The impact of screen use on sleep health across the lifespan: A National Sleep Foundation consensus statement.

OBJECTIVE: To achieve consensus on whether screen-based digital media (1) in general, (2) via prebedtime content, and (3) via prebedtime light impairs sleep health in (a) childhood, (b) adolescence, and (c) adulthood. Furthermore, to address whether employing behavioral strategies and interventions may reduce the potential negative effects of screens on sleep health. METHODS: The National Sleep Foundation convened a 16-person multidisciplinary expert panel ("Panel"). Panelists met virtually 5 times throughout 2023, during which they followed a modified Delphi RAND/UCLA Appropriateness Method to reach consensus. RESULTS: The Panel conducted a literature review starting with 2209 articles, narrowed down to 522 relevant empirical articles and 52 relevant review articles. The search was refined to include 35 experimental/intervention studies that examined whether there was a causal link between screen-based digital media and sleep. In addition, panelists reviewed 5 recent relevant systematic review articles. After reviewing the summarized current literature, panelists voted on 10 candidate statements about whether screen use impairs sleep health. The Panel met virtually to discuss the results of the first round of votes, which was then followed by a second round of voting, ultimately achieving consensus on 5 out of the 10 statements. CONCLUSIONS: The Panel achieved consensus that (1) in general, screen use impairs sleep health among children and adolescents, (2) the content of screen use before sleep impairs sleep health of children and adolescents, and (3) behavioral strategies and interventions may attenuate the negative effects of screen use on sleep health.

Digital Communications Technology Use and Feelings of Anxiety, Depression, and Loneliness Among Older Adults During the COVID-19 Pandemic.

Some have touted technology as a panacea for overcoming the isolation associated with COVID-19 mitigation policies; yet, these tools are not widely adopted by older adults. With data from the COVID-19 supplement to the National Health and Aging Trends Survey, we conduct adjusted Poisson regression modeling to examine digital communications use during COVID-19 and feelings of anxiety, depression, and loneliness during the COVID-19 pandemic among older adults (65+ years of age). Adjusted Poisson regression revealed that those who reported frequent use of video calls with friends and family (aPR = 1.22, 95% CI:1.06-1.41) and with healthcare providers (aPR = 1.22, 95% CI:1.03-1.45) were more likely to report feelings of anxiety than those not using these platforms; yet, reports of in-person visits with friends and family (aPR = 0.79, 95% CI: 0.66-0.93) and with healthcare providers (aPR = 0.88, 95% CI: 0.77-1.01) were associated with fewer feelings of depression and loneliness, respectively. Future research is needed to tailor digital technology to support older adults.

Examining understandability, information quality, and presence of misinformation in popular YouTube videos on sleep compared to expert-led videos.

The Internet is a common source of sleep information but may be subject to commercial bias and misinformation. We compared the understandability, information quality, and presence of misinformation of popular YouTube videos on sleep to videos with credible experts. We identified the most popular YouTube videos on sleep/insomnia and 5 videos from experts. Videos were assessed for understanding and clarity using validated instruments. Misinformation and commercial bias were identified by consensus of sleep medicine experts. The most popular videos received, on average, 8.2 (± 2.2) million views; the expert-led videos received, on average, 0.3 (± 0.2) million views. Commercial bias was identified in 66.7% of popular videos and 0% of expert videos (P < .012). The popular videos featured more misinformation than expert videos (P < .001). The popular videos about sleep/insomnia on YouTube featured misinformation and commercial bias. Future research may explore methods for disseminating evidence-based sleep information. CITATION: Robbins R, Epstein LJ, Iyer JM, et al. Examining understandability, information quality, and presence of misinformation in popular YouTube videos on sleep compared to expert-led videos. J Clin Sleep Med. 2023;19(5):991-994.

It's not all about the likes: Social media affordances with nighttime, problematic, and adverse use as predictors of adolescent sleep indicators.

