2021 %7 23.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Understanding adolescents' relationship with technology is a pressing topic in this digital era. There seem to be both beneficial and detrimental implications that originate from use of technology by adolescents. Approximately 95% of adolescents have access to a smartphone, and several studies show a positive correlation between screen addiction and trends of anxiety and depression. At the same time, research shows that two-thirds of adolescents believe that technology is a necessity for connecting and making new friends. Objective: The aim of this formative study was to understand adolescents' perception of their own and others’ relationship with personal technology. Methods: A survey was conducted with 619 adolescents ranging in age from 13 to 19 years. Adolescents were asked how they perceived the relationship with their personal technology, how they perceived others' (parents, siblings, or friends) relationship with personal technology, and how they wish to relate to their personal technology in the future. Results: "Essential,” “Distractive,” and “Addictive” were the most commonly selected descriptors to describe both adolescents' own relationship with technology (essential: 106/619, 17.1%; distractive: 105/619, 17%; addictive: 88/619, 14.2% ) and others’ relationship as well (essential: 96/619, 15.6%; distractive: 88/619, 14.3%; addictive: 90/619, 14.5%). Adolescents selected “Provides an escape” more to describe their own relationship with technology. Whereas, they selected “It's just a tool” and “Creates Barrier” more to describe others' relationship with technology. These trends are consistent across ages and genders. In addition, adolescents' aspirations for their relationship with their personal technology varied across ages: 13 to 15-year olds' top choice was “best friend”, 16 to 17-year olds’ top choice was “I don't believe in personal connection with mobile technology,” and 18 to 19-year olds’ top choice was “My personal assistant.” Conclusions: Our 3-lens method allows us to examine how adolescents perceive their relationship with personal technology in comparison to others, as well as their future technological aspirations. Our findings suggest that adolescents see both communalities as well as differences in their own and others' relationships with technology. Their future aspirations for personal technology vary across age and gender. These preliminary findings will be examined further in our follow-up research. %M 34941556 %R 10.2196/27852 %U https://formative.jmir.org/2021/12/e27852 %U https://doi.org/10.2196/27852 %U http://www.ncbi.nlm.nih.gov/pubmed/34941556 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e30310 %T Predicting Video Game Addiction Through the Dimensions of Consumer Video Game Engagement: Quantitative and Cross-sectional Study %A Abbasi,Amir Zaib %A Rehman,Umair %A Afaq,Zahra %A Rafeh,Mir Abdur %A Hlavacs,Helmut %A Mamun,Mohammed A %A Shah,Muhammad Umair %+ Department of Management Sciences, Shaheed Zulfikar Ali Bhutto Institute of Science and Technology, Street # 09, Plot # 67 Sector H-8/4, Islamabad, 46000, Pakistan, 92 514863363 ext 517, aamir.zaib.abbasi@gmail.com %K consumer video game engagement %K dedication %K absorption %K social connection %K interaction %K conscious attention %K enthusiasm %K video game addiction %K uses and gratifications theory %K cultivation theory %D 2021 %7 26.11.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Video games are expanding exponentially with their increased popularity among users. However, this popularity has also led to an increase in reported video game addiction. There may be consumer engagement–related factors that may influence video game addiction. Objective: This study aims to empirically examine the impact of the dimensions of consumer video game engagement on video game addiction. The dimensions are dedication, absorption, conscious attention, social connection, enthusiasm, and interaction. We utilize the uses and gratifications theory to study the video game engagement dimensions as potential factors through which gamers feel gratified and engaged in video game playing. Additionally, this study incorporates the cultivation theory to investigate how video game engagement factors trigger video game addiction. Methods: A two-step process was applied for data analysis on valid cases of 176 gamers aged 15-25 years: video game addiction was specified and validated as a reflective-formative construct, and hypothesis testing was later performed using the WarpPLS on valid respondents. Results: The analysis uncovered 2 dimensions of video game engagement: social connection with P=.08 and interaction with P=.49, which did not significantly contribute to video game addiction. Conclusions: This study offers unique insights to a myriad of stakeholders, mostly psychologists and psychiatrists, who routinely prescribe behavior modification techniques to treat video game addiction. %M 34842539 %R 10.2196/30310 %U https://games.jmir.org/2021/4/e30310 %U https://doi.org/10.2196/30310 %U http://www.ncbi.nlm.nih.gov/pubmed/34842539 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e30889 %T Gender-Based Differences and Associated Factors Surrounding Excessive Smartphone Use Among Adolescents: Cross-sectional Study %A Claesdotter-Knutsson,Emma %A André,Frida %A Fridh,Maria %A Delfin,Carl %A Hakansson,Anders %A Lindström,Martin %+ Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Sofiavägen 2D, Lund, SE-22241, Sweden, 46 768871765, emma.claesdotter-knutsson@med.lu.se %K smartphone %K cell phone %K adolescent %K sleep %K anxiety %K substance use %K nicotine %K alcohol drinking %K smartphone use %K addiction %K behavioral addiction %K worry %K pathology %K internet %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Excessive smartphone use is a new and debated phenomenon frequently mentioned in the context of behavioral addiction, showing both shared and distinct traits when compared to pathological gaming and gambling. Objective: The aim of this study is to describe excessive smartphone use and associated factors among adolescents, focusing on comparisons between boys and girls. Methods: This study was based on data collected through a large-scale public health survey distributed in 2016 to pupils in the 9th grade of primary school and those in the 2nd grade of secondary school. Bayesian binomial regression models, with weakly informative priors, were used to examine whether the frequency of associated factors differed between those who reported excessive smartphone use and those who did not. Results: The overall response rate was 77% (9143/11,868) among 9th grade pupils and 73.4% (7949/10,832) among 2nd grade pupils, resulting in a total of 17,092 responses. Based on the estimated median absolute percentage differences, along with associated odds ratios, we found that excessive smartphone use was associated with the use of cigarettes, alcohol, and other substances. The reporting of anxiety and worry along with feeling low more than once a week consistently increased the odds of excessive smartphone use among girls, whereas anxiety and worry elevated the odds of excessive smartphone use among boys. The reporting of less than 7 hours of sleep per night was associated with excessive smartphone use in all 4 study groups. Conclusions: The results varied across gender and grade in terms of robustness and the size of estimated difference. However, excessive smartphone use was associated with a higher frequency of multiple suspected associated factors, including ever having tried smoking, alcohol, or other substances; poor sleep; and often feeling low and feeling anxious. This study sheds light on some features and distinctions of a potentially problematic behavior among adolescents. %M 34813492 %R 10.2196/30889 %U https://pediatrics.jmir.org/2021/4/e30889 %U https://doi.org/10.2196/30889 %U http://www.ncbi.nlm.nih.gov/pubmed/34813492 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e29426 %T Passive Sensing of Preteens’ Smartphone Use: An Adolescent Brain Cognitive Development (ABCD) Cohort Substudy %A Wade,Natasha E %A Ortigara,Joseph M %A Sullivan,Ryan M %A Tomko,Rachel L %A Breslin,Florence J %A Baker,Fiona C %A Fuemmeler,Bernard F %A Delrahim Howlett,Katia %A Lisdahl,Krista M %A Marshall,Andrew T %A Mason,Michael J %A Neale,Michael C %A Squeglia,Lindsay M %A Wolff-Hughes,Dana L %A Tapert,Susan F %A Bagot,Kara S %A , %+ University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, United States, 1 (858) 280 6398, nwade@health.ucsd.edu %K preadolescents %K smartphone use %K passive sensing %K screen use %K screen time %K mobile phone %D 2021 %7 18.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Concerns abound regarding childhood smartphone use, but studies to date have largely relied on self-reported screen use. Self-reporting of screen use is known to be misreported by pediatric samples and their parents, limiting the accurate determination of the impact of screen use on social, emotional, and cognitive development. Thus, a more passive, objective measurement of smartphone screen use among children is needed. Objective: This study aims to passively sense smartphone screen use by time and types of apps used in a pilot sample of children and to assess the feasibility of passive sensing in a larger longitudinal sample. Methods: The Adolescent Brain Cognitive Development (ABCD) study used passive, objective phone app methods for assessing smartphone screen use over 4 weeks in 2019-2020 in a subsample of 67 participants (aged 11-12 years; 31/67, 46% female; 23/67, 34% White). Children and their parents both reported average smartphone screen use before and after the study period, and they completed a questionnaire regarding the acceptability of the study protocol. Descriptive statistics for smartphone screen use, app use, and protocol feasibility and acceptability were reviewed. Analyses of variance were run to assess differences in categorical app use by demographics. Self-report and parent report were correlated with passive sensing data. Results: Self-report of smartphone screen use was partly consistent with objective measurement (r=0.49), although objective data indicated that children used their phones more than they reported. Passive sensing revealed the most common types of apps used were for streaming (mean 1 hour 57 minutes