GOOD MORNING, EVERYONE.
NAME -- I'M A PROGRAM AT THE
NATIONAL HEART LUNG AND BLOOD
UPS TUT AT NIH. ON BEHALF OF
OBESITY WORKING GROUP I AM
EXCITED TO SERVE AS THE
MODERATOR OF TODAY'S OBESITY,
NUTRITION AND PHYSICAL ACTIVITY
SEMINAR. PAST PRESENTATIONS
HAVE RELATED A VARIETY OF
TOPICS. WE'VE HAD INFORMATION
ON TECH KNOWLEDGE, ASSISTED
INTERVENTIONS FOR WEIGHT
MANAGEMENT, FOOD AND SECURITY IN
COVID-19, THE ROLE OF TEACHING
KITCHENS AND ADDRESSING
NUTRITION DISPARITY, HOW TO
REDUCE OBESITY IN BALTIMORE AND
MANY OTHERS. TODAY'S
PRESENTATIONS IS BY DR. JASON
NAGATA. BEFORE WE START THE
PRESENTATION I WANT TO REVIEW A
FEW QUICK HOUSEKEEPING ITEMS.
THROUGHOUT THE PRESENTATION AND
DURING THE Q&A DISCUSSION,
PLEASE SEND ANY QUESTIONS YOU
HAVE TO THE E-MAIL ADDRESS
LISTED ON THE SLIDES. OR YOU
CAN CLICK ON THE LINK AT THE
BOTTOM OF THE SCREEN, THE LIVE
FEEDBACK BUTTON ON THE VIDEO
CAST SCREEN AND YOU SUBMIT A
QUESTION OR COMMENT AND THOSE
ARE ALL GO TO US AND WE'LL TRY
AND GET AS MANY QUESTIONS
ANSWERED AS POSSIBLE. SO NOW TO
BEGIN, LET ME GO AHEAD AND
INTRODUCE OUR SPEAKER. SO JASON
NAGATA IS AN ASSOCIATE PROFESSOR
OF PEDIATRICS AT THE UNIVERSITY
OF CALIFORNIA SAN FRANCISCO. HE
IS THE RECIPIENT OF AN NHLIB
DEVELOPMENT AWARD AND HAS AN
IMPRESSIVE PORTFOLIO LEVERAGING
COHORT STUDIES TO STUDY
CARDIOVASCULAR AND MENTAL
BEHAVIORS. HE HAS PUBLISHED
OVER 250 ARTICLE IN ACADEMIC
JOURNALS AND HIS RESEARCH HAS
BEEN COVERED EXTENSIVELY BY
NATIONAL MEDIA INCLUDING NBC
NEWS, NPR, USA TODAY, TIME
MAGAZINE, CNN AND U.S. NEWS. HE
IS THE RECIPIENT OF THE AMERICAN
ACADEMY OF PEDIATRICS EMERGING
LEE
LEADER IN ADOLESCENT HEALTH
AWARD AND SO WE ARE SO LUCKY TO
HAVE HIM HERE TODAY AND I AM
VERY EXCITED TO HEAR ABOUT HIS
IMPORTANT AND IMPACTFUL RESEARCH
OF CARDIOVASCULAR DISEASE RISK
IN ADOLESCENTS. SO WELCOME AND
PLEASE GO AHEAD AND TAKE IT
AWAY.
>> THANK YOU SO MUCH FOR THAT
VERY KIND INTRODUCTION. AND I'M
JUST SO HONORED TO BE HERE AND
GRATEFUL FOR THE NHLBI FOR
FUNDING THE RESEARCH THAT YOU'RE
GOING TO BE HEARING ABOUT TODAY.
I WANTED TO JUST START BY
MENTIONING THAT I REALLY GOT
INTERESTED IN ADOLESCENT SCREEN
USE RESEARCH PARTICULARLY DURING
THE PANDEMIC. AS MENTIONED, I'M
A PHYSICIAN, A PEDIATRICIAN WHO
SPECIALIZES IN YOUNG ADULT
HEALTH AND MY PRIMARY CLINICAL
POPULATION IS ADOLESCENTS AN
YOUNG ADULTS WITH EATING
DISORDERS AND IT WAS VERY CLEAR
TO ME ESPECIALLY DURING THE
PANDEMIC HOW MUCH SCREEN
EXPOSURE YOUNG PEOPLE HAVE TODAY
AND HOW IT CAN IMPACT BOTH THEIR
MENTAL AND PHYSICAL HEALTH. I
REMEMBER THAT MANY OF MY
PATIENTS REPORTED INCREDIBLE
AMOUNTS OF SCREEN USE ESPECIALLY
DURING THE PANDEMIC AND HOW THAT
COULD HAVE IMPACTED THEIR
OVERALL MENTAL HEALTH AND
PHYSICAL WELL BEING AND THAT LED
TO MY INTEREST IF DELVING DEEPER
INTO SOME OF THESE STUDIES TO
UNDERSTAND MORE LONG-TERM RISKS
OF ADOLESCENT SCREEN USE AND
WHAT THEY'RE EXPOSED TO TODAY
MORE THAN EVER BEFORE. SO
OVERALL MY RESEARCH GOAL IS TO
STUDY DOWNSTREAM HEALTH EFFECTS
OF ADOLESCENT AND YOUNG ADULT
BEHAVIORS IN ORDER TO INFORM
CLINICAL AND PUBLIC HEALTH
GUIDELINES TO PREVENT DISEASE
LATER IN ADULTHOOD. ADOLESCENCE
IS A REALLY IMPORTANT PERIOD
WHERE PEOPLE ARE DEVELOPING
LIFESTYLE BEHAVIORS THAT THEY
MAY CONTINUE FOR THE REST OF
THEIR LIVES AND SO IT'S VERY
IMPORTANT THAT WE INTERVENE AND
PREVENT SO THAT THE HEALTHY
LIFESTYLE BEHAVIORS CAN CONTINUE
THROUGH THE TRANSITION TO
ADULTHOOD AND LATER ADULTHOOD.
AS MENTIONED, I'M A A JUNIOR
INVESTIGATOR WHO WAS LUCKY
ENOUGH TO GET A CAREER
DEVELOPMENT AWARD FROM THE
NATIONAL INSTITUTES OF HEALTH
AND SPECIFICALLY THAT AWARD
SUPPORTED ME IN ANALYZING THREE
DIFFERENT LARGE LONG-TERM COHORT
STUDIES THAT HAVE FOLLOWED
PEOPLE FROM EITHER ADOLESCENCE
OR YOUNG ADULTHOOD FOR MANY
YEARS TO UNDERSTAND ASSOCIATIONS
WITH ADOLESCENCE SCREEN USE AND
THEN FUTURE CARDIOVASCULAR
DISEASE RISKS IN ORDER TO INFORM
SCREEN USE GUIDELINES SO I'M
VERY HAPPY TO SHARE SOME OF
THOSE RESULTS WITH YOU DURING
TODAY'S PRESENTATION. SO JUST
AS AN OVERVIEW OF TODAY'S TALK,
I AM GOING TO TALK ABOUT SOME OF
THE RESULTS FROM THE THREE
STUDIES THAT I HAVE ANALYZED.