OBJECTIVES: Adolescents are the most prominent users of social media, and their exposure to different contents, platforms, and types of use continues to develop. At the same time, sleep deprivation is on the rise, which may contribute to worsened health. Therefore, this cross-sectional study set out to examine the relationships among several social media affordances, habits of use, and sleep indicators in adolescents. METHODS: Students ages 12-18 from a high school on Long Island, New York (N = 410) participated in an anonymous online survey focusing on various aspects of social media use as well as major sleep indicators (sleep displacement, presleep arousal, sleep quality, fatigue). RESULTS: Snapchat was the only platform to predict a worsened sleep indicator (later bedtime) and it correlated with problematic, adverse, and nighttime use, possibly due to closer relationships among users. More viewing of posts of sports, friends, and family predicted better sleep. Additionally, nighttime social media use, problematic social media use, and adverse social media use each predicted at least one worsened sleep indicator in a hierarchical regression model. CONCLUSIONS: Although some implications were positive, results provided insight into the cons of social media use. This study provides evidence that in order to understand the role of social media in the sleep-wake process, one must look at the specific affordances each platform provides and the different nighttime, problematic, and adverse habits of use that can arise. Documenting the variety of media use behaviors, however, introduces a considerable multiple testing threat to this research area.

Sleep Research: A Primer for Media Scholars.

The average amount of sleep people of all ages get has declined sharply in the past 50 years. The detrimental health effects of sleep deprivation are well documented and substantial. Even though electronic media use often takes place in the hours before sleep, the extent to which media use may interact with sleep is understudied and not well understood. Communication scholars are well positioned to contribute to this area, as a systematic, theoretical understanding of the relationship between media and sleep is still lacking. This primer charts the state of knowledge on electronic media and sleep and explores possible next steps. First, we introduce the problem of sleep deprivation and describe the basic science of sleep with relevant terminology. Then, we review the research on electronic media and sleep and offer an agenda for research.

Self-control depletion and sleep duration: the mediating role of television viewing.

OBJECTIVE: Sleep insufficiency has been related to self-control failure: people fail to go to bed in time and end up sleep deprived. The role of state self-control in predicting bedtime and sleep duration has not yet been investigated. Based on research claiming an overlap between depleted self-control resources and fatigue, self-control depletion may foster earlier bedtimes. Conversely, self-control depletion also increases the propensity to procrastinate bedtime by giving in to the immediate gratification of late night entertainment. This study therefore looked at procrastinatory television viewing and its intermediary role in the association between state self-control and bedtime. The implications for sleep duration are examined. DESIGN: Firstyear students (N = 234) participated in an online survey. Using Day Reconstruction Method, they charted their activities and experiences during the preceding day and subsequent bedtime behavior. RESULTS: Self-control depletion was directly related to earlier bedtimes, which we explained by its similarity to fatigue. This was associated with longer sleep duration. Self-control depletion was indirectly related to later bedtimes because it increased the propensity to procrastinate by watching television. This was associated with shorter sleep duration. CONCLUSION: This study exposes a dual pathway between self-control depletion and sleep duration, whereby procrastinatory television viewing may reduce sleep duration.

Sleep latency versus shuteye latency: Prevalence, predictors and relation to insomnia symptoms in a representative sample of adults.

Shuteye latency (SEL) refers to the time spent performing activities in bed before attempting sleep. This study investigates (a) the prevalence, duration and predictors of SEL, (b) its association with insomnia symptoms (sleep onset latency [SOL], sleep quality and fatigue), and (c) the activities engaged in during SEL. A representative sample of 584 adults (18-96 years old) participated in an online survey. Respondents reported their SEL on weekday nights (Sunday to Thursday) and weekend nights (Friday and Saturday), and activities during SEL. One in five adults tried to sleep immediately at bedtime. Around 16% of respondents were awake >30 min on both weekday and weekend nights. Younger people and those with an eveningness preference reported longer SEL. Longer SEL corresponded with a progressive decline in sleep quality, increased SOL and more fatigue. Those with an SEL >30 min reported using both passive (e.g. television) and interactive (e.g. smartphone) media more frequently than respondents with an SEL < 30 min, but there was no difference between the groups for non-screen-related activities. Implications of SEL for measurements commonly used in sleep research are discussed. Shuteye latency may be symptomatic of how a modern lifestyle puts increasing pressure on sleep, but may also reveal a previously undocumented behaviour associated with insomnia symptoms.