per day, SD 1 hour 32 minutes), communication (mean 48 minutes per day, SD 1 hour 17 minutes), gaming (mean 41 minutes per day, SD 41 minutes), and social media (mean 36 minutes per day, SD 1 hour 7 minutes). Passive sensing of smartphone screen use was generally acceptable to children (43/62, 69%) and parents (53/62, 85%). Conclusions: The results of passive, objective sensing suggest that children use their phones more than they self-report. Therefore, use of more robust methods for objective data collection is necessary and feasible in pediatric samples. These data may then more accurately reflect the impact of smartphone screen use on behavioral and emotional functioning. Accordingly, the ABCD study is implementing a passive sensing protocol in the full ABCD cohort. Taken together, passive assessment with a phone app provided objective, low-burden, novel, informative data about preteen smartphone screen use. %M 34661541 %R 10.2196/29426 %U https://mental.jmir.org/2021/10/e29426 %U https://doi.org/10.2196/29426 %U http://www.ncbi.nlm.nih.gov/pubmed/34661541 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26273 %T Associations Between Social Media, Bedtime Technology Use Rules, and Daytime Sleepiness Among Adolescents: Cross-sectional Findings From a Nationally Representative Sample %A Hamilton,Jessica Leigh %A Lee,Woanjun %+ Department of Psychology, Rutgers University, 50 Joyce Kilmer Ave, Piscataway, NJ, 08854, United States, 1 (848) 445 2576, jessica.hamilton@rutgers.edu %K adolescents %K social media %K daytime sleepiness %K parenting %K bedtime %K mental health %K mobile phone %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Social media use is associated with poor sleep among adolescents, including daytime sleepiness, which affects adolescents’ mental health. Few studies have examined the associations among specific aspects of social media, such as frequency of checking and posting, perceived importance of social media for social belonging, and daytime sleepiness. Identifying whether certain adolescents are more at risk or protected from the effects of social media on sleepiness may inform future interventions for social media, sleep, and mental health. Objective: This study aims to examine the association between social media use frequency and importance, daytime sleepiness, and whether the perceived importance of social media for social interactions and parental rules around bedtime technology moderated these relationships. Methods: This cross-sectional survey study was conducted with a sample of 4153 adolescents from across the United States. Qualtrics was used to collect data via panel recruitment from a national sample representing the US demographics of teens aged 12 to 17 years. Participants completed measures of daytime sleepiness, frequency of social media checking and posting, and the importance of social media for social interactions. Parents reported whether they had a household rule around bedtime media and screen use. Hierarchical regressions and moderation analyses were conducted, covarying for age, gender, and age at first smartphone use. Results: Participants had a mean age of 14.64 (SD 1.66) years in grades 6 to 12, 46.45% (1929/4153) identified as female, and 67.93% (2821/4153) identified as White. The results indicated that adolescents who posted (B=0.70, SE 0.04; P<.001) or checked (B=0.76, SE 0.04; P<.001) social media more frequently or who perceived social media to be more important for social belonging (B=0.36, SE 0.02; P<.001) had higher levels of daytime sleepiness. Moderation analyses indicated that the relationship between social media use frequency and daytime sleepiness was exacerbated by higher levels of perceived social media importance (B=0.04, SE 0.01; P<.001). Adolescents without household rules around bedtime technology use were more likely to be affected by social media checking (B=−0.34, SE 0.09; P<.001) and importance (B=−0.16, SE 0.04; P<.001) on daytime sleepiness. Conclusions: The findings suggest that social media use frequency and perceived importance of social interactions are associated with daytime sleepiness among adolescents. It is important to consider youth’s perceptions of social media when assessing the potential effects of social media use frequency on youth well-being. Furthermore, youth who did not have parental rules around bedtime technology use were most likely to be affected by social media use and perceived importance. The findings may extend to other mental health outcomes and may guide future prevention and intervention programs designed to improve social media use, sleep, and mental health. %M 34524967 %R 10.2196/26273 %U https://mental.jmir.org/2021/9/e26273 %U https://doi.org/10.2196/26273 %U http://www.ncbi.nlm.nih.gov/pubmed/34524967 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26203 %T The Role of Mental Well-Being and Perceived Parental Supportiveness in Adolescents’ Problematic Internet Use: Moderation Analysis %A Hwang,Juwon %A Toma,Catalina L %+ School of Media and Strategic Communication, Oklahoma State University, 317-A Paul Miller Building, Stillwater, OK, 74078, United States, 1 6083324571, juwon.hwang.23@gmail.com %K problematic internet use %K PIU %K subjective mental well-being %K perceived parental supportiveness %K adolescents %K well-being %K young adult %K internet %K mental health %K support %K parent %K engagement %K social media %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Given the growing number of adolescents exhibiting problematic internet use (PIU) and experiencing its harmful consequences, it is important to examine the factors associated with PIU. Existing research has identified perceived parental supportiveness and adolescents’ subjective mental well-being as strong predictors of PIU. However, it is unknown how these factors work together in shaping adolescents’ engagement in PIU. Objective: This paper aimed to examine the role played by adolescents’ perception of parental supportiveness in conjunction with their subjective mental well-being in shaping their PIU. Methods: The study analyzed one of the Technology & Adolescent Mental Wellness (TAM) data sets that were collected from a nationally representative cross-sectional sample. Adolescents self-reported their internet use behavior, perceived parental supportiveness, and subjective mental well-being through an online research panel survey. Hierarchical linear regression analysis with an interaction term was performed. Results: A total of 4592 adolescents, aged 12 to 17 years, completed the survey. Adolescents reported a mean age of 14.61 (SD 1.68) and were 46.4% (2130/4592) female and 66.9% (3370/4592) White. Findings revealed that, controlling for adolescents’ demographics and social media use, higher levels of perceived parental supportiveness (β=–.285, P<.001) and higher levels of subjective mental well-being (β=–.079, P<.001) were associated with a lower likelihood of adolescent PIU. The moderation analysis showed that the negative association between perceived parental supportiveness and PIU was stronger when adolescents reported high (vs low) levels of mental well-being (β=–.191, P<.001). Conclusions: This study shows that perceived parental supportiveness was a stronger protective factor than adolescents’ mental well-being against PIU. The protective power of perceived parental supportiveness against PIU was strongest when adolescents had high mental well-being. The highest risk of PIU occurred when adolescents’ mental well-being was high, but parents were perceived as unsupportive. Our findings suggest that parental supportiveness should be targeted as part of PIU prevention efforts. %M 34524093 %R 10.2196/26203 %U https://mental.jmir.org/2021/9/e26203 %U https://doi.org/10.2196/26203 %U http://www.ncbi.nlm.nih.gov/pubmed/34524093 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 3 %P e28495 %T Rates of Assessment of Social Media Use in Psychiatric Interviews Prior to and During COVID-19: Needs Assessment Survey %A Raphaely,Shiri %A Goldberg,Simon B %A Moreno,Megan %A Stowe,Zachary %+ Department of Psychiatry, University of Wisconsin, 6001 Research Park Boulevard, Madison, WI, 53719, United States, 1 2063510110, shiri.raphaely@gmail.com %K social media %K screentime %K problematic Internet use %K psychiatric interview %K psychiatric training %K COVID-19 %K residency %K training %K survey %K psychiatry %K evaluation %K quarantine %D 2021 %7 14.9.2021 %9 Short Paper %J JMIR Med Educ %G English %X Background: Current research suggests that there is a nuanced relationship between mental well-being and social media. Social media offers opportunities for empowerment, information, and connection while also showing links with depression, high-risk behavior, and harassment. As this medium rapidly integrates into interpersonal interactions, incorporation of social media assessment into the psychiatric evaluation warrants attention. Furthermore, the COVID-19 pandemic and containment measures (ie, social distancing) led to increased dependence on social media, allowing an opportunity to assess the adaptation of psychiatric interviews in response to sociocultural changes. Objective: The first aim of this study was to evaluate if general psychiatry residents and child and adolescent psychiatry fellows assessed social media use as part of the clinical interview. Second, the study examined whether changes were made to the social media assessment in response to known increase of social media use secondary to social distancing measures during the COVID-19 pandemic. Methods: As part of a quality improvement project, the authors surveyed general psychiatry residents and child psychiatry fellows in a university-based training program (n=21) about their assessment of social media use in patient evaluations. Soon after the survey closed, “stay-at-home” orders related to the COVID-19 pandemic began. A subsequent survey was sent out with the same questions to evaluate if residents and fellows altered their interview practices in response to the dramatic sociocultural changes (n=20). Results: Pre-COVID-19 pandemic survey results found that 10% (2/21) of respondents incorporated social media questions in patient evaluations. In a follow-up survey after the onset of the pandemic, 20% (4/20) of respondents included any assessment of social media use. Among the 15 participants who completed both surveys, there was a nonsignificant increase in the likelihood of asking about social media use (2/15, 13% vs 4/15, 27%, for pre- and during COVID-19, respectively; McNemar χ21=0.25, P=.617, Cohen d=0.33). Conclusions: These small survey results raise important questions relevant to the training of residents and fellows in psychiatry. The findings suggest that the assessment of social media use is a neglected component of the psychiatric interview by trainees. The burgeoning use and diversity of social media engagement warrant scrutiny with respect to how this is addressed in interview training. Additionally, given minimal adaptation of the interview in the midst of a pandemic, these findings imply an opportunity for improving psychiatric training that incorporates adapting clinical interviews to sociocultural change. %M 34375297 %R 10.2196/28495 %U https://mededu.jmir.org/2021/3/e28495 %U https://doi.org/10.2196/28495 %U http://www.ncbi.nlm.nih.gov/pubmed/34375297 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e26485 %T Digital Technology Use and BMI: Evidence From a Cross-sectional Analysis of an Adolescent Cohort Study %A Shen,Chen %A Dumontheil,Iroise %A Thomas,Michael %A Röösli,Martin %A Elliott,Paul %A Toledano,Mireille %+ MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, St Mary's Campus, Norfolk Place, London, London, W2 1PG, United Kingdom, 44 02075943298, m.toledano@imperial.ac.uk %K adolescent %K digital technology %K obesity %K insufficient sleep %K mediation analysis %K mobile phone %D 2021 %7 5.