THE FIRST IS FROM THE CORONARY
ARTERY RISK DEVELOPMENT IN YOUNG
ADULT STUDY WHICH LOOKED AT
TELEVISION VIEWING IN YOUNG
ADULTS AND HAS HAD OVER 38 YEARS
OF FOLLOWUP NOW SO IT CAN REALLY
LOOK AT CARDIOVASCULAR DISEASE
RISK FACTORS AND EVEN PREMATURE
CARDIOVASCULAR DISEASE EVENTS
LIKE STROKE AND SECOND I'LL TALK
ABOUT THE LONGITUDINAL STUDY OF
ADOLESCENT TO ADULT HEALTH. BUT
FROM A SLIGHTLY EARLIER AGE
STARTING AT AGE 11 FOR
TELEVISION VIEWER EXPOSURE, OVER
24 YEARS AND FUTURE
CARDIOVASCULAR DISEASE RISK
FACTORS. AND FINALLY, I
ACTUALLY AM GOING TO SPEND MOST
TIME TALKING ABOUT A
CONTEMPORARY COHORT WHICH IS
STILL ON GOING, STARTED IN 2016
AND HAS -- SO I WILL PROVIDE A
LITTLE BIT MORE DETAILS ABOUT
THE STUDY DESIGN AND MEASURES OF
THE ABCD STUDY AND THEN I THINK
ONE OF THE NEW ASPECTS OF THAT
IS THAT IN ADDITION TO
TELEVISION VIEWING, THEY MEASURE
A LOT OF MORE CONTEMPORARY
SCREEN USE TRENDS INCLUDING
YOUTUBE, SOCIAL MEDIA, VIDEO
GAMES, AND SO WE'LL TALK A
LITTLE BIT ACTUALLY ABOUT JUST
CONTEMPORARY SCREEN USE TRENDS
THAT HAVE BEEN FOUND IN THE ABCD
STUDY AND THEN TALK ABOUT SOME
OF THE FINDINGS OF CONTEMPORARY
SCREEN USE AND CARDIOVASCULAR
DISEASE RISK FACTORS.
AND FINALLY, I WILL TRY
TO TIE THESE IN TO THE EXISTING
GUIDELINES FOR SCREEN USE AND
HOW THIS RESEARCH CAN INFORM
MORE UPDATED GUIDANCE FOR
ADOLESCENTS AND YOUNG ADULTS
PARTICULARLY ON HOW TO BEST USE
THE MORE CONTEMPORARY SCREEN
EXPOSURES LIKE THE SOCIAL MEDIA
AND YOUTUBE. SO TO BEGIN, I
WANTED TO START WITH THE
CORONARY ARTERY RISK DEVELOPMENT
IN YOUNG ADULT STUDY. THIS WAS
A LONG-TERM NATIONAL COHORT THAT
STARTED IN THE 1980S WITH 18 TO
30-YEAR-OLDS. SO YOUNG ADULTS.
THERE ARE OVER 5,000
PARTICIPANTS AT THE START OF THE
STUDY AND THE STUDY WAS DESIGNED
TO BE APPROXIMATELY EQUALLY
DESIGNED IN TERMS OF BLACK AND
WHITE PARTICIPANTS AS WELL AS
MEN AND WOMEN AND THE
RECRUITMENT WAS FROM FOUR
DIFFERENT SITES ACROSS THE U.S.
IN BIRMINGHAM, CHICAGO,
MINNEAPOLIS AND OAKLAND. NOW,
STARTING IN THE FIFTH YEAR OF
THE CARDIA STUDY, QUESTIONS
ABOUT TELEVISION VIEWING WERE
INTRODUCED AND SO WE HAVE
QUESTIONS ABOUT THE TELEVISION
VIEWING APPROXIMATELY EVERY FIVE
YEARS SINCE 1990. AND SO THAT
WAS THE MEAN EXPOSURE OF
TELEVISION VIEWING THAT WAS
MEASURED FOR THIS ANALYSIS AND
SINCE THAT STARTED A LITTLE BIT
LATER THE SAMPLE SIZE IS
SMALLER. IT'S ABOUT 4,300. SO
AS MENTIONED, THE MAIN EXPOSURE
OR RISK FACTOR THAT WAS EXAMINED
HERE WAS TELEVISION VIEWING AS
MEASURED BY SELF-REPORTED HOURS
PER DAY, WHICH WAS MEASURED
EVERY FIVE YEARS STARTING IN THE
FIFTH YEAR. AND FROM THOSE
REPEATED MEASURES OF TELEVISION
VIEWING, WE FIRST LOOKED AT THE
LEVEL OF APPROXIMATELY AGE 23.
SO IN THE YOUNG ADULT PERIOD AND
WE ALSO LOOKED AT TRENDS OVER
TIME. SO WE LOOKED AT IF THERE
WAS LIKE AN ANNUAL INCREASE OR
DECREASE AND SO WE LOOKED AT
BASICALLY THE RATE OF CHANGE OF
TELEVISION VIEWING SINCE YOUNG
ADULTHOOD. THE CARDIA STUDLY
HAS A LOT OF REALLY RICH
CARDIOVASCULAR DISEASE OUTCOME
MEASURES INCLUDING OBESITY,
DIABETES AND CHOLESTEROL WHICH
WERE ALSO COLLECTED AT EACH OF
THE FIVE-YEAR FOLLOWUPS AS WELL
AS CARDIOVASCULAR DISEASE EVENTS
LIKE HEART ATTACK OR CORONARY
HEART DISEASE, HEART FAILURE,
STROKE, OR A COMBINED OUTCOME
THAT WAS ANY OF THE
CARDIOVASCULAR DISEASE OUTCOMES.
