The Role of Technology and Social Media Use in Sleep-Onset Difficulties Among Italian Adolescents: Cross-sectional Study

Background The use of technology and social media among adolescents is an increasingly prevalent phenomenon. However, there is a paucity of evidence on the relationship between frequency of use of electronic devices and social media and sleep-onset difficulties among the Italian population. Objective The aim of this study is to investigate the association between the use of technology and social media, including Facebook and YouTube, and sleep-onset difficulties among adolescents from Lombardy, the most populous region in Italy. Methods The relationship between use of technology and social media and sleep-onset difficulties was investigated. Data came from the 2013-2014 wave of the Health Behavior in School-aged Children survey, a school-based cross-sectional study conducted on 3172 adolescents aged 11 to 15 years in Northern Italy. Information was collected on difficulties in falling asleep over the last 6 months. We estimated the odds ratios (ORs) for sleep-onset difficulties and corresponding 95% CIs using logistic regression models after adjustment for major potential confounders. Results The percentage of adolescents with sleep-onset difficulties was 34.3% (1081/3151) overall, 29.7% (483/1625) in boys and 39.2% (598/1526) in girls. It was 30.3% (356/1176) in 11-year-olds, 36.2% (389/1074) in 13-year-olds, and 37.3% (336/901) in 15-year-olds. Sleep-onset difficulties were more frequent among adolescents with higher use of electronic devices, for general use (OR 1.50 for highest vs lowest tertile of use; 95% CI 1.21-1.85), use for playing games (OR 1.35; 95% CI 1.11-1.64), use of online social networks (OR 1.40 for always vs never or rarely; 95% CI 1.09-1.81), and YouTube (OR 2.00; 95% CI 1.50-2.66). Conclusions This study adds novel information about the relationship between sleep-onset difficulties and technology and social media in a representative sample of school-aged children from a geographical location that has not been included in studies of this type previously. Exposure to screen-based devices and online social media is significantly associated with adolescent sleep-onset difficulties. Interventions to create a well-coordinated parent- and school-centered strategy, thereby increasing awareness on the unfavorable effect of evolving technologies on sleep among adolescents, are needed.

[1]  Robert Thornberg,et al.  Exploring Sex Differences in the Association between Bullying Involvement and Alcohol and Marijuana Use among U.S. Adolescents in 6th to 10th Grade , 2020, Substance use & misuse.

[2]  Wenjun Cao,et al.  The psychological impact of the COVID-19 epidemic on college students in China , 2020, Psychiatry Research.

[3]  Daniela Husárová,et al.  Difficulties in Getting to Sleep and their Association with Emotional and Behavioural Problems in Adolescents: Does the Sleeping Duration Influence this Association? , 2020, International journal of environmental research and public health.

[4]  Pierre de Bérail,et al.  The relations between YouTube addiction, social anxiety and parasocial relationships with YouTubers: A moderated-mediation model based on a cognitive-behavioral framework , 2019, Comput. Hum. Behav..

[5]  Latha Ravichandran,et al.  Effect of stress on sleep hygiene among school going adolescents in Chennai , 2019, Journal of family medicine and primary care.

[6]  Erlyana Erlyana,et al.  Associations of Social Media Use With Physical Activity and Sleep Adequacy Among Adolescents: Cross-Sectional Survey , 2019, Journal of medical Internet research.

[7]  M. Smorti,et al.  Adolescent selfie: an Italian Society of Paediatrics survey of the lifestyle of teenagers , 2019, Italian Journal of Pediatrics.

[8]  Sarah N. Biggs,et al.  Impact of high‐frequency email and instant messaging (E/IM) interactions during the hour before bed on self‐reported sleep duration and sufficiency in female Australian children and adolescents , 2019, Sleep health.

[9]  E. Lettieri,et al.  Use of Health Apps and Wearable Devices: Survey Among Italian Associations for Patient Advocacy , 2019, JMIR mHealth and uHealth.

[10]  M. Gaspar de Matos,et al.  Trends in sleeping difficulties among European adolescents: Are these associated with physical inactivity and excessive screen time? , 2018, International Journal of Public Health.

[11]  A. Sacker,et al.  Social Media Use and Adolescent Mental Health: Findings From the UK Millennium Cohort Study , 2018, EClinicalMedicine.

[12]  E. Scafato,et al.  Problematic social networking site usage and substance use by young adolescents , 2018, BMC Pediatrics.

[13]  P. Troped,et al.  Associations between perceived social and physical environmental variables and physical activity and screen time among adolescents in four European countries , 2018, International Journal of Public Health.

[14]  Heather Cleland Woods,et al.  Fear of missing out and sleep: Cognitive behavioural factors in adolescents' nighttime social media use. , 2018, Journal of adolescence.