Casual Sexual Scripts on the Screen: A Quantitative Content Analysis.

While existing content analyses have provided insightful information in terms of contextual factors and frequency of sexual behaviors, not much is known about the relational context in which sexual depictions generally occur. The current study addresses this void by employing content analytic methods to measure the frequency and context of depictions of sexual behavior within nine popular television shows produced in the U.S., while taking into account the type of sexual behavior. The results suggest that, in the analyzed television shows, sexual behaviors within a casual sexual context were almost as frequently shown as sexual behaviors within a committed relationship context. Whereas sexual behaviors within a committed relationship context were mainly limited to passionate kissing, sexual behaviors within a casual sexual context mostly consisted of explicit portrayals of sexual intercourse. Additionally, genre seemed to be an important factor when examining casual sexual television content. The situational comedy genre, for example, had no explicit portrayals of intercourse and mainly portrayed kissing couples within a committed relationship. The comedy drama genre, on the contrary, had the largest proportion of explicit sexual portrayals, usually between casual sexual partners. A second goal of this study was to analyze the portrayals of the typical casual sexual experience script and the typical casual sexual relationship script in which these sexual behaviors often occur. For instance, our analyses revealed that female characters were more likely to initiate casual sex compared to male characters. Moreover, casual sex often occurred between former partners.

Cancer-Diagnosed Individuals' Use of Television and the Internet as a Source for Peer Stories and Associated Emotional Responses.

When people are confronted with a potentially life-threatening disease such as cancer, they are likely to feel an urgent need for information about the disease and support from peers. Studies have shown that the mass media contain a lot of experiential information (i.e., peer stories) about cancer, either from real individuals or from fictional characters. To date, most studies have focused on using the Internet for peer support. This study aimed to extend this line of research by investigating (1) whether cancer-diagnosed individuals use both television and the Internet to access peer stories, (2) whether exposure to these stories results in different emotional outcomes, and (3) whether this differs depending on gender. A cross-sectional survey among 621 cancer-diagnosed individuals in Flanders (Belgium) showed that both television and the Internet were used as a source for following peer stories. Respondents indicated feeling fearful and concerned when following peer stories on entertainment television, but following peer stories on online forums was associated with feeling supported. These different emotional responses could be the result of the differences between these two content categories (i.e., fictional versus non-fictional peer stories). Future research should further examine these relationships by investigating the role of mass media content and how different psychological coping styles and personality traits moderate these associations.

Binge Viewing, Sleep, and the Role of Pre-Sleep Arousal.

STUDY OBJECTIVES: To investigate the prevalence of binge viewing, its association with sleep and examine arousal as an underlying mechanism of this association. METHODS: Four hundred twenty-three adults (aged 18-25 years old, 61.9% female) completed an online survey assessing regular television viewing, binge viewing, sleep quality (Pittsburgh Sleep Quality Index), fatigue (Fatigue Assessment Scale), insomnia (Bergen Insomnia Scale), and pre-sleep arousal (Pre-Sleep Arousal Scale). Regression analyses were conducted. Mediation analysis was performed using PROCESS Macro. RESULTS: There were 80.6% who identified themselves as a binge viewer. Among those who binge viewed (n = 341), 20.2% had binge viewed at least a few times a week during the past month. Among poor sleepers (Pittsburgh Sleep Quality Index > 5), 32.6% had a poor sleep quality associated with being a binge viewer. Higher binge viewing frequency was associated with a poorer sleep quality, increased fatigue and more symptoms of insomnia, whereas regular television viewing was not. Cognitive pre-sleep arousal fully mediated these relationships. CONCLUSIONS: New viewing styles such as binge viewing are increasingly prevalent and may pose a threat to sleep. Increased cognitive arousal functions as the mechanism explaining these effects. Measures of media exposure should take into account the user's level of engagement with media. Interventions aimed at (1) alerting viewers about excessive viewing duration and (2) reducing arousal before sleep may be useful ways to tackle sleep problems in binge viewers.

Bedtime, shuteye time and electronic media: sleep displacement is a two-step process.