AND THIS WAS ASCERTAINED THROUGH
PARTICIPANT CONTACT AND VITAL
SEARCHES, MEDICAL RECORD
SEARCHES AND SEARCHES OF THE
NATIONAL DEATH INDEX. SO JUST
TO SUMMARIZE THE OVERALL
TELEVISION VIEWING TRENDS DURING
THE COURSE OF THE CARDIA STUDY,
AS YOU CAN SEE, THERE WERE
DISPARITIES IN TERMS OF HOURS
PER DAY OF TELEVISION VIEWING
PARTICULARLY BY RACE, SO BLACK
MEN AND BLACK WOMEN WHO ARE THE
BLUE AND GREEN GENERALLY HAD
HIGHER AVERAGE TELEVISION
VIEWING THAN WHITE MEN AND WOMEN
WHO ARE THE RED AND YELLOW
COLORS HERE. BUT YOU CAN SEE
THAT ACTUALLY OVERALL IN THE
CARDIA STUDY, ON AVERAGE
TELEVISION VIEWING WAS MOSTLY
STABLE ON AVERAGE, BUT THERE
WERE CERTAINLY INDIVIDUALS
WITHIN THE STUDY WHO HAD
INCREASES OR DECREASES OVER
TIME. SO WHEN WE LOOKED AT
ASSOCIATIONS WITH BOTH
TELEVISION VIEWING LEVEL AT AGE
23 SO THAT WAS WHEN THE QUESTION
WAS FIRST INTRODUCED, WE CAN SEE
THAT YOUNG ADULT LEVELS OF
TELEVISION VIEWING AT AGE 23 WAS
ASSOCIATED WITH HIGHER ODDS OF
SUBSEQUENT OBESITY,
HYPERTENSION, DIABETES, HIGH
TRIGLYCERIDES AND DYSLIPIDEMIA,
WHICH INCLUDES HIGH
TRIGLYCERIDES, MORE LOW HDL
CHOLESTEROL. AND THESE WERE
BASED ON THESE OUTCOMES OVER
TIME. AND WE ALSO SAW ON THE
RIGHT THAT IF THERE WERE
INCREASES IN DAILY TELEVISION
VIEWING AFTER YOUNG ADULTHOOD,
SO SORT OF THE CHANGE OVER TIME,
THERE ARE ALSO ASSOCIATIONS WITH
SOME OF THE CARDIOVASCULAR
DISEASE RISK OUTCOMES. SO AFTER
YOUNG ADULTHOOD, IF THESE
PARTICIPANTS HAD RISES IN THEIR
TELEVISION VIEWING, THAT WAS
ALSO ASSOCIATED WITH OBESITY,
HYPERTENSION, LOW HDL
CHOLESTEROL, HIGH TRIGLYCERIDES
AND DYSLIPIDEMIA. SIMILARLY,
WHEN WE LOOK AT THE PREMATURE
CARDIOVASCULAR DISEASE EVENTS,
THERE WERE SIMILAR FINDINGS, SO
AT AGE 23, LEVELS OF TELEVISION
VIEWING WERE ASSOCIATED WITH
CORONARY HEART DISEASE AND ANY
CARDIOVASCULAR DISEASE EVENTS
AND SUBSEQUENT INCREASES IN
TELEVISION VIEWING AFTER YOUNG
ADULTHOOD WERE ASSOCIATED WITH
CORONARY HEART DISEASE, STROKE
AND ANY CARDIOVASCULAR DISEASE
EVENT. AND SO I THINK ONE OF
THE REAL RICHNESS OF THE CARDIA
STUDY IS THAT BECAUSE THERE'S
BEEN OVER 30 YEARS OF FOLLOWUP
NOW, YOU KNOW, THE PARTICIPANTS
ARE NOW IN THEIR 60S AND WE ARE
ABLE TO ACTUALLY REALLY FOLLOW,
YOU KNOW, FOLLOW THESE
PARTICIPANTS FOR MANY DECADES
AND THEY ARE NOW AT THE AGE
WHERE UNFORTUNATELY SOME OF THEM
ARE AFFECTED BY CARDIOVASCULAR
DISEASE EVENTS AND THERE ARE
ASSOCIATIONS BETWEEN TELEVISION
VIEWING IN YOUNG ADULTHOOD AND
FUTURE CARDIOVASCULAR DISEASE
EVENTS. SO THERE'S JUST A VERY
LONG FOLLOWUP PERIOD, WHICH I
THINK IS UNIQUE FOR THIS STUDY.
I NEXT WANTED TO TALK ABOUT THE
NATIONAL LONGITUDINAL STUDY OF
ADOLESCENT TO ADULT HEALTH.
THIS IS A REPRESENTATIVE COHORT
OF ADOLESCENTS THAT STARTED AT
AGE 11 TO 18 AND HAVE BEEN
FOLLOWED TO ADULTHOOD. THE
SAMPLE SIZE OF THIS STUDY WAS
INITIALLY OVER 20,000 AND IT WAS
SAMPLED ACROSS 132 SCHOOLS
THROUGH THE UNITED STATES IN
BOTH RURAL AND URBAN SETTINGS.
SO THE START OF THIS STUDY WAS
IN 1994 TO 1995. WITH 11 TO 18
YEARS OLD WHO WERE IN GRADES 7
TO 12 AND THEN THERE HAVE BEEN
NOW FIVE SUBSEQUENT WAVES OF
FOLLOWUP AND IT IS ALSO ON
ANGOING STUDY SO WAVE VI IS NOT
YET AVAILABLE BUT IT IS ONGOING.
SO WE DID USE ALL FIVE WAVES OF
DATA AND SO NOW PARTICIPANTS ARE
IN THEIR 30S TO 40S. ADD HEALTH
ALSO HAD A MEASURE OF TELEVISION
VIEWING ACROSS THE FIVE REPEATED
MEASURES. SIMILARLY IT WAS
HOURS PER DAY OF SELF-REPORTED
TELEVISION VIEWING AND THEY DID
MEASURE HEIGHT AND WEIGHT FROM
WHICH WE COULD GET BODY MASS
INDEX AND OBESITY AND THEN
STARTING IN THE FOURTH AND FIFTH
WAVES, THE ADD HEALTH STUDY
MEASURED WAIST CIRCUMFERENCE,
HYPERTENSION, DIABETES AND
CHOLESTEROL AND SO WE DID A
SIMILAR ANALYSIS AS FROM THE
CARDIA STUDY EXCEPT AS I
MENTIONED THESE ARE SLIGHTLY
YOUNGER PARTICIPANTS. AT
BASELINE THEY'RE IN THEIR
TEENAGER YEARS.
CONTINUING ON,
YOU WAS JUST SUMMARIZING THE
FINDINGS FROM THE ADD HEALTH
STUDY AND OVERALL WE HAD SIMILAR
FINDINGS TO THE CARDIA STUDY BUT
THIS WAS FROM A YOUNGER AGE
GROUP SO AGAIN, STARTING IF
ADOLESCENCE. IN THE ADD HEALTH
STUDY AVERAGE AMOUNT OF SCREEN
OR TELEVISION VIEWING WAS ABOUT
2.86 HOURS PER DAY AND THIS WAS
ASSOCIATED WITH HIGHER ODDS OF
SUBSEQUENT DIABETES, HIGHER
WAIST CIRCUMFERENCE AND INCREASE
THE BMI AT 24 YEARS FOLLOWUP.