[15]  Monica Anderson,et al.  Teens, Social Media & Technology 2018 , 2018 .

[16]  J. Chaput,et al.  Use of social media is associated with short sleep duration in a dose–response manner in students aged 11 to 20 years , 2018, Acta paediatrica.

[17]  Nazir S. Hawi,et al.  Internet gaming disorder in Lebanon: Relationships with age, sleep habits, and academic achievement , 2018, Journal of behavioral addictions.

[18]  Z. Trost,et al.  The Relationship Between Pain Severity and Alcohol Use Among School-Aged Children and Adolescents: The Moderating Role of Drinking Motives , 2018, Pain medicine.

[19]  Yalda T. Uhls,et al.  Benefits and Costs of Social Media in Adolescence , 2017, Pediatrics.

[20]  A. Chang,et al.  Digital Media and Sleep in Childhood and Adolescence , 2017, Pediatrics.

[21]  R. Kelishadi,et al.  The association of sleep and late-night cell phone use among adolescents. , 2017, Jornal de pediatria.

[22]  J. Twenge,et al.  Decreases in self-reported sleep duration among U.S. adolescents 2009-2015 and association with new media screen time. , 2017, Sleep medicine.

[23]  L. Bashore,et al.  Subjective Sleep Measures in Children: Self-Report , 2017, Front. Pediatr..

[24]  L. Stanca,et al.  Connecting Alone: Smartphone Use, Quality of Social Interactions and Well-Being , 2017 .

[25]  L. Hale,et al.  Association Between Portable Screen-Based Media Device Access or Use and Sleep Outcomes: A Systematic Review and Meta-analysis. , 2016, JAMA pediatrics.

[26]  Jie Tang,et al.  Validation of the Social Networking Activity Intensity Scale among Junior Middle School Students in China , 2016, PloS one.

[27]  D. Sigmundová,et al.  Weekday-weekend patterns of physical activity and screen time in parents and their pre-schoolers , 2016, BMC Public Health.

[28]  H. Woods,et al.  #Sleepyteens: Social media use in adolescence is associated with poor sleep quality, anxiety, depression and low self-esteem. , 2016, Journal of adolescence.

[29]  F. Elgar,et al.  Validity and Reliability of a Brief Symptom Checklist to Measure Psychological Health in School-Aged Children , 2016 .

[30]  Jason B. Colditz,et al.  The association between social media use and sleep disturbance among young adults. , 2016, Preventive medicine.

[31]  J. Trinder,et al.  What's Keeping Teenagers Up? Prebedtime Behaviors and Actigraphy-Assessed Sleep Over School and Vacation. , 2016, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[32]  L. Merdad,et al.  Sleep quantity, quality, and insomnia symptoms of medical students during clinical years , 2016, Saudi medical journal.

[33]  Stefania Sette,et al.  Technology Use and Sleep Quality in Preadolescence and Adolescence. , 2015, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[34]  Deborah Scharf,et al.  Say "GDNT": Frequency of Adolescent Texting at Night. , 2015, Sleep health.

[35]  C. Kelly,et al.  Validity of self-reported height and weight for estimating prevalence of overweight among Estonian adolescents: the Health Behaviour in School-aged Children study , 2015, BMC Research Notes.

[36]  G. Cardon,et al.  Reliability and validity of three questionnaires measuring context-specific sedentary behaviour and associated correlates in adolescents, adults and older adults , 2015, International Journal of Behavioral Nutrition and Physical Activity.

[37]  L. Hale,et al.  Screen time and sleep among school-aged children and adolescents: a systematic literature review. , 2015, Sleep medicine reviews.

[38]  A. Grob,et al.  Adolescents’ Electronic Media Use at Night, Sleep Disturbance, and Depressive Symptoms in the Smartphone Age , 2015, Journal of youth and adolescence.

[39]  Mari Hysing,et al.  Sleep and use of electronic devices in adolescence: results from a large population-based study , 2015, BMJ Open.

[40]  A. Chang,et al.  Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness , 2014, Proceedings of the National Academy of Sciences.

[41]  M. Colleoni,et al.  Night-time Hours and Activities of the Italians , 2014 .

[42]  Thomas Penzel,et al.  Agreement of different methods for assessing sleep characteristics: a comparison of two actigraphs, wrist and hip placement, and self-report with polysomnography. , 2014, Sleep medicine.

[43]  Daniel J Buysse,et al.  A 24-hour Approach to the Study of Health Behaviors: Temporal Relationships Between Waking Health Behaviors and Sleep , 2014, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[44]  S. Taheri,et al.  Associations between specific technologies and adolescent sleep quantity, sleep quality, and parasomnias. , 2014, Sleep medicine.

