Screen time

• Over the past four decades, the world has witnessed a tenfold increase in obesity in children and adolescents between 5 and 19 years old.
• More than 124 million children across the world are currently considered to be obese.
• I am a public health researcher who studies and teaches about the factors underlying the obesity epidemic.

Parsing the numbers

• But it has become an emerging health concern even in the poorest countries and regions.
• The standard measure used to determine obesity in children and adolescents has long been the body mass index, or BMI.
• Children whose BMI is a set threshold above the mean, or average, are considered obese.

Critical role of parents and caregivers

• Because of this, researchers have largely focused on understanding the individual eating and physical activity habits of these kids.
• In the case of childhood obesity, researchers like me also know that parental figures play critical roles in both mirroring and creating opportunities for physical activity and healthy eating.

Social determinants of childhood obesity

Social determinants of health refer to the conditions where people live, learn, work, play and worship that affect health and quality of life. The U.S. Department of Health and Human Services has described five broad categories of social determinants of health. These include:
• But social determinants can also facilitate or encourage unhealthy behaviors.
• Because of their underlying role in contributing to health outcomes like childhood obesity, social determinants have been described as the “causes of the causes.” In other words, if poor diet is one of the causes of childhood obesity, then the social determinants that shape a child and their family’s food environment – such as lack of neighborhood grocery stores or limited income to purchase healthy foods – would be a cause of that poor diet.

Role of processed foods and physical inactivity

• Globally, people are spending more time in cars and less time walking – one of the most basic forms of physical activity.
• Kids who would inadvertently be engaging in physical activity just by walking or biking to school are more likely to be taking cars and buses to school instead.
• When it comes to food, societies in the U.S. and around the world are producing and consuming more calorie-dense ultra-processed foods.
• The role of screen time in the childhood obesity epidemic is a significant and growing area of concern and research.

Addressing the underlying causes

• Combating the childhood obesity epidemic means making healthy eating an easier choice for children and families than staying inside and eating processed foods.
• However, the reality is that much of the world’s population now lives, works, plays and worships in places that make it more difficult to choose healthy behaviors.
• Policies and programs that address the social determinants of health are a critical part of curbing the childhood obesity epidemic.

• Managing a child’s screen time when they’re home sick from school has taken on a whole new dimension.
• For many parents, the challenge of juggling work and caring for a sick child at home inevitably leads to more TV or iPad.

Illness should not automatically equal unlimited screens

• The answer depends on several factors and understanding these elements can help parents manage their child’s screen time effectively and healthily.
• Still, we should also try to avoid a pattern where every minor illness is seen as a gateway to endless screen time.
• Over time, this could lead to a situation where children might exaggerate or even feign symptoms of illness to gain extra screen time.

How old is your child?

• The Australian screen time guidelines for young children and toddlers are less than those for older children.
• This means more guidance and support is needed to manage younger children’s use of screens.
• There are also continued concerns about the mental health impacts of young people’s social media use.

How sick is your child?

• Some illnesses, such as high fever or flu, necessitate ample rest to aid recovery.
• The stimulating effects of screen light can disrupt a child’s sleep, hindering the rest and recovery process.

What are the pre-existing rules in your house?

• Having a baseline – even if it is more generous – makes some screen time limits during a sick day an expected norm.
• Maintaining these rules can help prevent a free-for-all scenario, which could complicate matters once the child recovers and needs to readjust to their regular schedule.
• On the other hand, if there are no pre-existing rules for non-school days, introducing snap strict screen time regulations when a child is unwell may not be the best approach.

Keep an eye on things

• Consider supporting decisions that help them rest and then switch off after an agreed period.
• It’s also of course essential to distinguish between entertainment screen use and schoolwork that must be completed on a computer or tablet.
• Jordy Kaufman has received funding from the Australian Department of Education and Training to research children’s use of technology for education.

• New research from Koa Health, a leading global provider of digital mental health care, suggests that the link between screen time and subjective wellbeing is heavily dependent on context and individual circumstances.
• However, according to users, games and social media both improved and worsened wellbeing depending on the individual and their unique context.
• Dr. Aleksandar Matic, Research and Development Director at Koa Health, said, "In the end, smartphones are a tool.
• This data was further supplemented by insights from a qualitative survey exploring the relationship between screen time and two key elements of mental wellbeing—pleasure/happiness and worthwhileness/purpose.

• In teenagers, irregular bedtimes, short sleep duration and poor sleep quality are commonly reported sleep issues.
• In the longer term, poor sleep can lead to obesity, health conditions (including diabetes), mental health problems, and risk taking behaviour.

Sleep vulnerability

• The ongoing effects of colonisation, intergenerational trauma, and other social determinants of health increase the vulnerability of Aboriginal and Torres Strait Islander teenagers to poor sleep.
• While some poor sleep issues are transient, continued exposure to racism, discrimination, household overcrowding and lack of safe sleeping spaces lead to chronic sleep issues.
• This could be because although the need for healthy sleep is universal, the meaning of sleep health is shaped by cultural and societal factors.

A co-designed approach

• Community yarns also identified the need to strengthen local sleep health service delivery and train Aboriginal and Torres Strait Islander people as “sleep coaches”.
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What the program involves

• The program empowers young people to identify their sleep health goals and work with coaches to achieve them.
• At the beginning of the program, participants identify a group and an individual goal they would like to attain.
• The program has also led to the training of two Aboriginal and Torres Strait Islander people as Australia’s first Indigenous sleep coaches.

What happened as a result of improved sleep

• The program data shows the majority of the program participants were staying up until very late at the night.
• However, participants achieved their self-identified goals and believe this program gave them tools to improve their sleep.
• The project team and community members are working to co-design a sleep health program for adults and extend the youth sleep program to other communities.
• Yaqoot Fatima is supported by funding from the NHMRC Partnership Grant, MRFF Indigenous Health Research Grant, MRFF-EMCR grant, and Beyond Blue for sleep health research.