SO OVERALL, SIMILAR FINDINGS TO
THE CARDIA STUDY BUT WITH
TELEVISION VIEWING MEASURED FROM
ADOLESCENCE AND THEN INTO
PARTICIPANTS 30S AND 40S. SO I
DO THINK THAT SOME OF THE
STRENGTHS OF THE ADD HEALTH AND
THE CARDIA STUDIES WERE FOCUSES
ON ADOLESCENTS AND YOUNG
ADULTHOOD RESPECTIVELY WHICH I
MENTIONED IS A REALLY IMPORTANT
DEVELOPMENTAL PERIOD WHEN
LIFESTYLE BEHAVIORS LIKE SCREEN
USE ARE DEVELOPING AND CAN SORT
OF SET PATTERNS FOR THE REST OF
ADULTHOOD AND WE HAD REPEATED
MEASURES ACROSS LONG FOLLOWUP
PERIOD OF BOTH TELEVISION R
VIEWING AND SOME OF THE
CARDIOVASCULAR OUTCOME MEASURES.
WHILE THIS HAS ALLOWED US TO
HAVE LONG-TERM FOLLOWUP, SOME OF
THE LIMITATIONS AT LEAST FOR
THE -- FOR 2023 ARE THAT THE
FOCUS OF SCREEN EXPOSURE AND
THOSE STUDIES WERE TELEVISION
VIEWING WHICH WAS APPROPRIATE
FOR THE 80S AND 90S AS THAT WAS
REALLY THE DOMINANT SCREEN
EXPOSURE, BUT TODAY'S
ADOLESCENTS ARE EXPOSED TO MANY
OTHER CONTEMPORARY SCREEN
MODALITIES BEYOND TELEVISION
VIEWING ALTHOUGH IT IS CERTAINLY
ONE OF THEM. AND ALSO, TODAY'S
ADOLESCENTS AN YOUNG ADULTS
GENERALLY ARE EXPOSED TO MORE
SCREEN EXPOSURE THAN THEY WERE
IN THE 80S AND 90S AND SO REALLY
UNDERSTANDING HOW CONTEMPORARY
EXPOSURES AND IN DIFFERENT
CONTEXTS MAY IMPACT HEALTH
INCLUDING CARDIOVASCULAR DISEASE
RISK. SO NOW I'M GOING TO TALK
A LITTLE BIT MORE IN DEPTH ABOUT
THE ADOLESCENT BRAIN COGNITIVE
DEVELOPMENT STUDY OR THE ABCD
STUDY AND I THINK SOME OF THE
ADVANTAGES OF THE ABCD STUDY ARE
THAT FIRST IT'S A CONTEMPORARY
COHORT. AS I MENTIONED IT
STARTED IN 2016 TO 2018 AND
THERE WAS ONGOING CURRENT DATA
COLLECTION SO THE MEASURES ARE
ALL CONTEMPORARY AND IT CAPTURES
SORT OF NOVEL MEASURES OF SCREEN
EXPOSURE, WHICH I'LL TALK A
ABOUT A LITTLE BIT LATER. IT
ALSO IS A LONGITUDINAL STUDY AND
SO HAS ANNUAL DATA COLLECTION
FOR AT LEAST A DECADE AND IS
ALSO DEMOGRAPHICALLY DIVERSE
LARGE NATIONAL SAMPLE. SO THE
ABCD STUDY IS THE LONGst STUDY
OF BRAIN DEVELOPMENT AND CHILD
HEALTH IN THE UNITED STATES. IT
STARTED WITH 9 AND 10 YEARS AND
THE BASELINE SAMPLE WAS A LITTLE
LESS THAN 13,000 PARTICIPANTS.
THERE WERE MEASURES ON SCREEN
USE, MENTAL HEALTH, SUBSTANCE
USE, BRAIN IMAGING, BIO
SPECIMENS AND MANY OTHERS. THIS
IS A MAP OF THE 21 DIFFERENT
STUDY SITES ACROSS THE UNITED
STATES. AS YOU CAN SEE, IT'S
GEOGRAPHICALLY DIVERSE AND
THERE'S ALSO A NUMBER OF FEDERAL
PARTNERS WHO SUPPORTED THE ABCD
STUDY, MANY FROM THE NATIONAL
INSTITUTES OF HEALTH INCLUDING
THE NATIONAL HEART, BLOOD AND
LUNG INSTITUTE AS WELL AS OTHER
FEDERAL PARTNERS. SO I'M GOING
TO FOCUS A LITTLE BIT ABOUT THE
SCREEN USE MEASURES IN THE ABCD.
SO THERE'S ACTUALLY MULTIPLE
WAYS THAT THESE ARE ASSESSED IN
THE ABCD STUDY. THE FIRST IS
FROM THE YOUTH SURVEY, SO THE
ADOLESCENTS THEMSELVES ARE GIVEN
A SURVEY THAT ASKS THEM ABOUT
THE TOTAL TIME THEY'VE SPENT
ACROSS DIFFERENT MODALITIES AND
THEN SPECIFICALLY THEIR SCREEN
USE AT BEDTIME, CYBER BULLYING
EXPOSURE OR PERPETRATION AND
THEN ALSO MEASURES OF
PROBLEMATIC SCREEN USE. SO
THESE ARE QUESTIONNAIRES THAT
ARE MEANT TO MEASURE SOCIAL
MEDIA, VIDEO GAME AND MOBILE
PHONE ADDICTION OR PROBLEMATIC
USE. AND THEN THE PARENTS OF
THE ADOLESCENTS ARE ALSO GIVEN A
SURVEY AND SO THE PARENTS REPORT
ON THE CHILD'S SCREEN TIME AND
THERE ARE QUESTIONS ABOUT PARENT
MONITORING OF SCREEN USE,
SPECIFICALLY AND THEN THERE IS
ALSO A MOBILE PHONE APP THAT HAS
BEEN INTRODUCED WHICH ACTUALLY
WILL -- FOR PARTICIPANTS WHO OPT
INTO THIS PROTOCOL THERE'S A
PASSIVE SENSING OF TIME,
FREQUENCY AND DURATION THAT THE
PARTICIPANTS HAVE ON THEIR
SMARTPHONES IF THEY HAVE A SMART
PHONE. THIS IS JUST A TIMELINE
OF THE YEARS THAT THE MEASURES
ARE COLLECTED SO THE YOUTH
SURVEY AND PARENT SURVEY ARE
COLLECTED AT EVERY YEAR OF THE
STUDY STARTING FROM YEAR ZERO
AND THEN STARTING IN YEAR TWO,
WHEN THE PARTICIPANTS WERE 11 TO
12 YEARS OLD, QUESTIONS ABOUT
THE PROBLEMATIC SCREEN USE,
CYBER BULLYING AND BEDTIME
SCREEN USE WERE INTRODUCED AND
HAVE BEEN COLLECTED SINCE AND
THEN STARTING IN YEAR 4, THE
MOBILE PHONE APP OR THE YEARS
APP WAS INTRODUCED. AND THAT
WILL CONTINUE ONWARD. IN
ADDITION TO THE SCREEN USE
MEASURES SH THESE ARE JUST SOME
OF THE OTHER MEASURES THAT ARE
COLLECTED BY THE ABCD STUDY. SO
IN TERMS OF CARDIOVASCULAR
HEALTH, BMI OR HEIGHT AND WEIGHT
IS AVAILABLE AT EACH OF THE
YEARS. BLOOD PRESSURE,
HEMOGLOBIN AND A IS C ARE
STARTED IN YEAR TWO IN THE EVEN
NUMBERED YEARS AND IN TERMS OF
OTHER SELF-REPORTED
QUESTIONNAIRES THERE'S A
PHYSICAL ACTIVITY QUESTIONNAIRE
EVERY YEAR. IN YEAR ONE THERE
WAS A NUTRITION QUESTIONNAIRE
THAT WAS BASED ON THE MIND DIET
WHICH I'LL TALK ABOUT LATER. A
SLEEP QUESTIONNAIRE EVERY YEAR,
AND THEN REALLY COMPREHENSIVE
ASSESSMENT OF MENTAL HEALTH AS
WELL AS SPECIFICALLY EATING
DISORDERS WHICH I'LL TALK A
LITTLE BIT MORE ABOUT LATER IN
THE TALK AS WELL AS -- AND THEN
IN ADDITION TO THE MOBILE PHONE
APP IN EVEN NUMBERED YEARS
STARTING IN YEAR TWO THE
PARTICIPANTS ALSO HAVE A FIT BIT
AND SO THAT -- FROM THAT THERE
CAN BE OBJECTIVE MEASURES OF
PHYSICAL ACTIVITY LIKE STEPS PER
DAY AS WELL AS SLEEP MEASURES.