This study argues that going to bed may not be synonymous with going to sleep, and that this fragmentation of bedtime results in a two-step sleep displacement. We separated bedtime (i.e. going to bed) from shuteye time (i.e. attempting to go to sleep once in bed) and assessed the prevalence of electronic media use in both time slots. A convenience sample of 338 adults (aged 18-25 years, 67.6% women) participated in an online survey. Results indicated a gap of 39 min between bedtime and shuteye time, referred to as 'shuteye latency'. Respondents with a shuteye latency of, respectively, ≤30 min, ≤1 or >1 h, were 3.3, 6.1 and 9.3 times more likely to be rated as poor sleepers compared to those who went to sleep immediately after going to bed. Before bedtime, volume of electronic media use (17 h 55 min per week) was higher than non-media activities (14 h per week), whereas the opposite was true after bedtime (media = 3 h 41 min, non-media = 7 h 46 min). Shuteye latency was related exclusively to prebedtime media use. Findings confirmed the proposed fragmentation of bedtime. Sleep displacement should therefore be redefined as a two-step process, as respondents not only engage in the delay of bedtime, but also in the delay of shuteye time once in bed. Theoretical, methodological and practical implications are discussed.

Stem cell research: the role of information seeking and scanning.

BACKGROUND: The mass media have held an ongoing debate about stem cell research. However, few studies have investigated how individuals obtain information on stem cell research and whether this affects their knowledge and perspectives on stem cell research. OBJECTIVE: This study aims to investigate whether (i) cancer-diagnosed and non-diagnosed individuals differ in terms of their acquisition of stem cell research information, (ii) whether this information acquisition is associated with stem cell research knowledge and perspectives and (iii) whether having had a cancer diagnosis moderates these associations. METHOD: A standardised, cross-sectional survey was conducted among a convenience sample of 621 cancer-diagnosed and 1387 non-diagnosed individuals in Flanders (Belgium). RESULTS: The results indicate that stem cell research information acquisition explains a significant part of the variance of stem cell research knowledge (8.9%) and of the societal benefits of stem cell research (6.7%) and of embryonic stem cell research evaluation (3.9%) and morality (2%). These associations did not differ between cancer-diagnosed and non-diagnosed individuals but cancer-diagnosed individuals did seek more stem cell research information. CONCLUSION: Acquiring stem cell research information, both intentionally and unintentionally, is positively related to stem cell research knowledge and perspectives. Future research should further identify ways to promote health information acquisition behaviour because it is associated with better knowledge and more positive opinion formation.

The Use of Media as a Sleep Aid in Adults.

A sample of 844 adults, aged 18-94 years old, was queried about media habits and sleep behavior in face-to-face interviews with standardized questionnaires. A substantial proportion of this sample reported using books (39.8%), television (31.2%), music (26.0%), Internet (23.2%), and videogames (10.3%) as a sleep aid. The use of media as sleep aids was associated with increased fatigue and higher scores on the Pittsburgh Sleep Quality Index (PSQI), indicating poorer sleep quality. There was no relationship with sleep duration. Finally, results suggest that media use coincides with later bedtimes, but also later rise times, a process called time shifting.

Bedtime mobile phone use and sleep in adults.

BACKGROUND: The few studies that have investigated the relationship between mobile phone use and sleep have mainly been conducted among children and adolescents. In adults, very little is known about mobile phone usage in bed our after lights out. This cross-sectional study set out to examine the association between bedtime mobile phone use and sleep among adults. METHODS: A sample of 844 Flemish adults (18-94 years old) participated in a survey about electronic media use and sleep habits. Self-reported sleep quality, daytime fatigue and insomnia were measured using the Pittsburgh Sleep Quality Index (PSQI), the Fatigue Assessment Scale (FAS) and the Bergen Insomnia Scale (BIS), respectively. Data were analyzed using hierarchical and multinomial regression analyses. RESULTS: Half of the respondents owned a smartphone, and six out of ten took their mobile phone with them to the bedroom. Sending/receiving text messages and/or phone calls after lights out significantly predicted respondents' scores on the PSQI, particularly longer sleep latency, worse sleep efficiency, more sleep disturbance and more daytime dysfunction. Bedtime mobile phone use predicted respondents' later self-reported rise time, higher insomnia score and increased fatigue. Age significantly moderated the relationship between bedtime mobile phone use and fatigue, rise time, and sleep duration. An increase in bedtime mobile phone use was associated with more fatigue and later rise times among younger respondents (≤ 41.5 years old and ≤ 40.8 years old respectively); but it was related to an earlier rise time and shorter sleep duration among older respondents (≥ 60.15 years old and ≥ 66.4 years old respectively). CONCLUSION: Findings suggest that bedtime mobile phone use is negatively related to sleep outcomes in adults, too. It warrants continued scholarly attention as the functionalities of mobile phones evolve rapidly and exponentially.

