Evaluating a Middle-School Digital Citizenship Curriculum (Screenshots): Quasi-Experimental Study.

BACKGROUND: Screenshots is an in-school curriculum that seeks to develop positive digital social skills in middle school students with the long-term goal of improving their health and well-being. The program imparts knowledge and teaches skills upon which young adolescents can build a set of beliefs and behaviors that foster respectful interactions, prosocial conflict resolutions, and safe and secure use of communication technology. Intervening in this way can improve young people's mental health by limiting their exposure to cyberbullying and other forms of negative online interactions. This study reports on an evaluation of the Screenshots program conducted with seventh graders in a public school system in a midsized New England city. OBJECTIVE: This study aims to determine the effectiveness of the Screenshots program in increasing participants' knowledge about key concepts of digital citizenship and in shifting beliefs and intended behaviors to align with prosocial and safe online interactions. In addition, the study examines whether the program has varying effects on males' and females' conflict and bullying resolution strategies. METHODS: This quasi-experimental evaluation was conducted in four middle schools in which one group of seventh graders received the Screenshots curriculum and another did not. Before and after the curriculum, all students completed a questionnaire that measured their knowledge of and beliefs about digital citizenship and related online behavioral concepts, their attitudes regarding strategies for stopping online bullying, and their intended online conflict resolution behaviors. RESULTS: The sample included 92 students who received the curriculum and 71 students who were included in the comparison group. Pre- to postinstruction retention rates ranged from 52% (33/63) to 84% (21/25), varying by school and condition. The results showed an increase in knowledge about key curricular concepts for some students (F1,32=9.97; P=.003). In response to some individual items, students decreased their belief supportive of a negative online behavior (F1,76=9.00; P=.004) and increased their belief consistent with an online safety behavior (F1,42=4.39; P=.04) compared with the comparison group. Gender moderated the results related to conflict resolution, with males from one school reducing their endorsement of an aggressive option (F2,40=5.77; P=.006) and males from another school increasing their reported tendency to pursue a nonaggressive option (F2,28=3.65; P=.04). On average, participants reported learning something new from the classes. CONCLUSIONS: This study represents a rare evaluation of an in-school digital citizenship program and demonstrates the effectiveness of Screenshots. Students' increased knowledge of key curricular concepts represents a foundation for developing future beliefs and healthy behaviors. Differences in how adolescent males and females experience and perpetrate online aggression likely explain the conflict resolution findings and emphasize the need to examine gender differences in response to these programs. Students' high ratings of the relevance of Screenshots' content reinforce the need for this type of intervention.

Current Research and Viewpoints on Internet Addiction in Adolescents.

PURPOSE OF REVIEW: This review describes recent research findings and contemporary viewpoints regarding internet addiction in adolescents including its nomenclature, prevalence, potential determinants, comorbid disorders, and treatment. RECENT FINDINGS: Prevalence studies show findings that are disparate by location and vary widely by definitions being used. Impulsivity, aggression, and neuroticism potentially predispose youth to internet addiction. Cognitive behavioral therapy and medications that treat commonly co-occurring mental health problems including depression and ADHD hold considerable clinical promise for internet addiction. SUMMARY: The inclusion of internet gaming disorder in the DSM-5 and the ICD-11 has prompted considerable work demonstrating the validity of these diagnostic approaches. However, there is also a movement for a conceptualization of the disorder that captures a broader range of media-use behaviors beyond only gaming. Efforts to resolve these approaches are necessary in order to standardize definitions and clinical approaches. Future work should focus on clinical investigations of treatments, especially in the USA, and longitudinal studies of the disorder's etiology.

Internet Use, Depression, and Anxiety in a Healthy Adolescent Population: Prospective Cohort Study.

BACKGROUND: Psychiatric disorders, including conduct disturbances, substance abuse, and affective disorders, emerge in approximately 20% of adolescents. In parallel with the rise in internet use, the prevalence of depression among adolescents has increased. It remains unclear whether and how internet use impacts mental health in adolescents. OBJECTIVE: We assess the association between patterns of internet use and two mental health outcomes (depression and anxiety) in a healthy adolescent population. METHODS: A total of 126 adolescents between the ages of 12 and 15 years were recruited. Participants reported their typical computer and internet usage patterns. At baseline and one-year follow-up, they completed the Beck Depression Index for primary care (BDI-PC) and the Beck Anxiety Inventory for Primary Care (BAI-PC). Individual linear regressions were completed to determine the association between markers of internet use at baseline and mental health outcomes at one-year follow-up. All models controlled for age, gender, and ethnicity. RESULTS: There was an inverse correlation between minutes spent on a favorite website per visit and BAI-PC score. No association was found between internet use and BDI-PC score. CONCLUSIONS: There is no relationship between internet use patterns and depression in adolescents, whereas internet use may mitigate anxiety in adolescents with higher levels of baseline anxiety.