AND THAT'S JUST TO SAY THAT
THOSE ARE THE MAINLY ASSESSMENTS
THAT I'LL BE TALKING ABOUT IN
TODAY'S TALK BUT THERE ARE
THOUSANDS OF OTHERS THAT ARE
AVAILABLE IN THE ABCD STUDY AND
INCLUDING NEUROIMAGING, GEO
CODED DATA AND NEUROCOGNITION,
OTHER PHYSICAL HEALTH AND BIO
SPECIMEN MEASURES. NOVEL
TECHNOLOGIES AND THEN DURING THE
PANDEMIC, THERE WERE ACTUALLY
SPECIFIC PANDEMIC QUESTIONNAIRES
ABOUT THE COVID-19 AND
INFECTIONS AS WELL. AND SO IF
YOU'RE INTERESTED, THE LINK
BELOW TO THE ABCD STUDY PROTOCOL
HAS A MORE COMPREHENSIVE LIST OF
ALL THE MEASURES THAT ARE
AVAILABLE. SO I THINK THAT I
WANTED TO ACTUALLY JUST TALK A
LITTLE BIT ABOUT THE SCREEN USE
TRENDS THAT WERE FOUND IN THE
ADOLESCENT BRAIN COGNITIVE
DEVELOPMENT STUDY, ESPECIALLY
WITH THE FOCUS ON SOME OF THE
MORE CONTEMPORARY PATTERNS. SO
STARTING AT BASELINE, SO AGAIN,
THIS IS 2016 TO 2018, WHEN THE
PARTICIPANTS WERE 9 TO 10 YEARS
OLD, THE AVERAGE AMOUNT OF
SCREEN TIME PER DAY ACROSS THE
MODALITIES IS ABOUT FOUR HOURS
PER DAY. AND THERE WERE
DISPARITIES BY RACE, SO OVERALL,
BLACK, ADOLESCENTS HAD ABOUT
FIVE HOURS PER DAY WHERE AS
ASIAN OR WHITE WAS MORE CLOSER
TO THREE HOURS PER DAY.
OVERALL, BOYS REPORTED ABOUT .75
MORE HOURS OF OVERALL SCREEN
TIME THAN GIRLS AND THIS WAS
DRIVEN BY VIDEO GAMES AND THEN
ALSO THERE WERE SOME SOCIO
ECONOMIC DISPARITIES SUCH THAT
PARTICIPANTS FROM LOWER INCOME
BACKGROUNDS ACTUALLY HAD HIGHER
SCREEN TIME ACROSS THE
MODALITIES EXCEPT FOR VIDEO
CHATS AND LOWER PARENT EDUCATION
WAS ALSO ASSOCIATED WITH HIGHER
TOTAL SCREEN TIME. I MENTIONED
THAT STARTING IN THE SECOND YEAR
OF THE STUDY THERE WERE
VALIDATED QUESTIONNAIRES THAT
MEASURED PROBLEMATIC SCREEN USE
FOR MOBILE PHONES, SOCIAL MEDIA
AND VIDEO GAMES AND I THOUGHT
THAT THESE ARE INTERESTING
BECAUSE IN ADDITION TO TIME THEY
ACTUALLY TALK A LITTLE BIT ABOUT
THE QUALITY AND HOW SORT OF
SCREEN USE MAKES SOME OF THESE
ADOLESCENTS FEEL AND SO HERE ARE
JUST SOME EXAMPLES OF SOME OF
THE FINDINGS. AGAIN, THESE ARE
11 TO 12-YEAR-OLDS. THEY'RE
STILL QUITE YOUNG. BUT AMONG
THOSE WHO HAD MOBILE PHONES,
ALMOST HALF OF THEM SAID THEY
LOSE TRACK OF HOW MUCH TIME
THEY'RE SPENDING ON THEIR PHONE.
ABOUT 31% SAID THAT THEY
INTERRUPT WHATEVER ELSE THEY'RE
DOING WHENEVER THEY'RE ON THEIR
PHONE AND 11% SAID THE THOUGHT
OF BEING WITHOUT THEIR PHONE
MAKES THEM FEEL DISTRESSED. IN
TERMS OF THOSE WHO HAD SOCIAL
MEDIA ALMOST A QUARTER SAID THEY
PLANNED USE OF SOCIAL MEDIA
APPS. 18% SAID THEY USE SOCIAL
MEDIA APPS SO I CAN FORGET ABOUT
MY PROBLEMS AND 16% SAY THAT
I'VE TRIED TO USE MY SOCIAL
MEDIA APPS LESS BUT I CAN'T.
AND THEN AMONG THOSE WHO PLAYED
VIDEO GAMES 41% SAID THEY SPEND
A LOT OF TIME THINKING ABOUT
VIDEO GAMES. 21% SAID THEY FEEL
THE NEED TO PLAY VIDEO GAMES
MORE AND MORE AND 24% SAID THEY
PLAY VIDEO GAMES SO THEY CAN
FORGET ABOUT THEIR PROBLEMS.
