Kathleen Head and Sasha Wee Electronic Device Exposure and Sleep Quality in Adolescents: A Cross Sectional Study, Part 2 Kathleen Head and Sasha Wee

Brief Overview 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 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 (low exposure v high exposure) 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 Target population: Adolescents ages 12-17 yo in the Charleston area Source Population: Adolescents ages 12-17 yo presenting for well child checks at 2 pediatric clinics in Charleston, SC. MUSC serves approximately 7000 pediatric patients. Patients 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. Eligible patients will be identified the day prior to the visit, and a list will be provided to registration. As you are working on these aspects think about the timeline for your study and when information will be collected. Draw a figure depicting different aspects of your study à a study over view.

Sample Size Calculations Group 1: Low exposure to electronics (<5 devices per household) Group 2: High exposure to electronics (≥5 devices per household) Mean for Cleveland Sleep Questionnaire: 35.2, SD 11 Meaningful difference in sleep quality questionnaire is +/– 5 points from the mean (30-40) Estimated population size is 3300 patients (based on percentage of 10-19 year olds in each practice) Assuming 1:1 ratio of high exposure to low exposure, because we have a cut off of 5 devices for low versus high exposure. Attempting recruitment of equal number of patients from low income practice and high income practice. .

Data Collection Parental survey: What is the number of used and working total electronic devices present in the household, either personal or work issued? List number in each category below. Categories: Smartphones, Desktop or laptop computer, Tablet, Streaming Media Device (Apple TV, Roku, Google Chromecast, Amazon Fire TV), Video game consoles or handheld gaming devices (such as Gameboy or Nintendo switch) How many people live in the household? Include the ages of any children (<18 yo). Adolescent survey: What is the number of total electronic devices present in the household? 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? Adolescent will also answer the Cleveland Adolescent Sleepiness Questionnaire

Data analysis Comparing two means: Mean sleep quality score in low electronic device exposure group versus Mean sleep quality score in high electronic device exposure group Exposure variable is dichotomous. Outcome variable is continuous (means). Measure of association: Mean differences, logistical regression Adjust for covariates: Family size and ages of members in the household, Average household income, Self reported total screen time, Duration of sleep

Limitations of Study It has not been studied what a “high” exposure number of devices is. According to a recent Pew study, the average American household has 5 devices, so this number was used for our cutoff. Number of devices may not actually indicate exposure. For example, some families might only have one device, but that device is being used constantly Significant clinically meaningful difference for sleep questionnaire is not known, estimates are that it is half a standard deviation on either side of the mean It is difficult to families to remember how many devices (particularly working devices) they may have in the home or accessible to children so reporting may be skewed. May not be generalizable outside of the Charleston area

References LeBourgeois, M. K., Hale, L., Chang, A.-M., Akacem, L. D., Montgomery-Downs, H. E., & Buxton, O. M. (2017). Digital Media and Sleep in Childhood and Adolescence. Pediatrics, 140(Supplement 2), S92-S96. doi:10.1542/peds.2016-1758J Pew Research Center, May 2018, “Teens, Social Media & Technology 2018” Reid Chassiakos, Y., Radesky, J., Christakis, D., Moreno, M. A., & Cross, C. (2016). Children and Adolescents and Digital Media. Pediatrics, 138(5). doi:10.1542/peds.2016-2593 Rideout, V. (2015). The Common Sense Census: Media Use by Tweens and Teens. Retrieved from https://www.commonsensemedia.org/research/the-common-sense-census-media-use-by-tweens-and-teens Spilsbury, J. C., Drotar, D., Rosen, C. L., & Redline, S. (2007). The Cleveland adolescent sleepiness questionnaire: a new measure to assess excessive daytime sleepiness in adolescents. J Clin Sleep Med, 3(6), 603-612. http://www.pewresearch.org/fact-tank/2017/05/25/a-third-of-americans-live-in-a-household-with-three-or-more-smartphones/ Dean AG, Sullivan KM, Soe MM. OpenEpi: Open Source Epidemiologic Statistics for Public Health, Version. www.OpenEpi.com, updated 2013/04/06, accessed 2018/11/27.

Timeline Lorem Ipsum Sit Amet Data Collection Data analysis 20XX Lorem ipsum dolor sit amet, consectetur adipiscing. Sit Amet Lorem ipsum dolor sit amet, consectetur adipiscing. 20XX Data Collection Administer surveys, target n=152 Jun- Dec Data analysis Analyze data results Jan