A Preliminary Evaluation of a School-Based Media Education and Reduction Intervention.

While media education and reduction programs have been proposed to prevent adverse health and academic outcomes related to heavy electronic media use among school-aged children, few have been formally piloted and evaluated. We used a quasi-experimental design to evaluate the effectiveness of Take the Challenge (TtC), a school-based media education/reduction program for the primary prevention of sleep deprivation, dysfunctional social-emotional behaviors, and poor academic performance. Sixth- to eighth-grade students at a rural Midwestern U.S. middle school received the TtC program, while a similar school in the same district served as the comparison group. Health-related and academic measures were collected from students and teachers at both schools before and after the intervention. The primary outcome measure was student-reported electronic media use (television, video games, Internet). Secondary measures included student health behaviors (student-reported sleep, exercise, and outdoor play) and academic activities (teacher-reported homework and classroom performance). Compared to the comparison group, students receiving TtC slept more and reduced television viewing, background television time, after-school video gaming, and weekend Internet use. Teachers reported increases in the extent to which TtC students completed homework assignments and stayed on task in the classroom. Well-designed school-based programs such as TtC can reduce electronic media use among middle-school children and improve related health and academic outcomes.

Adolescents' use of sexually explicit Internet material and their sexual attitudes and behavior: Parallel development and directional effects.

Although research has repeatedly demonstrated that adolescents' use of sexually explicit Internet material (SEIM) is related to their endorsement of permissive sexual attitudes and their experience with sexual behavior, it is not clear how linkages between these constructs unfold over time. This study combined 2 types of longitudinal modeling, mean-level development and cross-lagged panel modeling, to examine (a) developmental patterns in adolescents' SEIM use, permissive sexual attitudes, and experience with sexual behavior, as well as whether these developments are related; and (b) longitudinal directionality of associations between SEIM use on the 1 hand and permissive sexual attitudes and sexual behavior on the other hand. We used 4-wave longitudinal data from 1,132 7th through 10th grade Dutch adolescents (M(age) T1 = 13.95; 52.7% boys) and estimated multigroup models to test for moderation by gender. Mean-level developmental trajectories showed that boys occasionally and increasingly used SEIM over the 18-month study period, which co-occurred with increases in their permissive attitudes and their experience with sexual behavior. Cross-lagged panel models revealed unidirectional effects from boys' SEIM use on their subsequent endorsement of permissive attitudes, but no consistent directional effects between their SEIM use and sexual behavior. Girls showed a similar pattern of increases in experience with sexual behavior, but their SEIM use was consistently low and their endorsement of permissive sexual attitudes decreased over the 18-month study period. In contrast to boys, girls' SEIM use was not longitudinally related to their sexual attitudes and behavior. Theoretical and practical implications of these gender-specific findings are discussed. (PsycINFO Database Record

Media use and depression: exposure, household rules, and symptoms among young adolescents in the USA.

OBJECTIVES: To determine the longitudinal and cross-sectional associations between different types of electronic media use (mobile phones, TV, computers, video games, and music) and young adolescents' depressive symptoms, and to explore the potential for household media rules to reduce young people's depression. METHODS: 126 young adolescents were recruited from the Northeastern USA. Each type of media use was assessed using survey questions, time use diaries, and ecological momentary assessment. The Beck Depression Index for Primary Care was administered at baseline and 1 year later as part of a questionnaire that also included items assessing the presence of household rules about TV and video games. RESULTS: Baseline use of mobile phones and TV viewing were associated with higher levels of depression 1 year later controlling for demographic information and baseline depression score. Having household rules about TV at baseline predicted lower levels of depression at follow-up. CONCLUSIONS: Both TV viewing and mobile phone use may contribute to the development of depressive symptoms. Implementing household rules about the duration and content of TV could help reduce depression in young adolescents.

Sex-related online behaviors and adolescents' body and sexual self-perceptions.