AND THEN FROM THOSE PROBLEMATIC
USE QUESTIONNAIRES WE CALCULATED
A TOTAL SCORE AND OVERALL BOYS
REPORTED HIGHER PROBLEMATIC
VIDEO GAME USAGE THAN GIRLS
WHERE AS GIRLS REPORTED HIGHER
PROBLEMATIC SOCIAL MEDIA AND
PHONE USE AND THERE WERE ALSO
DISPARITIES SUCH THAT NATIVE
AMERICAN, BLACK AND LATINX
ADOLESCENTS REPORTED HIGHER
PROBLEMATIC SCORES ACROSS ALL
THE PROBLEMATIC SCREEN MEASURES
COMPARED TO NON-LATINX WHITE
ADOLESCENTS. AT THE SECOND YEAR
FOLLOWUP THERE WAS ALSO A CYBER
BULLYING QUESTIONNAIRE AND
ALMOST 10% OF THESE 11 TO
12-YEAR-OLDS HAD REPORTED THAT
THEY HAD BEEN VICTIM OF CYBER
BULLYING AT SOME POINT IN THEIR
LIFETIME. IT WAS MUCH LOWER
WITH PERPETRATION BUT I DO THINK
THAT THAT'S, YOU KNOW,
POTENTIALLY REPORTING BIASES AS
KIDS MAY NOT WANT TO DISCLOSE IF
THEY WERE PERPETRATORS. ONE
OTHER I THINK INTERESTING AND
IMPORTANT RISK FACTOR WAS THAT
GAY LESBIAN AND BY SEXUAL
REPORTED HIGHER ODDS OF BEING A
VICTIM OF CYBER BULLYING AND
LOWER ODDS OF VICTIMIZATION OF
CYBER BULLYING FOR BOYS THAN
GIRLS. SO I HAD MENTIONED THAT
AT THE BASELINE OF THE STUDY IN
2016 TO '18 THE AVERAGE SCREEN
TIME REPORTED WAS ABOUT FOUR
HOURS PER DAY. I THINK ONE OF
THE REALLY IMPORTANT THINGS
ABOUT THE ABCD STUDY IS THAT,
YOU KNOW, IT CONTINUED ON
THROUGH THE COVID-19 PANDEMIC
AND AS I MENTIONED THERE WERE
ADDITIONAL SURVEYS SENT OUT MORE
FREQUENTLY AMIDST THE PANDEMIC
AND SO AT THE BEGINNING OR THE
FIRST OF THE SURVEYS WAS
COLLECTED IN MAY OF 2020 SO
EARLY ON IN THE PANDEMIC. AND
OVERALL IN THE ABCD STUDY, THE
AVERAGE THEN INCREASED TO ALMOST
8 HOURS OF RECK RERIGHTSAL
SCREEN TIME PER DAY. AND SO
THAT'S NOT INCLUDING ANY KIND OF
SCHOOL WORK OR HOMEWORK THAT WAS
DONE ON SCREENS BECAUSE I KNOW A
LOT OF, YOU KNOW, SCHOOLS WENT
TO REMOTE SETTINGS AT THAT TIME.
THIS WAS SPECIFICALLY FOR
RECREATIONAL SCREEN TIME AND
THIS WAS LARGELY DRIVEN BY
STREAMING VIDEOS, MOVIES OR
TELEVISION AS WELL AS VIDEO
PLAYED HERE. SO I DO THINK THIS
FINDING THAT SCREEN TIME DOUBLED
EARLY ON IN THE PANDEMIC IS A
REALLY IMPORTANT ONE. AND WE
HAVE OVERALL SEEN THAT THAT
TREND HAS STARTED TO REVERSE, SO
WHILE THERE WAS -- AND I WILL
SAY THAT THERE ALSO WAS LIKE A
RISE IN SCREEN USE IN THE COHORT
EVEN BEFORE THE PANDEMIC
STARTED. I THINK THIS IS ALSO,
YOU KNOW, EXPECTED AS
ADOLESCENTS AGE IN GENERAL, MORE
SCREEN TIME IS EXPECTED, BUT WE
HAVE STARTED TO SEE THE -- A
LITTLE BIT OF A DECREASE I THINK
AS -- AS THE PANDEMIC HAD WANED.
BUT I JUST DID WANT TO MENTION
THAT THE PANDEMIC FINDINGS IN
PARTICULAR ABOUT THE DOUBLING OF
SCREEN TIME WERE, YOU KNOW --
BECAUSE THIS IS A LARGE NATIONAL
STUDY THAT COVERS CONTEMPORARY
EXPOSURES, THE -- THAT STUDY WAS
PUBLISHED IN JOURNAL OF
PEDIATRICS AND WAS COVERED BY
NATIONAL NEWS AND WAS ALSO
ACTUALLY CITED AMIDST THE YOUTH
MENTAL HEALTH CRISIS BY THE U.S.
SURGEON GENERAL'S REPORT ON THE
MENTAL HEALTH CRISIS IN 2021.