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of digital technology such as mobile phones is ubiquitous in adolescents. However, excessive use may have adverse health effects, possibly partially mediated by disruptions to sleep. Objective: This study aims to assess the social predictors of digital technology use and their cross-sectional association with BMI z scores and being overweight in a large sample of adolescents. Methods: We used baseline data from a subset of a large adolescent cohort from 39 schools across Greater London who participated in the Study of Cognition, Adolescents and Mobile Phones (n=1473). Digital technology use included phone calls, internet use on mobile phones, and video gaming on any device. Multilevel regression was used to assess the associations between digital technology use and age-specific and sex-specific BMI z scores and being overweight (including obesity). Measurements were derived from height and weight, obtained by the Tanita BC-418 Body Composition Analyzer. We examined whether these associations were mediated by insufficient sleep. Results: Generally, participants with lower socioeconomic status reported more use of digital technology. Controlling for socioeconomic status, internet use on mobile phones for more than 3 hours per day was associated with higher BMI z scores (adjusted β=.30, 95% CI 0.11-0.48) and greater odds of being overweight (adjusted odds ratio 1.60, 95% CI 1.09-2.34), compared with low use (≤30 minutes). Similar associations were found between video gaming and BMI z scores and being overweight. The BMI z score was more strongly related to weekday digital technology use (internet use on mobile phones and video gaming) than weekend use. Insufficient sleep partly mediated the associations between digital technology use and BMI z scores (proportion of mediation from 8.6% to 17.8%) by an indirect effect. Conclusions: We found an association between digital technology use and BMI in adolescents, partly mediated by insufficient sleep, suggesting that the underlying mechanisms may be multifactorial. Further research with longitudinal data is essential to explore the direction of the relationships. %M 35143408 %R 10.2196/26485 %U https://www.jmir.org/2021/7/e26485 %U https://doi.org/10.2196/26485 %U http://www.ncbi.nlm.nih.gov/pubmed/35143408 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e29411 %T “It's Been Negative for Us Just All the Way Across the Board”: Focus Group Study Exploring Parent Perceptions of Child Screen Time During the COVID-19 Pandemic %A Hammons,Amber J %A Villegas,Elizabeth %A Robart,Ryan %+ Department of Child and Family Science, California State University, Fresno, 5241 North Maple Avenue, Fresno, CA, 93740, United States, 1 559 278 1158, ahammons@csufresno.edu %K children %K COVID-19 %K experiences %K family %K outcomes %K pandemic %K parenting %K parents %K screen time %D 2021 %7 8.6.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Child screen time (ST) has soared during the COVID-19 pandemic as lockdowns and restrictions have forced changes to regular family routines. It is important to investigate how families are navigating ST. Objective: This study aimed to explore families’ experiences of ST during the COVID-19 pandemic. Methods: Virtual focus group sessions were conducted between December 2020 and February 2021 in English and Spanish. Transcripts were analyzed using reflexive thematic analysis. Results: In total, 48 parents (predominantly Hispanic) residing in California participated in 1 of 14 focus group sessions. Children were attending school remotely at the time of the study. A total of 6 themes and 1 subtheme were identified: (1) total ST has increased; (2) children are too attached to screens; (3) ST has advantages and disadvantages but parents perceive ST as mostly negative; (4) parents and children have limited options; (5) ST restrictions (subtheme: children react negatively when ST is restricted); and (6) parents are concerned that children are not getting enough exercise. Conclusions: This study provides a cross-sectional insight into how family life has changed with regard to ST during the COVID-19 pandemic. Parents expressed concerns about total ST, the addictive nature of it, and lack of physical activity. It is important that future studies examine the long-term effects of heavy ST and preemptively introduce ways to redirect children’s ST habits as the country attempts to establish a new normal. %M 34081606 %R 10.2196/29411 %U https://pediatrics.jmir.org/2021/2/e29411 %U https://doi.org/10.2196/29411 %U http://www.ncbi.nlm.nih.gov/pubmed/34081606 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e18771 %T Exploring Canadian Children’s Social Media Use, Digital Literacy, and Quality of Life: Pilot Cross-sectional Survey Study %A Donelle,Lorie %A Facca,Danica %A Burke,Shauna %A Hiebert,Bradley %A Bender,Emma %A Ling,Stephen %+ Arthur Labatt Family School of Nursing, The University of Western Ontario, 1151 Richmond Street, London, ON, N6A3K7, Canada, 1 5198688675, dfacca2@uwo.ca %K child %K children %K internet %K social media %K digital literacy %K digital inclusion %K quality of life %K mobile phone %D 2021 %7 26.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Understanding social media use and digital literacy among young Canadian children is an increasing area of concern, given the importance of digital inclusion for full and informed participation in evolving educational, civic, corporate, social, and economic spaces. Objective: The aim of this study was to explore internet and social media knowledge as well as social media use among Canadian children aged between 6 and 10 years. Methods: We conducted interview surveys with 42 children aged between 6 and 10 years who participated in an after-school health promotion program in an urban community in Southwestern Ontario to understand their digital literacy skills and social media use. The data were analyzed using both quantitative and qualitative methods. Results: Of the 42 children who participated in this study, 24 (57%) reported that they used social media, specifically YouTube (19/24, 79% reported use), Snapchat (16/24, 67% reported use), and Facebook (8/24, 33% reported use). While using social media, children reported sharing personal information, including videos or pictures of themselves (12/24, 50%), videos or pictures of others (8/24, 33%), and their birthday (12/24, 50%), whereas only one-third (9/24, 38%) of the children believed that only close family and friends had access to the content they shared. When reporting on the quality of life in the context of using social media, most (17/24, 71%) children never felt sad, half (12/24, 50%) never had difficulty making new friends, and nearly one-third (7/24, 30%) indicated that they never had difficulty wanting to play outside. Conclusions: Owing to the rapidly evolving uptake and use of social media among young Canadians, the implementation of childhood digital health literacy education is vital to best support digital inclusion and well-being in Canada. The findings of our study highlight the need for future research to understand where children receive their digital literacy knowledge from and whether this knowledge is gained through self-directed social media use or observation from other actors, such as parents, siblings, or friends. %M 34037525 %R 10.2196/18771 %U https://formative.jmir.org/2021/5/e18771 %U https://doi.org/10.2196/18771 %U http://www.ncbi.nlm.nih.gov/pubmed/34037525 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e24196 %T Parents’ Attitudes Toward School Students’ Overuse of Smartphones and Its Detrimental Health Impacts: Qualitative Study %A Buabbas,Ali %A Hasan,Huda %A Shehab,Abrar Abdulmohsen %+ Department of Community Medicine and Bahavioural Sciences, Faculty of Medicine, Kuwait University, Jabriya, 320 St, Hawally Governorate, 13110, Kuwait, 965 246 36559, ali.buabbas@hsc.edu.kw %K smartphones %K overuse impact %K school students %K parents’ attitudes %D 2021 %7 20.5.