BACKGROUND AND OBJECTIVE: This study investigated: (1) the prevalence and development of 2 receptive (sexually explicit Internet material [SEIM] use and sexual information seeking) and 2 interactive (cybersex and general social networking site [SNS] use) online behaviors in adolescence; (2) whether development of these behaviors predict adolescents' body and sexual self-perceptions; and (3) whether parental strategies regarding adolescents' Internet use reduce engagement in sex-related online behaviors. METHODS: Four-wave longitudinal data among 1132 seventh- to 10th-grade Dutch adolescents (mean age at wave 1: 13.95 years; 52.7% boys) were collected. Developmental trajectories of sex-related online behaviors were estimated by using latent growth curve modeling. Self-perception outcomes at wave 4 and parental strategies predicting online behaviors were investigated by adding regression paths to growth models. RESULTS: Boys occasionally and increasingly used SEIM. Patterns for girls' SEIM use and boys' and girls' sexual information seeking and cybersex were consistently low. SNS use, however, was a common, daily activity for both. Higher initial levels and/or faster increases in sex-related online behaviors generally predicted less physical self-esteem (girls' SNS use only), more body surveillance, and less satisfaction with sexual experience. Private Internet access and less parental rule setting regarding Internet use predicted greater engagement in sex-related online behaviors. CONCLUSIONS: Although most sex-related online behaviors are not widespread among youth, adolescents who engage in such behaviors are at increased risk for developing negative body and sexual self-perceptions. Particular attention should be paid to adolescents' SNS use because this behavior is most popular and may, through its interactive characteristics, elicit more critical self-evaluations. Prevention efforts should focus on parents' role in reducing risky sex-related online behaviors.

Differences in media access and use between rural Native American and White children.

INTRODUCTION: Native American children experience greater disparities in the number and magnitude of health-related diseases than White children. Multimedia-based health interventions may afford valuable opportunities for reaching this underserved demographic; however, limited data are available describing the use of media technologies among Native Americans. This study characterized diverse media access and use between rural Native American and White children. METHODS: Surveys were administered to students (n=477) aged 10-15 years in grades 6-8 across four public middle schools in the rural Upper Peninsula of the Midwestern USA state of Michigan. RESULTS: Native American children (n=41) were more likely than White children (n=436) to have a video game system in their bedroom (65.9% vs 45.4%; p=0.01) and watch more minutes of television on Saturdays (110.3±91.7 vs 80.7±80.8; p=0.03). Native American children also had fewer computers within the home (1.20±0.81 vs 1.68±1.21; p=0.01) than White children and less household internet access (75.6% vs 87.1%; p=0.04), but demonstrated more use in minutes after school (79.9±97.9 vs 51.1±71.6; p=0.02) and on Saturdays (92.6±107.4 vs 60.0±85.1; p=0.02). CONCLUSIONS: This represents the first cross-cultural comparison of media access and use between Native American and White children from rural Michigan. Greater computer and internet use observed among the Native American children surveyed in this study supports the use of web-based public health initiatives aimed at reducing health disparities within this vulnerable group.

Feasibility of an Online and Mobile Videogame Curriculum for Teaching Children Safe and Healthy Cellphone and Internet Behaviors.

OBJECTIVE: Increased prevalence and penetration of cellphone and mobile Internet use have raised significant concerns about children's health and safety by offering new spaces for cyberbullying, harassment, and sexual misconduct. "Cyberhero Mobile Safety" is a videogame-based education program designed using tenets of the capacity model with the goal of instilling the knowledge and skills necessary to safely and productively navigate the mobile online environment. This study evaluates its usability, appeal, and perceived impact and usefulness. MATERIALS AND METHODS: Six educational videogames were part of a program delivered to 3rd-6th grade students (n=108) across six public schools in Upstate New York. Videogame play was electronically captured to evaluate usability. Likeability, acceptability, and perceived usefulness of videogame content were evaluated through postgame questionnaires. RESULTS: Videogame usability criteria were achieved on 82.7 percent of the students' gameplays. On a scale from 1 (low) to 5 (high), mean ratings were 4.09 (standard deviation [SD]=1.28) for likeability, 3.54 (SD=1.61) for acceptability, and 4.16 (SD=1.33) for perceived message usefulness. CONCLUSIONS: The "Cyberhero Mobile Safety" program is a feasible and potentially effective platform for delivering information about safe and healthy cellphone and Internet use to children. Results support the use of the capacity model to design educational videogames because games that aligned with theory principles were reported as having the most impact and being the most useful at shifting children's online behaviors. Future research should directly test the individual components of the capacity model to inform educational game design.

Exploring the perspectives of obese adolescent girls.

To understand obese adolescent girls' perspectives regarding their weight and health we studied video intervention/prevention assessment audiovisual narratives created by 14 obese girls ages 12 to 20 years. The narratives included interviews, monologues, and daily activities. Themes included illness conceptualizations, health concerns, health misinformation, and distress regarding appearance deriving from both within and without. The predominant theme was ambivalence about obesity. Close examination of these themes revealed potential footholds for intervention. Sensitive exploration of issues such as appearance and psychosocial distress might strengthen the patient-clinician partnership in identifying a patient's strengths and motivating weight loss.