AND SO I DO THINK THESE FINDINGS
WERE IMPORTANT IN, YOU KNOW, OUR
ADOLESCENTS WERE REALLY EXPOSED
TO A LOT OF SCREEN TIME DURING
THE PANDEMIC. I ALSO JUST WANT
TO TALK A LITTLE BIT ABOUT SOME
OF THE OTHER FINDINGS FROM THE
ABCD STUDY DURING THE PANDEMIC
BECAUSE I THINK THEY ARE
RELEVANT TO SCREEN TIME AND ARE
ALSO JUST INTERESTING AND ONE OF
THE STRENGTHS OF THE ABCD STUDY
THAT THERE WERE THESE ADDITIONAL
PANDEMIC MEASURES THAT CAN GIVE
US A SENSE OF TRENDS IN OUR
NATION'S ADOLESCENTS DURING THE
PANDEMIC. SO AS I MENTIONED
THERE'S ALSO A PHYSICAL ACTIVITY
QUESTIONNAIRE THAT WAS ASKED AND
SO THIS CAN ASSESS MODERATE TO
VIGOROUS PHYSICAL ACTIVITY AND
SO THIS WAS, YOU KNOW, ASSESSED
IN THE ANNUAL SURVEYS EVEN
BEFORE THE PANDEMIC AND SO IT'S
JUST TO SAY THAT, YOU KNOW, THE
CURRENT GUIDELINE FROM THE
DEPARTMENT OF HEALTH AND HUMAN
SERVICES PHYSICAL ACTIVITY
GUIDELINES FOR AMERICANS
RECOMMEND AT LEAST 60 MINUTES OF
MODERATE TO VIGOROUS PHYSICAL
ACTIVITY PER DAY IN CHILDREN AND
ADOLESCENTS AND THIS WAS ALREADY
QUITE LOW EVEN BEFORE THE
PANDEMIC, SO ONLY 16% OF ABCD
STUDY PARTICIPANTS AT BASELINE
WHEN THEY WERE 9 TO 10 YEARS OLD
MET THAT GUIDELINE OF 60 MINUTES
PER DAY, BUT THIS DROPPED TO
ABOUT 11% EARLY IN THE PANDEMIC
SO AROUND MAY TO AUGUST OF 2020,
AND THEN IT DROPPED EVEN FURTHER
TO ONLY 5% BY OCTOBER TO
MARCH -- OCTOBER 2020 TO
MARCH 2021. SO I DO THINK THAT
JUST STARTING WITH ALREADY LOW
ADHERENCE TO GUIDELINES AND THEN
SUBSEQUENT DROPS AS THE PANDEMIC
KIND OF MOVED ON IS ALSO
IMPORTANT. AS I MENTIONED,
THERE WERE ALSO OBJECTIVE
MEASURES OF PHYSICAL ACTIVITY SO
THOSE PRIOR -- THE PRIOR SLIDE
WAS BASED ON SELF-REPORT. BUT
BASED ON THE FIT BIT WEARING,
WHICH IS MORE OBJECTIVE MEASURE,
THERE ALSO -- THIS ALSO
CORROBORATES DECREASES IN
PHYSICAL ACTIVITY DURING THE
PANDEMIC AND SO THE RED BARS
HERE REPRESENT THE DAILY STEPS
ON AVERAGE THAT WERE TAKEN PRIOR
TO THE PANDEMIC AND THEN THE
BLUE WAS DURING THE PANDEMIC AND
SO YOU CAN SEE THAT THERE WERE
DEFINITELY DROPS OVERALL IN
STEPS PER DAY. AND THEY WERE
ACTUALLY MOST PRONOUNCED ON
WEEKDAYS SO MONDAY THROUGH
FRIDAY AND THE DIFFERENCES WERE
A LITTLE BIT LESS ON THE
WEEKENDS AND WE'RE NOT ENTIRELY
SURE FOR THAT, BUT ONE
HYPOTHESIS IS THAT ACTUALLY
GOING TO PE CLASS OR HAVING
SPORTS TEAM PRACTICE DURING THE
WEEK ACTUALLY DOES, YOU KNOW,
POTENTIALLY PROVIDE ADOLESCENTS
WITH PHYSICAL ACTIVITY
OPPORTUNITIES, SO IT COULD HAVE
BEEN THAT NOT HAVING IN PERSON
PHYSICAL ACTIVITY CLASSES REALLY
DECREASED AS WELL AS OF COURSE
LIKE MANY OTHER FACTORS LIKE
LOCKDOWNS AND CANCELLATION OF
OTHER ACTIVITIES. IF WE
ACTUALLY LOOK AT SOME OF THE
OBJECTIVE MEASURES THAT WERE
ALSO INTERESTING FINDINGS, SUCH
THAT THE PANDEMIC WAS ALSO
ASSOCIATED WITH HIGHER WEIGHT,
SO ON AVERAGE ABOUT 1.68
KILOGRAMS. SO THAT'S LIKE 3
POUNDS HIGHER AS WELL AS HIGHER
RATES OF HIGH BLOOD PRESSURE OR
HYPERTENSION. SO PREPANDEMIC,
3.4%, DURING THE PANDEMIC, 6.4%
AS WELL AS A HIGHER DIASTOLIC
BLOOD PRESSURE PERCENTILE. I
SHOULD ALSO NOTE THAT THE
HYPERTENSION PREVALENCE WAS
BASED ON BLOOD PRESSURE
PERCENTILE SO THEY ARE ADJUSTED
FOR SEX AND AGE. SO IT'S NOT
JUST AN AGE EFFECT. SO THOSE
WERE -- I JUST THINK SOME
INTERESTING TRENDS FROM THE ABCD
STUDY ON SCREEN USE AND ALSO
SOME OF THE FINDINGS FROM THE
PANDEMIC AND NOW I'M GOING TO
TALK A LITTLE BIT ABOUT SOME
ASSOCIATIONS WITH HEALTH
OUTCOMES. THE FIRST ONE I'M
GOING TO TALK ABOUT IS SLEEP.
SO AS I MENTIONED THERE WAS ALSO
A SCREEN SURVEY SENT ABOUT
BEDTIME. SO OVERALL 63% OF
PARTICIPANTS REPORTED THEY HAD
AN ELECTRONIC DEVICE IN THEIR
BEDROOM AND 17% SAID THEY WERE
WOKEN UP BY NOTIFICATIONS IN THE
PAST WEEK AND THEN THE
ADOLESCENTS REPORTED THAT 15%
SAID THAT THEY HAD SOME TROUBLE
FALLING OR STAYING ASLEEP IN THE
PAST WEEKS AND 28% HAD OVERALL
SLEEP DISTURBANCES MEASURED BY
20 SOMETHING ITEM QUESTIONNAIRE
ACTUALLY FROM THE PARENTS. AND
SO HAVING A TV OR INTERNET
CONNECTED DEVICE IN THE BEDROOM
OR LEAVING THEIR PHONE RINGER
ACTIVATED OVERNIGHT WAS
ASSOCIATED WITH TROUBLE FALLING
OR STAYING ASLEEP AND THEN
SPECIFIC SCREEN MODALITY USE
INCLUDING PHONE CALLS, TEXT
MESSAGES OR E-MAILS, SOCIAL
MEDIA, VIDEO GAMES, CHAT ROOMS
AND WATCHING STREAMING
TELEVISION VIDEOS, THOSE WERE
ALL ASSOCIATED WITH TROUBLE
FALLING AND STAYING ASLEEP AND
OVERALL SLEEP DISTURBANCE IN THE
ABCD STUDY. I NEXT WANTED TO
LOOK AT BODY MASS INDEX
PERCENT -- BMI PERCENTILE AT ONE
YEAR FOLLOWUP. SO THE NEXT FEW
STUDIES THAT I'M GOING TO TALK
ABOUT LOOK AT SCREEN TIME OR
SCREEN EXPOSURE AS THE -- AS THE
MAIN EXPOSURE AND THEN VARIOUS
HEALTH OUTCOMES. SO THIS ONE
WAS A PROSPECTIVE ANALYSIS
LOOKING AT SCREEN TIME EXPOSURE
AT BASELINE OR YEAR ZERO AND
THEN BMI PERCENTILE WHICH IS THE
WAY THAT BMI IS MEASURED AND
STANDARDIZED IN PEDIATRIC
POPULATIONS ONE YEAR LATER WHILE
CONTROLLING FOR BMI AT BASELINE
AND A NUMBER OF OTHER SOCIO
ECONOMIC DEMOGRAPHIC CONTROLS.