[45]  A. Harvey,et al.  The sleep and technology use of Americans: findings from the National Sleep Foundation's 2011 Sleep in America poll. , 2013, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[46]  Brian O'Neill,et al.  Mobile internet access and use among European children: initial findings of the Net Children Go Mobile project , 2013 .

[47]  Antonio Bernabe-Ortiz,et al.  Association between Facebook Dependence and Poor Sleep Quality: A Study in a Sample of Undergraduate Students in Peru , 2013, PloS one.

[48]  P. Mitchell,et al.  Physical Activity and Sedentary Behaviors and Health-Related Quality of Life in Adolescents , 2012, Pediatrics.

[49]  Guadalupe Espinoza,et al.  The Pervasiveness, Connectedness, and Intrusiveness of Social Network Site Use Among Young Adolescents , 2011, Cyberpsychology Behav. Soc. Netw..

[50]  Meena Kumari,et al.  Sleep epidemiology--a rapidly growing field. , 2011, International journal of epidemiology.

[51]  T. Ohida,et al.  The association between use of mobile phones after lights out and sleep disturbances among Japanese adolescents: a nationwide cross-sectional survey. , 2011, Sleep.

[52]  Michelle M. Garrison,et al.  Media Use and Child Sleep: The Impact of Content, Timing, and Environment , 2011, Pediatrics.

[53]  O. Tzischinsky,et al.  Sleep patterns, electronic media exposure and daytime sleep‐related behaviours among Israeli adolescents , 2010, Acta paediatrica.

[54]  C. Björkelund,et al.  Thirty‐six‐year secular trends in sleep duration and sleep satisfaction, and associations with mental stress and socioeconomic factors – results of the Population Study of Women in Gothenburg, Sweden , 2010, Journal of sleep research.

[55]  M. Gradisar,et al.  Electronic media use and sleep in school-aged children and adolescents: A review. , 2010, Sleep medicine.

[56]  L. Kannas,et al.  Test-retest reliability of selected items of Health Behaviour in School-aged Children (HBSC) survey questionnaire in Beijing, China , 2010, BMC Medical Research Methodology.

[57]  Ilse de Bourdeaudhuij,et al.  Sedentary patterns and media availability in European adolescents: The HELENA study. , 2010, Preventive medicine.

[58]  R. Iannotti,et al.  The Health Behaviour in School-aged Children (HBSC) study: methodological developments and current tensions , 2009, International Journal of Public Health.

[59]  O. Samdal,et al.  Time trends in sleep-onset difficulties among Norwegian adolescents: 1983—2005 , 2008, Scandinavian journal of public health.

[60]  C. Nygård,et al.  Use of information and communication technology (ICT) and perceived health in adolescence: the role of sleeping habits and waking-time tiredness. , 2007, Journal of adolescence.

[61]  C. Currie,et al.  Measuring the health and health behaviours of adolescents through cross-national survey research: recent developments in the Health Behaviour in School-aged Children (HBSC) study , 2007, Journal of Public Health.

[62]  S. Denny,et al.  Sleep and adolescence. Do New Zealand teenagers get enough? , 2006, Journal of paediatrics and child health.

[63]  C. Roberts,et al.  Validity of self-reported height and weight and predictors of bias in adolescents. , 2005, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[64]  Gahan Fallone,et al.  Evidence for the validity of a sleep habits survey for adolescents. , 2003, Sleep.

[65]  T. Cole,et al.  Establishing a standard definition for child overweight and obesity worldwide: international survey , 2000, BMJ : British Medical Journal.

[66]  M. Chambers,et al.  Actigraphy and insomnia: a closer look. Part 1. , 1994, Sleep.

[67]  D. Wetter,et al.  The relation between cigarette smoking and sleep disturbance. , 1994, Preventive medicine.

[68]  V. Strasburger,et al.  Children, adolescents, and television. , 1990, Pediatrics in review.

[69]  B. Wold,et al.  Health behaviour in schoolchildren A WHO cross-national survey A presentation of philosophy, methods and selected results of the first survey , 1986 .

[70]  C. Dolea,et al.  World Health Organization , 1949, International Organization.

[71]  G. Lazzeri.  Growing up unequal: gender and socioeconomic differences in young people's health and well-being. Health Behaviour in School-aged Children (HBSC) study: international report from the 2013/2014 survey , 2016 .

[72]  D. Sigmundová,et al.  Test–retest reliability of selected physical activity and sedentary behaviour HBSC items in the Czech Republic, Slovakia and Poland , 2014, International Journal of Public Health.

[73]  C. Currie,et al.  Health Behaviour in School-aged Children (HBSC) study protocol: Background, methodology and mandatory items for the 2013/14 survey , 2014 .

[74]  American Academy of Pediatrics: Children, adolescents, and television. , 2001, Pediatrics.