Characteristics of screen media use associated with higher BMI in young adolescents.

OBJECTIVES: This study investigates how characteristics of young adolescents' screen media use are associated with their BMI. By examining relationships between BMI and both time spent using each of 3 screen media and level of attention allocated to use, we sought to contribute to the understanding of mechanisms linking media use and obesity. METHODS: We measured heights and weights of 91 13- to 15-year-olds and calculated their BMIs. Over 1 week, participants completed a weekday and a Saturday 24-hour time-use diary in which they reported the amount of time they spent using TV, computers, and video games. Participants carried handheld computers and responded to 4 to 7 random signals per day by completing onscreen questionnaires reporting activities to which they were paying primary, secondary, and tertiary attention. RESULTS: Higher proportions of primary attention to TV were positively associated with higher BMI. The difference between 25th and 75th percentiles of attention to TV corresponded to an estimated +2.4 BMI points. Time spent watching television was unrelated to BMI. Neither duration of use nor extent of attention paid to video games or computers was associated with BMI. CONCLUSIONS: These findings support the notion that attention to TV is a key element of the increased obesity risk associated with TV viewing. Mechanisms may include the influence of TV commercials on preferences for energy-dense, nutritionally questionable foods and/or eating while distracted by TV. Interventions that interrupt these processes may be effective in decreasing obesity among screen media users.

Is television viewing associated with social isolation? Roles of exposure time, viewing context, and violent content.

OBJECTIVE: To estimate associations between children's peer integration and amount of time they spend (1) watching television, (2) watching violent television, and (3) co-viewing television with friends. DESIGN: Survey using nationally representative data from the Panel Study of Income Dynamics-Child Development Supplement Wave 1. SETTING: Nationwide survey of families with young children performed in 1997. PARTICIPANTS: Of 3562 children, 1356 had sufficient data for inclusion in analyses (563 children aged 6 to 8 years and 793 children aged 9 to 12 years). MAIN EXPOSURE: Total time viewing television, with and without friends present, and time viewing violent and nonviolent television content. MAIN OUTCOME MEASURE: Amount of time children spent with friends as reported in two 24-hour activity diaries. RESULTS: Viewing violent programs (but not nonviolent programs) was negatively related to time children spent with friends (aged 6-8 years, unstandardized regression coefficient [beta] = - 0.34, 95% confidence interval [CI], - 0.59 to - 0.08; aged 9-12 years, beta = - 0.41, 95% CI, - 0.65 to - 0.18). More time viewing television with friends was associated with more time engaging in other activities with friends (aged 6-8 years, beta = 0.98, 95% CI, 0.61 to 1.36; aged 9-12 years, beta = 1.03, 95% CI, 0.72 to 1.34). CONCLUSIONS: The more time that children spent viewing violent programs, the less time they spent with their friends. While this study cannot determine the direction of effects for this relationship, a cyclical process between violent media and peer integration best explains the findings. To optimize social development and mental health, children's access to violent media should be limited.

Time well spent? Relating television use to children's free-time activities.

OBJECTIVES: This study assessed the claim that children's television use interferes with time spent in more developmentally appropriate activities. METHODS: Data came from the first wave of the Child Development Supplement, a nationally representative sample of children aged 0 to 12 in 1997 (N = 1712). Twenty-four-hour time-use diaries from 1 randomly chosen weekday and 1 randomly chosen weekend day were used to assess children's time spent watching television, time spent with parents, time spent with siblings, time spent reading (or being read to), time spent doing homework, time spent in creative play, and time spent in active play. Ordinary least squares multiple regression was used to assess the relationship between children's television use and time spent pursuing other activities. RESULTS: Results indicated that time spent watching television both with and without parents or siblings was negatively related to time spent with parents or siblings, respectively, in other activities. Television viewing also was negatively related to time spent doing homework for 7- to 12-year-olds and negatively related to creative play, especially among very young children (younger than 5 years). There was no relationship between time spent watching television and time spent reading (or being read to) or to time spent in active play. CONCLUSIONS: The results of this study are among the first to provide empirical support for the assumptions made by the American Academy of Pediatrics in their screen time recommendations. Time spent viewing television both with and without parents and siblings present was strongly negatively related to time spent interacting with parents or siblings. Television viewing was associated with decreased homework time and decreased time in creative play. Conversely, there was no support for the widespread belief that television interferes with time spent reading or in active play.