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parents’ awareness of the risks of the overuse of smartphones (SPs) among their children and parents’ attitudes toward this societal phenomenon are crucial factors to consider when investigating the causes and effects of, as well as interventions to control, this public health issue. Objective: This study aimed to explore the awareness and attitudes of parents regarding SP overuse among their children and the detrimental impacts associated with it. Methods: The qualitative method of semistructured face-to-face interviews was used to collect data from fathers and mothers of children aged 6-18 years from all 6 educational/governorate regions in the governmental sector in Kuwait. Results: A total of 120 parents agreed to participate in the study; there were more female (75/120, 62.5%) than male (45/120, 37.5%) respondents. Almost all of the participants (118/120, 98.3%) were aware that the overuse of SPs could lead to their children becoming addicted to the devices; they were also aware that there could be side effects on their children’s health (117/120, 97.5%). Although the participants, mostly the mothers, supervised their children’s use of SPs closely (106/120, 88.3%), the majority could not control their children’s length of time using SPs, as the children considered this a deprivation of their rights. Eye-related problems, headaches, and anger were the most common side effects experienced by the children. Conclusions: Although the parents were aware of the detrimental impacts of SP overuse, the majority could not control the length of time their children spent using the devices. It was found that strong social bonds among family members play a large role in controlling the use of SPs. A number of solutions for families and the government to combat the overuse of SPs are suggested. %M 33878024 %R 10.2196/24196 %U https://pediatrics.jmir.org/2021/2/e24196 %U https://doi.org/10.2196/24196 %U http://www.ncbi.nlm.nih.gov/pubmed/33878024 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e24802 %T An App-Based Parenting Program to Promote Healthy Energy Balance–Related Parenting Practices to Prevent Childhood Obesity: Protocol Using the Intervention Mapping Framework %A Karssen,Levie T %A Vink,Jacqueline M %A de Weerth,Carolina %A Hermans,Roel C J %A de Kort,Carina P M %A Kremers,Stef PJ %A Ruiter,Emilie L M %A Larsen,Junilla K %+ Behavioural Science Institute, Radboud University, Postbus 9104, Nijmegen, 6500 HE, Netherlands, 31 0640969305, l.karssen@bsi.ru.nl %K childhood obesity %K preventive intervention %K parenting practices %K energy-balance related behavior %K socio-economic position %K mHealth %K behavior change %K mobile phone %D 2021 %7 14.5.2021 %9 Protocol %J JMIR Form Res %G English %X Background: The family environment plays an important role in the development of children’s energy balance–related behaviors. As a result, parents’ energy balance–related parenting practices are important targets of preventive childhood obesity programs. Families with a lower socioeconomic position (SEP) may benefit from participating in such programs but are generally less well reached than families with a higher SEP. Objective: This paper describes the application of the Intervention Mapping Protocol (IMP) for the development of an app-based preventive intervention program to promote healthy energy balance–related parenting practices among parents of children (aged 0-4 years) with a lower SEP. Methods: The 6 steps of the IMP were used as a theory- and evidence-based framework to guide the development of an app-based preventive intervention program. Results: In step 1, behavioral outcomes for the app-based program (ie, children have a healthy dietary intake, sufficient sleep, and restricted screen time and sufficient physical activity) and sociocognitive (ie, knowledge, attitudes, and self-efficacy) and automatic (ie, habitual behaviors) determinants of energy balance–related parenting were identified through a needs assessment. In step 2, the behavioral outcomes were translated into performance objectives. To influence these objectives, in step 3, theory-based intervention methods were selected for each of the determinants. In step 4, the knowledge derived from the previous steps allowed for the development of the app-based program Samen Happie! through a process of continuous cocreation with parents and health professionals. In step 5, community health services were identified as potential adopters for the app. Finally, in step 6, 2 randomized controlled trials were designed to evaluate the process and effects of the app among Dutch parents of infants (trial 1) and preschoolers (trial 2). These trials were completed in November 2019 (trial 1) and February 2020 (trial 2). Conclusions: The IMP allowed for the effective development of the app-based parenting program Samen Happie! to promote healthy energy balance–related parenting practices among parents of infants and preschoolers. Through the integration of theory, empirical evidence, and data from the target population, as well as the process of continued cocreation, the program specifically addresses parents with a lower SEP. This increases the potential of the program to prevent the development of obesity in early childhood among families with a lower SEP. Trial Registration: Netherlands Trial Register NL6727, https://www.trialregister.nl/trial/6727; Netherlands Trial Register NL7371, https://www.trialregister.nl/trial/7371. %M 33988510 %R 10.2196/24802 %U https://formative.jmir.org/2021/5/e24802 %U https://doi.org/10.2196/24802 %U http://www.ncbi.nlm.nih.gov/pubmed/33988510 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25219 %T Predictors of Parental Barriers to Reduce Excessive Child Screen Time Among Parents of Under-Five Children in Selangor, Malaysia: Cross-sectional Study %A Mansor,Elliza %A Ahmad,Norliza %A Raj,Diana %A Mohd Zulkefli,Nor Afiah %A Mohd Shariff,Zalilah %+ Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, 43400, Malaysia, 60 019 271 0577, lizaahmad@upm.edu.my %K child %K self-efficacy %K screen time %K Malaysia %K parent-child relations %K public sector %K children %K screen %K parental %D 2021 %7 13.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Globally, there is an increasing prevalence of excessive screen time exposure among young children, including in Malaysia. Parents are advised to limit this exposure, but there are barriers for many of them to follow this recommendation. To date, there is a lack of research on the factors that cause these parental barriers. Objective: This study aimed to determine the parental barrier toward the reduction of excessive child screen time and its predictors among parents of children aged younger than 5 years in the Petaling District, Selangor, Malaysia. Methods: A cross-sectional study was conducted from April 2019 to June 2020 among 789 parent-child dyads attending child health clinics in the Petaling District. Validated self-administered questionnaires were used to capture information on sociodemographic, parental, child-related, and environmental factors and parental barriers. Stratified sampling with probability proportionate to size was employed. Data were analyzed using SPSS Statistics version 25 (IBM Corp). Descriptive analysis and bivariable analysis were performed before multiple linear regression was used to identify predictors of parental barriers. Results: The overall mean score of parental barriers was 3.51 (SD 0.83), indicating that the average numbers of barriers experienced by parents were more than 3. The multivariable analysis showed that the predictors of parental barriers included monthly household income (adjusted β=–.03, 95% CI –0.05 to –0.02), parents who worked in public sectors (adjusted β=.18, 95% CI 0.06 to 0.29), positive parental attitude on screens (adjusted β=.68, 95% CI 0.58 to 0.79), low parent self-efficacy to influence child’s physical activity (adjusted β=–.32, 95% CI –0.43 to –0.20), and child screen time (adjusted β=.04, 95% CI 0.02 to 0.06). Conclusions: The strongest predictor of parental barriers to reduce excessive child screen time was the positive parental attitude on screen time which could contribute to their abilities to limit child screen time. Thus, future intervention strategies should aim to foster correct parental attitudes toward screen time activities among young children. %M 33847590 %R 10.2196/25219 %U https://www.jmir.org/2021/4/e25219 %U https://doi.org/10.2196/25219 %U http://www.ncbi.nlm.nih.gov/pubmed/33847590 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e19461 %T Parents’ Perspectives on Using Artificial Intelligence to Reduce Technology Interference During Early Childhood: Cross-sectional Online Survey %A Glassman,Jill %A Humphreys,Kathryn %A Yeung,Serena %A Smith,Michelle %A Jauregui,Adam %A Milstein,Arnold %A Sanders,Lee %+ Clinical Excellence Research Center, School of Medicine, Stanford University, 365 Lasuen Street, #308, Stanford, CA, 94305, United States, 1 8314195302, jill.r.glassman@stanford.edu %K parenting %K digital technology %K mobile phone %K child development %K artificial intelligence %D 2021 %7 15.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Parents’ use of mobile technologies may interfere with important parent-child interactions that are critical to healthy child development. This phenomenon is known as technoference. However, little is known about the population-wide awareness of this problem and the acceptability of artificial intelligence (AI)–based tools that help with mitigating technoference. Objective: This study aims to assess parents’ awareness of technoference and its harms, the acceptability of AI tools for mitigating technoference, and how each of these constructs vary across sociodemographic factors. Methods: We administered a web-based survey to a nationally representative sample of parents of children aged ≤5 years. Parents’ perceptions that their own technology use had risen to potentially problematic levels in general, their perceptions of their own parenting technoference, and the degree to which they found AI tools for mitigating technoference acceptable were assessed by using adaptations of previously validated scales. Multiple regression and mediation analyses were used to assess the relationships between these scales and each of the 6 sociodemographic factors (parent age, sex, language, ethnicity, educational attainment, and family income). Results: Of the 305 respondents, 280 provided data that met the established standards for analysis. Parents reported that a mean of 3.03 devices (SD 2.07) interfered daily in their interactions with their child. Almost two-thirds of the parents agreed with the statements “I am worried about the impact of my mobile electronic device use on my child” and “Using a computer-assisted coach while caring for my child would help me notice more quickly when my device use is interfering with my caregiving” (187/281, 66.5% and 184/282, 65.1%, respectively). Younger age, Hispanic ethnicity, and Spanish language spoken at home were associated with increased technoference awareness. Compared to parents’ perceived technoference and sociodemographic factors, parents’ perceptions of their own problematic technology use was the factor that was most associated with the acceptance of AI tools. Conclusions: Parents reported high levels of mobile device use and technoference around their youngest children. Most parents across a wide sociodemographic spectrum, especially younger parents, found the use of AI tools to help mitigate technoference during parent-child daily interaction acceptable and useful. %M 33720026 %R 10.2196/19461 %U https://www.jmir.org/2021/3/e19461 %U https://doi.org/10.2196/19461 %U http://www.ncbi.nlm.nih.gov/pubmed/33720026 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e24106 %T A Multicomponent Intervention to Reduce Screen Time Among Children Aged 2-5 Years in Chandigarh, North India: Protocol for a Randomized Controlled Trial %A Kaur,Nimran %A Gupta,Madhu %A Malhi,Prahbhjot %A Grover,Sandeep %+ Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India, 91 7087008223, madhugupta21@gmail.com %K multimedia %K digital-media %K preschooler %K sedentary behaviors %K toddler %K sedentary %K screen %K children %K youth %D 2021 %7 11.