Fear of cancer is associated with cancer information seeking, scanning and avoiding: a cross-sectional study among cancer diagnosed and non-diagnosed individuals.

BACKGROUND: Nowadays, there is an abundance of health and cancer information in the mass media. Because of this high amount of information, it is possible for individuals to find or incidentally encounter cancer information, but it is also possible to be overloaded by this information and, consequently, to avoid it. Previous studies have indicated that fear of cancer could be both positively and negatively related to behaviours such as screening, help-seeking and information avoidance. OBJECTIVE: The aims of this study were (1) to assess the relationship between fear of cancer and cancer information acquisition and avoiding behaviour, (2) to examine whether this relationship was curvilinear, and (3) to determine whether this relationship was moderated by being diagnosed with cancer or not. METHOD: Six hundred and twenty-one cancer diagnosed and 1387 non-diagnosed individuals were recruited through a convenience sample in Flanders (Belgium) and filled in a standardised survey questionnaire. RESULTS: The results showed a positive linear association between fear of cancer and information seeking, scanning and avoiding. Being diagnosed with cancer or not did not moderate this relationship. CONCLUSION: Fear of cancer is positively associated with cancer information acquisition and avoiding behaviour. This suggests that fear of cancer predicts different behaviours in different individuals.

Violent video games and delinquent behavior in adolescents: A risk factor perspective.

Over the years, criminological research has identified a number of risk factors that contribute to the development of aggressive and delinquent behavior. Although studies have identified media violence in general and violent video gaming in particular as significant predictors of aggressive behavior, exposure to violent video games has been largely omitted from the risk factor literature on delinquent behavior. This cross-sectional study therefore investigates the relationship between violent video game play and adolescents' delinquent behavior using a risk factor approach. An online survey was completed by 3,372 Flemish adolescents, aged 12-18 years old. Data were analyzed by means of negative binomial regression modelling. Results indicated a significant contribution of violent video games in delinquent behavior over and beyond multiple known risk variables (peer delinquency, sensation seeking, prior victimization, and alienation). Moreover, the final model that incorporated the gaming genres proved to be significantly better than the model without the gaming genres. Results provided support for a cumulative and multiplicative risk model for delinquent behavior. Aggr. Behav. 41:267-279, 2015. © 2015 Wiley Periodicals, Inc.

Media use, cancer knowledge and lifestyle choices: a cross-sectional analysis.

BACKGROUND: Both media use and cancer knowledge have been identified as important predictors of a healthy lifestyle. However, little is known about the interplay between these two variables, and about differences between cancer diagnosed and non-diagnosed consumers of media and knowledge. This study investigated the relationship between media use (television and internet exposure) and lifestyle choices of cancer diagnosed and non-diagnosed individuals, and looked at the influence of cancer knowledge on this relationship. METHODS: A cross-sectional, quantitative survey (the Leuven Cancer Information Survey) was administered to 621 cancer diagnosed and 1387 non-diagnosed individuals, aged 16-88 years old in Flanders (Belgium). Bivariate analyses, hierarchical linear regression analyses and advanced moderation and mediation analyses were conducted. RESULTS: Internet exposure was not a predictor of lifestyle choices. Television exposure, however, was a negative predictor of healthy lifestyle choices. Moreover, television exposure was a direct negative predictor of cancer knowledge, which in turn positively predicted lifestyle choices. However, no differences were found in the investigated relationships between the two subsamples. CONCLUSION: These results indicate that higher levels of television exposure coincide with less cancer knowledge and with less healthy lifestyle choices. It offers a pathway for intervention by suggesting that improving cancer knowledge through television might positively affect lifestyle choices.