The Relationships between Screen Use and Health Indicators among Infants, Toddlers, and Preschoolers: A Meta-Analysis and Systematic Review
Abstract
:1. Introduction
2. Method
2.1. Information Source and Search Strategy
2.2. Study Selection
2.3. Data Extraction
2.4. Quality and Risk of Bias Assessment
2.5. Synthesis of Results
2.5.1. Coding of Health Indicators
2.5.2. Statistical Analysis
3. Results
3.1. Description of Studies
3.2. Systematic Review
3.2.1. Physical Health Indicators
3.2.2. Behavioral Health Indicator
3.2.3. Psychosocial Health Indicators
3.3. Meta-Analysis
3.3.1. Overweight/Obesity
3.3.2. Sleep Duration
4. Discussion
4.1. Strengths and Limitations
4.2. Implications and Recommendations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Summary Code | Studies Supporting Association (%) | Meaning of Code |
---|---|---|
(+) | 60–100 | Positive association |
(-) | 60–100 | Negative association |
NA | 0–33 | No association |
U | 34–59 | Unclear association |
Variable Classifications | Variables | Positive Association | Negative Association | No Association | Association (% of Studies Examining the Variable that Support Association) |
---|---|---|---|---|---|
Physical health outcomes | Adiposity | [24,25,46,47,48,49,50], [51] (boy), [52,53,54,55,56,57,58,59,60,61,62,63] | [64] | (++) 20/21=95.2% | |
Cognitive development | [65] | [23,28,66,67,68,69,70] | [69,71,72,73] | (-) 7/12 = 58.3%, (+) 1/12 = 8.3%, NA4/12 = 33.3%, so, unclear | |
Executive function | [69,74,75,76] | (--) 4/4 = 100% | |||
Motor development | [23,67,73] | [73] | (--) 3/4 = 75% | ||
Musculoskeletal risk | [77,78] | (+) 100% | |||
Behavioral health outcomes | Healthy dietary behavior | [25,48,79,80] | (--) 4/4 = 100% | ||
Physical activity | [25] | (-) | |||
Sedentary activity | [48,77] | (+) | |||
Sleep problems | [19,25], [26] (touchscreen, TV), [27,29,56,70,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96] | [19] | (++) 23/24 = 95.8% | ||
Psychosocial health outcomes | Aggressive behavior | [97] (antisocial), [98,99] | (++) 3/3 = 100% | ||
Behavioral and emotional outcomes | [100] (Prosocial behavior) | [11,75,93,99], [100] (Hyperactivity), [101,102,103,104,105,106,107] (Attentional problem), [108] (Attentional problem) | [100] (Peer problems, Emotional symptoms, Conduct problems) | (--) 12/14 = 85.6% | |
Bullying | [23,109,110] | (+) | |||
Social and emotional skills | [111] | [112] | unclear | ||
Parental interaction (Responsiveness) | [21,113] | (+) |
Subsample | No. of Studies | OR (95%CI), Random Effect Models | PQ | I2 (%) | Egger Result |
---|---|---|---|---|---|
Exceeding ≥ 1 h/d | 4 (6) | 1.872 (1.678,2.088) | p < 0.001 | 21% | p = 0.943 |
Exceeding ≥ 2 h/d | 4 (10) | 1.262 (1.155,1.379) | p < 0.001 | 71.80% | p = 0.588 |
Exceeding > 1 h/d | 4 (6) | 1.988 (1.445,2.735) | p < 0.001 | 0 | p = 0.456 |
Subsample | No. of Studies | OR (95%CI), Random Effect Models | PQ | I2 (%) | Egger Result |
---|---|---|---|---|---|
Exceeding ≥ 1 h/d | 4 (11) | 1.420 (1.392, 1.449) | p = 0.009 | 57.6% | p = 0.102 |
Exceeding ≥ 2 h/d | 2 (10) | 2.283 (2.132, 2.445) | p < 0.001 | 84.70% | p = 0.069 |
Exceeding (Y) | 9 (14) | 1.053 (1.024, 1.082) | p < 0.001 | 86.80% | p = 0.146 |
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Li, C.; Cheng, G.; Sha, T.; Cheng, W.; Yan, Y. The Relationships between Screen Use and Health Indicators among Infants, Toddlers, and Preschoolers: A Meta-Analysis and Systematic Review. Int. J. Environ. Res. Public Health 2020, 17, 7324. https://doi.org/10.3390/ijerph17197324
Li C, Cheng G, Sha T, Cheng W, Yan Y. The Relationships between Screen Use and Health Indicators among Infants, Toddlers, and Preschoolers: A Meta-Analysis and Systematic Review. International Journal of Environmental Research and Public Health. 2020; 17(19):7324. https://doi.org/10.3390/ijerph17197324
Chicago/Turabian StyleLi, Chao, Gang Cheng, Tingting Sha, Wenwei Cheng, and Yan Yan. 2020. "The Relationships between Screen Use and Health Indicators among Infants, Toddlers, and Preschoolers: A Meta-Analysis and Systematic Review" International Journal of Environmental Research and Public Health 17, no. 19: 7324. https://doi.org/10.3390/ijerph17197324