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Excessive digital screen exposure (≥1 hour per day) is associated with limited growth and development in children. Objective: This study aims to develop and assess a multicomponent intervention program's effectiveness in reducing excessive screen time among children aged 2-5 years. Methods: A theory-based multicomponent intervention known as Program to Lower Unwanted Media Screens (PLUMS) at the household level has been developed. It is based on the social cognitive theory for children and self-determination theory for caregivers. After pretesting, a randomized control trial will be conducted to assess this intervention's effectiveness among healthy children aged 2-5 (±3 months) years and their primary caregivers who have at least one digital media gadget at home in zone three of Chandigarh (population of 2,730,035). A sample size of 428 children is estimated per arm. PLUMS includes disseminating specific information, education, communication in the form of videos and posters to the primary caregivers, and conducting motivational interviewing as and when needed. Children will be provided suggestions for playful activities as alternatives to digital media gadgets. The primary outcome is the mean change in the duration of screen time, and secondary outcomes are sleep duration and patterns, emotional-behavioral problems, and level of physical activity of the children. Per-protocol and intention-to-treat analyses will be conducted using SPSS for Macintosh, Version 25.0. Results: The intervention package will be disseminated once a week for 8 weeks to the participants via the caregivers' preferred means of communication. The endline assessment will be done immediately postintervention and after the 6 months of follow-up. The Institute's ethics committee, Postgraduate Institute of Medical Education and Research, Chandigarh, India, has approved this study (INT/IEC/2019/000711). The Indian Council of Medical Research, New Delhi (3/1/3/Next-100/JRF-2015/HRD), and PGIMER, Chandigarh (71/2-Edu-16/92, Dated 08/01/2018) funded this study. Conclusions: PLUMS might be effective in reducing excessive screen time among children aged 2-5 years in a North Indian Union Territory. Trial Registration: Clinical Trial Registry India CTRI/2017/09/009761; https://tinyurl.com/53q6dpjs International Registered Report Identifier (IRRID): DERR1-10.2196/24106 %M 33570499 %R 10.2196/24106 %U http://www.researchprotocols.org/2021/2/e24106/ %U https://doi.org/10.2196/24106 %U http://www.ncbi.nlm.nih.gov/pubmed/33570499 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e20319 %T The Role of Technology and Social Media Use in Sleep-Onset Difficulties Among Italian Adolescents: Cross-sectional Study %A Varghese,Nirosha Elsem %A Santoro,Eugenio %A Lugo,Alessandra %A Madrid-Valero,Juan J %A Ghislandi,Simone %A Torbica,Aleksandra %A Gallus,Silvano %+ Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, Milan, 20156, Italy, 39 02 39014562, eugenio.santoro@marionegri.it %K sleep-onset difficulties %K adolescents %K social media %K electronic device use %D 2021 %7 21.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of technology and social media among adolescents is an increasingly prevalent phenomenon. However, there is a paucity of evidence on the relationship between frequency of use of electronic devices and social media and sleep-onset difficulties among the Italian population. Objective: The aim of this study is to investigate the association between the use of technology and social media, including Facebook and YouTube, and sleep-onset difficulties among adolescents from Lombardy, the most populous region in Italy. Methods: The relationship between use of technology and social media and sleep-onset difficulties was investigated. Data came from the 2013-2014 wave of the Health Behavior in School-aged Children survey, a school-based cross-sectional study conducted on 3172 adolescents aged 11 to 15 years in Northern Italy. Information was collected on difficulties in falling asleep over the last 6 months. We estimated the odds ratios (ORs) for sleep-onset difficulties and corresponding 95% CIs using logistic regression models after adjustment for major potential confounders. Results: The percentage of adolescents with sleep-onset difficulties was 34.3% (1081/3151) overall, 29.7% (483/1625) in boys and 39.2% (598/1526) in girls. It was 30.3% (356/1176) in 11-year-olds, 36.2% (389/1074) in 13-year-olds, and 37.3% (336/901) in 15-year-olds. Sleep-onset difficulties were more frequent among adolescents with higher use of electronic devices, for general use (OR 1.50 for highest vs lowest tertile of use; 95% CI 1.21-1.85), use for playing games (OR 1.35; 95% CI 1.11-1.64), use of online social networks (OR 1.40 for always vs never or rarely; 95% CI 1.09-1.81), and YouTube (OR 2.00; 95% CI 1.50-2.66). Conclusions: This study adds novel information about the relationship between sleep-onset difficulties and technology and social media in a representative sample of school-aged children from a geographical location that has not been included in studies of this type previously. Exposure to screen-based devices and online social media is significantly associated with adolescent sleep-onset difficulties. Interventions to create a well-coordinated parent- and school-centered strategy, thereby increasing awareness on the unfavorable effect of evolving technologies on sleep among adolescents, are needed. %M 33475517 %R 10.2196/20319 %U http://www.jmir.org/2021/1/e20319/ %U https://doi.org/10.2196/20319 %U http://www.ncbi.nlm.nih.gov/pubmed/33475517 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 1 %P e22494 %T Managing Game-Related Conflict With Parents of Young Adults With Internet Gaming Disorder: Development and Feasibility Study of a Virtual Reality App %A Shin,Yu-Bin %A Kim,Jae-Jin %A Kim,Hyunji %A Kim,Soo-Jeong %A Eom,Hyojung %A Jung,Young Hoon %A Kim,Eunjoo %+ Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonju-ro 211, Gangnam-gu, Seoul, 06273, Republic of Korea, 82 2 2019 3340, ejkim96@yuhs.ac %K internet gaming disorder %K family conflict %K coping behavior %K virtual reality %D 2021 %7 18.1.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Individuals with internet gaming disorder (IGD) report facing family conflicts repeatedly because of their excessive internet gaming. With recent advancements in virtual reality (VR) technology, VR therapy has emerged as a promising method for the management of various psychiatric disorders, including IGD. Given that several risk and protective factors for young people with addiction can be influenced by their interpersonal context, the potential utility of VR-based apps for managing family conflicts needs to be examined with reference to IGD management. However, few studies have evaluated potential treatment modules related to interpersonal conflict management, such as emotion regulation and taking the perspective of others. Objective: This preliminary study aims to examine the potential use of a VR-based app in the management of game-related conflicts with parents of young adults with IGD and matched controls. Methods: In total, 50 young male adults (24 with IGD and 26 controls) were recruited to participate in the study. We developed a virtual room where game-related family conflicts arise. Using this room, participants completed 2 VR tasks that required them to express anger and then implement coping skills (ie, risk/benefit assessment of stopping a game and taking parents’ perspective) to deal with negative emotions in interpersonal conflict situations and to decrease one’s gaming behavior. Results: The results showed that immersion in our VR app tended to provoke negative emotions in individuals with IGD. In addition, after a risk/benefit assessment of stopping a game, the response of stopping a game immediately increased significantly in the IGD group, suggesting that patients’ gaming behavior could be changed using our VR program. Furthermore, in individuals with IGD, longer gaming hours were associated with a lower level of perceived usefulness of the coping skills training. Conclusions: The findings of this study indicate that our VR app may be useful for implementing more desirable behaviors and managing gaming-related family conflicts in individuals with IGD. Our VR app may offer an alternative for individuals with IGD to learn how a vicious cycle of conflicts is developed and to easily and safely assess their dysfunctional thoughts behind the conflicts (ie, perceived unreasonable risks of stopping a game and thoughts acting as a barrier to taking the perspective of others). %M 33459603 %R 10.2196/22494 %U http://games.jmir.org/2021/1/e22494/ %U https://doi.org/10.2196/22494 %U http://www.ncbi.nlm.nih.gov/pubmed/33459603 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e21923 %T Smartphone Overuse and Visual Impairment in Children and Young Adults: Systematic Review and Meta-Analysis %A Wang,Jian %A Li,Mei %A Zhu,Daqiao %A Cao,Yang %+ Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Södra Grev Rosengatan 1, Örebro, 70182, Sweden, 46 196026236, yang.cao@oru.se %K visual impairment %K smartphone %K mobile phone %K overuse %K child %K young adult %K systematic review %K meta-analysis %D 2020 %7 8.12.2020 %9 Review %J J Med Internet Res %G English %X Background: Smartphone overuse has