Kathleen Head and Sasha Wee Electronic Device Exposure and Sleep Quality in Adolescents: A Cross Sectional Study Kathleen Head and Sasha Wee

Background- Exposure Media use has changed throughout generations There are currently many avenues for digital media (broadcast media, but also social media, such as Facebook, Twitter, Instagram, etc). Newer media allows users to both interact and passively consume media. In 1970, children began to regularly watch TV at 4 years of age. Now children interact with digital media at 4 mo of age. Hours spent in front of the TV have actually declined over the years due to consumption of other forms of media while use of mobile devices has risen drastically. According to a technical report from the AAP, ¾ of adolescents own a smartphone, 24% describe themselves as “constantly connected” to the internet and 60% report feeling addicted to their phones. From AAP technical report: Children and Adolescents and Digital Media (2016) Pew data suggest that teenagers between 14 and 17 years old send a median of 100 texts per day most teenagers maintain a “social media portfolio” of several selected sites including, as indicated by rates of use in the Pew survey, Instagram (52%), Snapchat (41%), Twitter (33%), Google+ (33%), Vine (24%), Tumblr (14%), and other social media (11%).

Background- Exposure https://www.commonsensemedia.org/the-common-sense-census-media-use-by-tweens-and-teens-infographic

They used to think lower income families may have less access to devices, however, this has not proven to be the case

Background- Outcome 50% - 90% of adolescents do not get as much sleep as they may need A majority of studies find an adverse association between electronic device exposure and sleep health, due to delayed bedtimes reduced total sleep duration. Interaction between electronic device use and poor sleep is multifactorial including time displacement (i.e., time spent on screens replaces time spent sleeping and other activities); psychological stimulation due to media content the effects of light emitted from devices on circadian timing, sleep physiology, and alertness. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5658795/

Study Question and Hypothesis Research Question Do the total number of electronic devices (TVs, tablets, smart phones, computers, handheld video games) in the household impact the quality of sleep in children ages 12-17 years of age? Hypothesis Null: There is no relationship between the total number of electronic devices in the household and the quality of sleep in children ages 12-17 years of age. Alternative: There is a relationship between the total number of electronic devices in the household and the quality of sleep in children ages 12-17 years of age. Research/operational: The greater the number of electronic devices in the household, the poorer the quality of sleep in children ages 12-17 years of age. Unique Aspect of Study Most studies analyzing electronic device use in children focus on screen time (which can be underestimated). Quantifying number of devices a child is exposed to in his/her household is an alternative way to evaluate electronic media use. There have been no studies of this nature to date focusing on adolescents in the Charleston area.

Study Design Exposure: Total number of electronic devices in the household Outcome: Quality of sleep in children ages 12-17 years of age Type of study: Cross sectional, to be completed over June to December in the same calendar year Covariates: Family size and ages of members in the household Average household income Self reported total screen time

Study Population Target population: Adolescents ages 12-17 yo in the Charleston area Source Population: All adolescents ages 12-17 yo presenting for well child checks in the MUSC Pediatric Primary Care Clinic and Charleston Pediatrics Clinic. MUSC serves approximately 7000 pediatric patients from the Tri-county Area (Berkeley, Charleston, and Dorchester, majority Charleston County). 10-19 year olds make up approximately 18% of the clinic population. 89% of the patient population is Medicaid. Charleston Pediatrics serves 4300 children in the Charleston area. 10-19 year olds make up 47% of the practice. 95% of the patients are privately insured. Exclusion criteria: Children 12-17 yo coming in for sick visit Children with known sleep disorder (obstructive sleep apnea, primary insomnia) Children with history of autism spectrum disorder Children who are nonverbal or have other complex medical conditions that would preclude them from answering the survey Between the ages of 12-17 years of age, it is recommended adolescents have one well child check per year.

Measuring Exposure: Total Number of Electronic Devices in the Household Eligible patients will be identified the day prior to the visit, and a list will be provided to registration. Patients will be provided all surveys at registration. Surveys may be completed at any point before or during the visit. Physician will prompt patient and guardian to return surveys at the end of the visit. Parental survey: What is the number of total electronic devices present in the household, either personal or work issued? This includes laptops, desktop computers, tablets, TVs, smart phones, and handheld gaming devices (such as Gameboy).. How many people live in the household? Include the ages of any children (<18 yo). Adolescent survey How many hours do you estimate you spend a day in front of a screen for school or personal use? Do your parents place any restrictions on the amount of time you are allowed to be in front of a screen? How soon after waking up do you interact with a device? How close to bedtime do you interact with a device?

Measuring Outcome: Cleveland Adolescent Sleepiness Questionnaire