been cited as a potentially modifiable risk factor that can result in visual impairment. However, reported associations between smartphone overuse and visual impairment have been inconsistent. Objective: The aim of this systematic review was to determine the association between smartphone overuse and visual impairment, including myopia, blurred vision, and poor vision, in children and young adults. Methods: We conducted a systematic search in the Cochrane Library, PubMed, EMBASE, Web of Science Core Collection, and ScienceDirect databases since the beginning of the databases up to June 2020. Fourteen eligible studies (10 cross-sectional studies and 4 controlled trials) were identified, which included a total of 27,110 subjects with a mean age ranging from 9.5 to 26.0 years. We used a random-effects model for meta-analysis of the 10 cross-sectional studies (26,962 subjects) and a fixed-effects model for meta-analysis of the 4 controlled trials (148 subjects) to combine odds ratios (ORs) and effect sizes (ES). The I2 statistic was used to assess heterogeneity. Results: A pooled OR of 1.05 (95% CI 0.98-1.13, P=.16) was obtained from the cross-sectional studies, suggesting that smartphone overuse is not significantly associated with myopia, poor vision, or blurred vision; however, these visual impairments together were more apparent in children (OR 1.06, 95% CI 0.99-1.14, P=.09) than in young adults (OR 0.91, 95% CI 0.57-1.46,P=.71). For the 4 controlled trials, the smartphone overuse groups showed worse visual function scores compared with the reduced-use groups. The pooled ES was 0.76 (95% CI 0.53-0.99), which was statistically significant (P<.001). Conclusions: Longer smartphone use may increase the likelihood of ocular symptoms, including myopia, asthenopia, and ocular surface disease, especially in children. Thus, regulating use time and restricting the prolonged use of smartphones may prevent ocular and visual symptoms. Further research on the patterns of use, with longer follow up on the longitudinal associations, will help to inform detailed guidelines and recommendations for smartphone use in children and young adults. %M 33289673 %R 10.2196/21923 %U https://www.jmir.org/2020/12/e21923 %U https://doi.org/10.2196/21923 %U http://www.ncbi.nlm.nih.gov/pubmed/33289673 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e20529 %T The Association Between Electronic Device Use During Family Time and Family Well-Being: Population-Based Cross-Sectional Study %A Zhao,Sheng Zhi %A Guo,Ningyuan %A Wang,Man Ping %A Fong,Daniel Yee Tak %A Lai,Agnes Yuen Kwan %A Chan,Sophia Siu-Chee %A Lam,Tai Hing %A Ho,Daniel Sai Yin %+ School of Nursing, University of Hong Kong, 21 Sassoon Road, Pokfulam, HK, Hong Kong, 000000, China (Hong Kong), 852 39176636, mpwang@hku.hk %K eDevice %K smartphone %K mobile phone %K well-being %K family dinner %K family communication %K public health %D 2020 %7 14.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic devices (eDevices) may have positive or negative influences on family communication and well-being depending on how they are used. Objective: We examined eDevice use during family time and its association with the quality of family communication and well-being in Hong Kong Chinese adults. Methods: In 2017, a probability-based 2-stage random sampling landline telephone survey collected data on eDevice use in daily life and during family time (eg, family dinner) and the presence of rules banning eDevice use during family dinner. Family communication quality was rated from 0 to 10 with higher scores being favorable. Family well-being was calculated as a composite mean score of 3 items each using the same scale from 0 to 10. The associations of family communication quality and well-being with eDevice use in daily life and during family time were estimated using beta-coefficient (β) adjusting for sociodemographics. The mediating role of family communication quality in the association between eDevice use and family well-being was analyzed. Results: Of the 2064 respondents (mean age 56.4 [SD 19.2] years, 1269/2064 [61.48%] female), 1579/2059 (76.69%) used an eDevice daily for a mean of 3.6 hours (SD 0.1) and 257/686 (37.5%) used it for 30+ minutes before sleep. As much as 794/2046 (38.81%) often or sometimes used an eDevice during family time including dinner (311/2017, 15.42%); 713/2012 (35.44%) reported use of an eDevice by family members during dinner. Lower family communication quality was associated with hours of eDevice use before sleep (adjusted β=–.25; 95% CI –0.44 to –0.05), and often use (vs never use) of eDevice during family dinner by oneself (adjusted β=–.51; 95% CI –0.91 to –0.10) and family members (adjusted β=–.54; 95% CI –0.79 to –0.29). Similarly, lower family well-being was associated with eDevice use before sleep (adjusted β=–.26; 95% CI –0.42 to –0.09), and often use during family dinner by oneself (adjusted β=–.48; 95% CI –0.83 to –0.12) and family members (adjusted β=–.50; 95% CI –0.72 to –0.28). Total ban of eDevice use during family dinner was negatively associated with often use by oneself (adjusted odds ratio 0.49; 95% CI 0.29 to 0.85) and family members (adjusted odds ratio 0.41; 95% CI 0.28, 0.60) but not with family communication and well-being. Lower family communication quality substantially mediated the total effect of the association of eDevice use time before sleep (61.2%) and often use at family dinner by oneself (87.0%) and by family members (67.8%) with family well-being. Conclusions: eDevice use before sleep and during family dinner was associated with lower family well-being, and the association was substantially mediated by family communication quality. Our results suggest that interventions on smart use of eDevice may improve family communication and well-being. %M 33052120 %R 10.2196/20529 %U http://www.jmir.org/2020/10/e20529/ %U https://doi.org/10.2196/20529 %U http://www.ncbi.nlm.nih.gov/pubmed/33052120 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e16388 %T Relationship Between Depression and the Use of Mobile Technologies and Social Media Among Adolescents: Umbrella Review %A Arias-de la Torre,Jorge %A Puigdomenech,Elisa %A García,Xavier %A Valderas,Jose M %A Eiroa-Orosa,Francisco Jose %A Fernández-Villa,Tania %A Molina,Antonio J %A Martín,Vicente %A Serrano-Blanco,Antoni %A Alonso,Jordi %A Espallargues,Mireia %+ Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill campus, London, SE5 8AF, United Kingdom, 44 634722677, jorgeariasdelatorre@gmail.com %K mobile technologies and social media %K depression %K adolescents %K review %D 2020 %7 26.8.2020 %9 Review %J J Med Internet Res %G English %X Background: Despite the relevance of mobile technologies and social media (MTSM) for adolescents, their association with depressive disorders in this population remains unclear. While there are previous reviews that have identified the use of MTSM as a risk factor for developing depression, other reviews have indicated their possible preventive effect. Objective: The aim of this review was to synthesize the current evidence on the association between MTSM use and the development or prevention of depressive disorders in adolescents. Methods: An umbrella review was conducted using information published up to June 2019 from PubMed/MEDLINE, PsycINFO, Web of Science, and The Cochrane Library. Systematic reviews focusing on the adolescent population (up to 20 years old) and depression and its potential relationship with MTSM use were included. Screening of titles, abstracts, and full texts was performed. After selecting the reviews and given the heterogeneity of the outcome variables and exposures, a narrative synthesis of the results was carried out. Results: The search retrieved 338 documents, from which 7 systematic reviews (3 meta-analyses) were selected for data extraction. There were 11-70 studies and 5582-46,015 participants included in the 7 reviews. All reviews included quantitative research, and 2 reviews also included qualitative studies. A statistically significant association between social media and developing depressive symptoms was reported in 2 reviews, while 5 reviews reported mixed results. Conclusions: Excessive social comparison and personal involvement when using MTSM could be associated with the development of depressive symptomatology. Nevertheless, MTSM might promote social support and even become a point of assistance for people with depression. Due to the mixed results, prospective research could be valuable for providing stronger evidence. %M 32663157 %R 10.2196/16388 %U http://www.jmir.org/2020/8/e16388/ %U https://doi.org/10.2196/16388 %U http://www.ncbi.nlm.nih.gov/pubmed/32663157 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17996 %T The Cyclic Value-Context Reinforcement Model of Problematic Internet Use: Empirical Validation Using a Thematic Analysis of Children’s Counseling Data %A Doh,Young Yim %A Kim,Bugeun %A Lee,Seul %A Gweon,Gahgene %+ Graduate School of Convergence Science and Technology, Seoul National University, 1 Gwanakro, Seoul, Republic of Korea, 82 318889172, ggweon@snu.ac.kr %K problematic internet use %K children %K cyclic value context reinforcement model %K psychosocial value %K environmental context %K internet utility %D 2020 %7 14.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Research on problematic internet use has focused on devising diagnostic criteria or describing the factors that influence internet overuse. However, a paradigm shift is necessary in studying the phenomenon of increased internet use not just from a pathological point of view but also from a developmental point of view that considers children’s behavior of adapting to a technology-oriented society. Objective: In this paper, we propose the Cyclic Value-Context Reinforcement Model (CVCRM) to understand problematic internet use behavior. The purpose of our study was to construct a developmental process model that provides a holistic understanding of problematic internet use behavior of children and to empirically validate the proposed model by conducting a thematic analysis on actual counseling data. Methods: To validate the CVCRM, we conducted thematic analysis using the counseling data from 312 Korean children aged 7-18 years. For the coding process, 7 master’s and doctoral student researchers participated as coders, and 2 professors supervised the coding process and results. Results: This project was funded from October 2015 to September 2019 to analyze counseling data from 312 children who participated in counseling sessions during January 2012 to May 2014. Based on the data analysis, we present the CVCRM, which integrates existing theoretical approaches and encompasses the 3 interacting aspects that induce and reinforce problematic internet use in children: psychosocial value, environmental context, and internet utility. Specifically, using counseling data, we empirically ascertained that problematic internet use behavior feeds into children’s psychosocial values and environmental contexts, which in turn facilitates problematic internet use in a cyclical manner. Conclusions: Through this empirical validation, the CVCRM can provide a theoretical framework and an integrated perspective on the developmental mechanism of problematic internet use behavior of children. %M 32460233 %R 10.2196/17996 %U https://www.jmir.org/2020/7/e17996 %U https://doi.org/10.2196/17996 %U http://www.ncbi.nlm.nih.gov/pubmed/32460233 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e18095 %T Relationships Between the Usage of Televisions, Computers, and Mobile Phones and the Quality of Sleep in a Chinese Population: Community-Based Cross-Sectional Study %A Xie,Yao Jie %A Cheung,Daphne SK %A Loke,Alice Y %A Nogueira,Bernice L %A Liu,Karry M %A Leung,Angela YM %A Tsang,Alice SM %A Leong,Cindy SU %A Molassiotis,Alex %+ School of Nursing, The Hong Kong Polytechnic University, FG424, PolyU, Hong Kong, China (Hong Kong), 852 63135399, grace.yj.xie@polyu.edu.hk %K electronic device %K screen-based %K sleep %K Chinese %K digital %K mobile phone %D 2020 %7 7.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: No study has comprehensively investigated the association between the usage of typical screen-based electronic media devices and sleep quality in a Chinese population with individuals in a wide range of ages. Objective: This study aimed to understand the characteristics of television (TV) viewing, computer usage, and mobile phone usage in a representative Chinese population in Macau and to examine their roles in predicting the variations in sleep quality. Methods: This cross-sectional study was an analysis of 1500 Macau residents aged 15 to 90 years based on a community-based health needs assessment study entitled, “Healthy Living, Longer Lives.” Data collection was conducted in 7 districts of Macau from 2017 to 2018 through face-to-face interviews. The durations of daily TV viewing, computer usage, and mobile phone usage were recorded in a self-administered questionnaire. The Chinese version of the Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality. Results: The prevalence of TV, computer, and mobile phone usage was 78.4% (1176/1500), 51.6% (769/1490), and 85.5% (1276/1492), respectively. The average daily hours of usage were 1.75 (1.62), 1.53 (2.26), and 2.85 (2.47) hours, respectively. Females spent more time watching TV (P=.03) and using mobile phones (P=.02) and less time on the computer (P=.04) as compared to males. Older adults were more likely to watch TV while young people spent more time using the computer and mobile phones (P for all trends<.001). The mean PSQI global score was 4.79 (2.80) among the participants. Females exhibited significantly higher PSQI scores than males (5.04 vs 4.49, respectively; P<.001). No linear association was observed between the PSQI score and the amount of time spent on the 3 electronic devices (P=.58 for PSQI-TV, P=.05 for PSQI-computer, and P=.52 for PSQI-mobile phone). Curve estimation showed significant quadratic curvilinear associations in PSQI-TV (P=.003) and PSQI-computer (P<.001) among all the participants and in PSQI-mobile phone among youths (age, 15-24 years; P=.04). After adjustment of the gender, age, body mass index, demographics, and lifestyle factors, more than 3 hours of TV viewing and 4 hours of computer usage or mobile phone usage was associated with 85% (95% CI 1.04-1.87; P=.008), 72% (95% CI 1.01-2.92; P=.045), and 53% (95% CI 1.06-2.22; P=.03) greater odds of having poor sleep quality (PSQI score>5), respectively. Conclusions: The mobile phone was the most popular screen-based electronic device used in the Macau population, especially among young people. “J” shape associations were observed between sleep quality and the duration of TV viewing, computer usage, and mobile phone usage, indicating that the extreme use of screen-based electronic devices predicted poorer sleep status, whereas moderate use would be acceptable. %M 32369439 %R 10.2196/18095 %U https://www.jmir.org/2020/7/e18095 %U https://doi.org/10.2196/18095 %U http://www.ncbi.nlm.nih.gov/pubmed/32369439 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 1 %P e17165 %T College Student Problematic Internet Use and Digital Communication Medium Used With Parents: Cross-Sectional Study %A Kerr,Bradley %A D'Angelo,Jon D %A Diaz-Caballero,Ali %A Moreno,Megan A %+ University of Wisconsin-Madison, 2870 University Ave, Suite 200, Madison, WI, , United States, 1 608 262 4440, bkerr@wisc.edu %K parents %K young adults %K social media %D 2020 %7 23.4.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Problematic internet use (PIU) is associated with mental health concerns such as depression and affects more than 12% of young adults. Few studies have explored potential influences of parent–college student digital communication on college students’ risk of PIU. Objective: This study sought to understand the relationship between parent–college student digital communication frequency via phone calls, text messages, and Facebook contacts and PIU among college students. Methods: Incoming first-year students were randomly selected from registrar lists of a midwestern and northwestern university for a 5-year longitudinal study. Data from interviews conducted in summer 2014 were used. Measures included participants’ daily Facebook visits, communication frequency with parents via phone call and text message, and 3 variables related to Facebook connection status and communication: (1) parent–college student Facebook friendship status, (2) college student blocking personal Facebook content from parent, and (3) Facebook communication frequency. PIU risk was assessed using the Problematic and Risky Internet Use Screening Scale. Analysis included participants who reported visiting Facebook at least once per day. Multiple linear regression was used, followed by a post hoc mediation with Hayes process macro to further investigate predictive relationships among significant variables. Results: A total of 151 participants reported daily Facebook use and were included in analyses. Among these participants, 59.6% (90/151) were female, 62.3% (94/151) were from the midwestern university, and 78.8% (119/151) were white. Mean Facebook visits per day was 4.3 (SD 3.34). There was a collective significant effect between participant daily Facebook visits, college student–parent phone calls, texts, and all 3 Facebook connection variables (F6,144=2.60, P=.02, R2=.10). Phone calls, text messages, and Facebook contacts were not associated with PIU risk. However, two individual items were significant predictors for PIU: participant daily Facebook visits were positively associated with increased PIU risk (b=0.04, P=.006) and being friends with a parent on Facebook was negatively associated with PIU risk (b=–0.66, P=.008). Participant daily Facebook visits were not a significant mediator of the relationship between college student–parent Facebook friendship and PIU risk (b=–0.04; 95% CI –0.11 to 0.04). Conclusions: This study did not find support for a relationship between parent–college student digital communication frequency and PIU among college students. Instead, results suggested Facebook friendship may be a protective factor. Future studies should examine how a parent-child Facebook friendship might protect against PIU among children at varying developmental stages. %M 32324140 %R 10.2196/17165 %U http://pediatrics.jmir.org/2020/1/e17165/ %U https://doi.org/10.2196/17165 %U http://www.ncbi.nlm.nih.gov/pubmed/32324140 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 2 %P e16736 %T Measuring Interests Not Minutes: Development and Validation of the Adolescents’ Digital Technology Interactions and Importance Scale (ADTI) %A Moreno,Megan A %A Binger,Kole %A Zhao,Qianqian %A Eickhoff,Jens %+ Department of Pediatrics, University of Wisconsin-Madison, 2870 University Ave, Suite 200, Madison, WI, 53705, United States, 1 6082632846, mamoreno@pediatrics.wisc.edu %K technology %K adolescents %K methodology, survey %K social media %K screen time %K instrument development %D 2020 %7 12.2.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Interactive digital technology use is integral to adolescents’ lives and has been associated with both health benefits and risks. Previous studies have largely focused on measuring the quantity of technology use or understanding the use of specific platforms. To better understand adolescents’ interactive digital technology use, we need new approaches that consider technology interactions and their importance. Objective: This study aimed to develop an assessment tool to evaluate adolescents’ digital technology interactions and their perceived importance. Methods: We used a validated scale development approach comprising 2 initial steps to create an item pool: item pool development and item pool refinement. These steps relied upon empirical literature review and an expert convening. We then evaluated the item pool using a Web-based survey. Data were collected via Qualtrics panel recruitment from a national sample of 12- to 18-year-olds. Participant data were randomly split into a development subsample for exploratory factor analysis (EFA) and a test subsample for confirmatory factor analysis (CFA). We assessed Cronbach alpha as well as model fit characteristics including root mean square error of approximation (RMSEA) and comparative fit index (CFI). Results: Our initial item pool had 71 items and the refined item pool contained 40. A total of 761 adolescents assessed the item pool via Web-based survey. Participants had a mean age of 14.8 (SD 1.7) years and were 52.8% (402/761) female and 77.5% (590/761) white. The EFA analysis included 500 participants and an 18-item draft scale was created. The CFA included 261 participants to test the draft scale. Adequate model fit for the scale was indicated by an RMSEA of 0.063 and a CFI of 0.95. The final scale included 18 items in a 3-factor model, with Cronbach alpha for the 3 factors of .87 (factor 1), .90 (factor 2) and .82 (factor 3). The 3 factors were named (1) technology to bridge online and offline experiences, (2) technology to go outside one’s identity or offline environment, and (3) technology for social connection. Conclusions: The resulting Adolescents’ Digital Technology Interactions and Importance (ADTI) scale is a promising and psychometrically validated tool for identifying the importance of distinct technology interactions. The scale is informed by relevant theory and expert input. The 3 subscales have utility for future studies to understand whether certain subscale score ranges are associated with health or well-being outcomes. %M 32049068 %R 10.2196/16736 %U https://www.jmir.org/2020/2/e16736 %U https://doi.org/10.2196/16736 %U http://www.ncbi.nlm.nih.gov/pubmed/32049068 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e14290 %T Associations of Social Media Use With Physical Activity and Sleep Adequacy Among Adolescents: Cross-Sectional Survey %A Shimoga,Sandhya V %A Erlyana,Erlyana %A Rebello,Vida %+ Department of Health Care Administration, California State University Long Beach, 1250 Bellflower Blvd, Long Beach, CA, 90840, United States, 1 562 985 5800, erlyana.erlyana@csulb.edu %K adolescent %K social media %K exercise %K sleep %D 2019 %7 18.06.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Adolescents’ use of social media, which has increased considerably in the past decade, has both positive and negative influences on adolescents’ health and health behaviors. As social media is the most prominent communication tool of choice for adolescents, it is important to understand the relationship between the frequency of social media use and health behaviors among this population. Objective: The objective of our study was to examine the associations between the frequency of social media use and physical activity and sleep adequacy among middle and high school students. Methods: We used data from the Monitoring the Future survey (2014 and 2015), a nationally representative, annual, cross-sectional survey of American 8th-, 10th-, and 12th-grade students (N=43,994). Health behaviors examined were frequency of vigorous physical activity and frequency of getting 7 hours of sleep (never/seldom, sometimes, and every day/nearly every day). We measured frequency of social media use using a Likert-like scale (never, a few times a year, 1-2 times a month, once a week, or every day). Multivariable generalized ordered logistic regressions examined the association of social media use with different levels of physical activity and sleep. We estimated marginal effects (MEs) for the main independent variable (social media use frequency) by holding all other variables at their observed values. Results: The study population comprised 51.13% (21,276/42,067) female students, 37.48% (17,160/43,994) from the South, and 80.07% (34,953/43,994) from a metropolitan area, with 76.90% (33,831/43,994) reporting using social media every day. Among physically active students, frequent social media use was associated with a higher likelihood of vigorous daily exercise (ME 50.1%, 95% CI 49.2%-51.0%). Among sedentary students, frequent social media use was associated with a lower likelihood of vigorous daily exercise (ME 15.8%, 95% CI 15.1%-16.4%). Moderately active students who used social media once or twice a month had the highest likelihood of reporting vigorous daily exercise (ME 42.0%, 95% CI 37.6%-46.3%). Among those who normally got adequate sleep, daily social media users were least likely to report adequate sleep (ME 41.3%, 95% CI 40.4%-42.1%). Among those who were usually sleep deprived, daily social media users were more likely to report adequate sleep (ME 18.3%, 95% CI 17.6%-19.0%). Conclusions: Regular social media use every day was associated with a reinforcement of health behaviors at both extremes of health behaviors, whereas a medium intensity of social media use was associated with the highest levels of physical activity and lowest sleep adequacy among those with moderate health behaviors. Hence, finding an optimal level of social media use that is beneficial to a variety of health behaviors would be most beneficial to adolescents who are in the middle of the health behavior spectrum. %M 31215512 %R 10.2196/14290 %U http://www.jmir.org/2019/6/e14290/ %U https://doi.org/10.2196/14290 %U http://www.ncbi.nlm.nih.gov/pubmed/31215512 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 1 %P e11791 %T “If You Let Them, They Will Be on It 24 Hours a Day”: Qualitative Study Conducted in the United States Exploring Brazilian Immigrant Mothers’ Beliefs, Attitudes, and Practices Related to Screen Time Behaviors of Their Preschool-Age Children %A Lindsay,Ana Cristina %A Moura Arruda,Carlos André %A Machado,Márcia MT %A Greaney,Mary L %+ Department of Exercise and Health Sciences, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125, United States, 1 6172877579, Ana.Lindsay@umb.edu %K Brazil %K immigrants %K mothers %K child, preschool %K screen time %D 2019 %7 21.01.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The increasing prevalence of excessive screen time (ST) among children is a growing public health concern, with evidence linking it to an increased risk of overweight and obesity among children. Objective: This study aimed to explore the beliefs, attitudes, and practices of Brazilian immigrant mothers living in the United States related to their preschool-age children’s ST behaviors. Methods: A qualitative study comprising 7 focus group discussions (FGDs) was conducted with Brazilian immigrant mothers living in the United States. All FGDs were audio-recorded and professionally transcribed verbatim. The Portuguese transcripts were analyzed using thematic analysis. Results: In total, 37 women participated in the FGDs. Analyses revealed that although most mothers expressed concerns for their preschool-age children’s ST, nearly all viewed ST as an acceptable part of their children’s daily lives. Furthermore, mothers perceived that ST has more benefits than disadvantages. The mothers’ positive beliefs about (eg, educational purposes and entertainment) and perceived functional benefits of ST (eg, ability to keep children occupied so tasks can be completed and facilitation of communication with family outside the United States) contributed to their acceptance of ST for their preschool-age children. Nevertheless, most mothers spoke of needing to balance their preschool-age children’s ST with other activities. Mothers reported using several parenting practices including monitoring time and content, setting limits and having rules, and prompting their children to participate in other activities to manage their preschool-age children’s ST. Conclusions: This study provides new information on the beliefs, attitudes, and practices of Brazilian immigrant mothers living in the United States related to their preschool-age children’s ST. Study findings revealed several potentially modifiable maternal beliefs and parenting practices that may provide important targets for parenting- and family-based interventions aimed at limiting preschool-age children’s ST. %M 31518308 %R 10.2196/11791 %U http://pediatrics.jmir.org/2019/1/e11791/ %U https://doi.org/10.2196/11791 %U http://www.ncbi.nlm.nih.gov/pubmed/31518308 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e11012 %T A Novel Approach to Evaluating Mobile Smartphone Screen Time for iPhones: Feasibility and Preliminary Findings %A Gower,Aubrey D %A Moreno,Megan A %+ Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin - Madison, Suite 200, 2870 University Avenue, Madison, WI, 53705, United States, 1 608 262 7103, adgower@wisc.edu %K smartphone %K youth %K mobile apps %K mobile phone %K screenshot %D 2018 %7 19.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Increasingly high levels of smartphone ownership and use pose the potential risk for addictive behaviors and negative health outcomes, particularly among younger populations. Previous methodologies to understand mobile screen time have relied on self-report surveys or ecological momentary assessments (EMAs). Self-report is subject to bias and unreliability, while EMA can be burdensome to participants. Thus, a new methodology is needed to advance the understanding of mobile screen time. Objective: The objective of this study was to test the feasibility of a novel methodology to record and evaluate mobile smartphone screen time and use: battery use screenshot (BUS). Methods: The BUS approach, defined for this study as uploading a mobile phone screenshot of a specific page within a smartphone, was utilized within a Web-based cross-sectional survey of adolescents aged 12-15 years through the survey platform Qualtrics. Participants were asked to provide a screenshot of their battery use page, a feature within an iPhone, to upload within the Web-based survey. Feasibility was assessed by smartphone ownership and response rate to the BUS upload request. Data availability was evaluated as apps per BUS, completeness of data within the screenshot, and five most used apps based on battery use percentage. Results: Among those surveyed, 26.73% (309/1156) indicated ownership of a smartphone. A total of 105 screenshots were evaluated. For data availability, screenshots contained an average of 10.2 (SD 2.0) apps per screenshot and over half (58/105, 55.2%) had complete data available. The most common apps or functions included Safari and Home and Lock Screen. Conclusions: Study findings describe the BUS as a novel approach for real-time data collection focused on iPhone screen time and use among young adolescents. Although feasibility showed some challenges in the upload capacity of young teens, data availability was generally strong across this large dataset. These data from screenshots have the potential to provide key insights into precise mobile smartphone screen use and time spent per mobile app. Future studies could explore the use of the BUS methodology on other mobile smartphones such as Android phones to correlate mobile smartphone screen time with health outcomes. %M 30455163 %R 10.2196/11012 %U http://mhealth.jmir.org/2018/11/e11012/ %U https://doi.org/10.2196/11012 %U http://www.ncbi.nlm.nih.gov/pubmed/30455163