AND SO WE CONDUCTED LINEAR
REGRESSION, ADJUSTING FOR THESE
CONTROLS. AND OVERALL, THE SORT
OF BREAKDOWN OF THE BMI
CATEGORIES IN THE ABCD STUDY
WERE THAT ABOUT 62% WERE NORMAL
WEIGHT. 16% WOULD HAVE BEEN
CONSIDERED OVERWEIGHT, SO BMI
PERCENTILE OF 85th TO 95th
PERCENTILE AND THEN 17.8 WOULD
HAVE BEEN CONSIDERED OBESE WITH
THE BMI GREATER THAN THE 95th
PERCENTILE AND SO OVERALL WE DID
FIND THAT EACH ADDITIONAL HOUR
OF SCREEN TIME WAS ASSOCIATED
WITH THE .22 HIGHER BMI
PERCENTILE AT ONE YEAR FOLLOWUP
AND PARTICULARLY, TEXTING, VIDEO
CHAT AND VIDEO GAMES WERE
SIGNIFICANTLY PROSPECTIVELY
ASSOCIATED WITH HIGHER BMI
PERCENTILE AND I WILL SAY THAT
THIS IS A RELATIVELY SMALL
EFFECT SIZE BUT IF YOU THINK
ABOUT THAT THAT'S FOR EACH HOUR
AND THE AVERAGE NUMBER OF HOURS
IS FOUR HOURS PER DAY, AND THEN
THIS WAS ONLY JUST FOR ONE YEAR
FOLLOWUP, I DO THINK THAT THAT
CAN ADD UP WITH YEARS OF SCREEN
EXPOSURE AND THEN ESPECIALLY IF
IT'S MULTIPLE HOURS PER DAY. SO
SOME OF THE POTENTIAL MECHANISMS
THAT COULD LEAD TO HIGHER BMI OR
WEIGHT GAIN, BASED ON SCREEN
EXPOSURE COULD BE THAT WHEN
PEOPLE ARE IN FRONT OF SCREENS
THEY MAY BE DISTRACTED AND THEY
COULD HAVE MORE -- THERE HAVE
BEEN SOME STUDIES THAT SHOW THAT
DISTRACTED SCREEN USE CAN LEAD
TO INCREASED SNACKING OR
OVEREATING EVEN IN ABSENCE OF
HUNGER. THERE ARE ALSO
POTENTIALLY FOOD ADVERTISEMENTS
ON SCREENS AND THEN ALSO FOR THE
MOST PART SCREEN USE IS
SEDENTARY AND THAT CAN DISPLACE
TIME FOR PHYSICAL ACTIVITY. ONE
THING IN'T WHATTED TO MENTION IS
I SHOWED A LITTLE BIT ABOUT THE
PANDEMIC RESULTS OF THE FIT BIT
BUT I WANTED TO TALK A LITTLE
BIT MORE ABOUT FIT BIT IN
CONTEXT OF JUST SCREEN USE. AND
ALSO BMI. SO OVERALL THE FIT
BIT PROTOCOL IN ABCD WAS THERE
WAS A THREE WEEK PERIOD THAT
THEY WORE A FIT BIT AND DATA
COLLECTED AND THIS WAS AROUND
THE ANNUAL SURVEY. THIS WAS
STARTED IN YEAR 2 AND WE ENDED
UP CATEGORIZING FIT BIT INTO
DIFFERENT CATEGORIES AND THIS
WAS BASED ON THE FACT THAT ABOUT
12,000 STEPS PER DAY, PROXIMATE
60 MINUTES OF MODERATE TO
VIGOROUS ACTIVITY WHICH I
MENTIONED WAS GUIDELINE, SO
CUTOFFS BASED ON 12,000 AND THEN
6,000 WHICH IS HALF OF THAT.
OVERALL, JUST IN TERMS OF SOME
OF THE GENERAL TRENDS IN FIT
BIT, WE DID FIND THAT MORE STEPS
WERE ASSOCIATED OR YOUTH WITH
PARTNERED PARENTS HAD MORE
STEPS. ACTUALLY BLACK COMPARED
TO WHITE HAD MORE STEPS.
HETEROSEXUAL VERSUS SEXUAL
MINORITIES HAD MORE STEPS,
HIGHER INCOMES AND THEN ALSO
MALES WERE ASSOCIATED WITH MORE
STEPS OVERALL. AND ONE OF THE
UNANSWERED QUESTIONS IS THAT
EVEN THOUGH WE GENERALLY KNOW
THAT PHYSICAL ACTIVITY CAN BE
GOOD FOR CARDIOVASCULAR HEALTH
AND TOO MUCH SEDENTARY SCREEN
TIME MAY NOT BE GOOD FOR
CARDIOVASCULAR HEALTH, SOME GAPS
REMAIN IN THAT WE DON'T ENTIRELY
UNDERSTAND -- THE RESPONSE
RELATIONSHIPS AND ALSO WE DON'T
KNOW HOW SCREEN AND PHYSICAL
ACTIVITY COMBINATIONS MAY IMPACT
HEALTH OUTCOMES. AND THEN ALSO
AS I MENTIONED, THE ADVANTAGE OF
FIT BIT IS THAT THESE ARE
OBJECTIVE MEASURES AS OPPOSED TO
SELF-REPORT. AND SO WE TRIED TO
UNDERSTAND WHAT COMBINATIONS OF
SCREEN TIME AND PHYSICAL
ACTIVITY WERE ASSOCIATED WITH
BMI PERCENTILE AND OBESITY. SO
WE DID MAKE DIFFERENT CATEGORIES
OF SCREEN TIME SO 0 TO 4, 4 TO 8
OR GREATER THAN 8, SO GREATER
THAN 8 WAS CONSIDERED HIGH. AND
THEN THE STEP CATEGORIES AS I
MENTIONED, WE ALSO MADE LOW,
MEDIUM AND HIGH BASED ON THE
APPROXIMATE STEPS THAT MIRRORED
THE PHYSICAL ACTIVITY GUIDE
GUIDELINES. SO WE LOOKED AT
THESE DIFFERENT COMBINATIONS OF
SCREENS AND STEPS WITH BMI
PERCENTILE AND OBESITY,
ADJUSTING FOR COMPOUNDERS. AND
SO OVERALL, ABOUT THE AVERAGE
NUMBER OF STEPS PER DAY WAS
ABOUT 9,000. WE'VE ALREADY
TALKED A LITTLE BIT ABOUT THE
SCREEN TIME TRENDS, BUT BY THIS
TIME, AT YEAR TWO, THE AVERAGE
SCREEN TIME IS ABOUT 6.5 HOURS
PER DAY. AND SO OVERALL, IN
TERMS OF THIS DOSE RESPONSE
RELATIONSHIP, THE FIRST MODEL IS
JUST LOOKING AT SCREEN TIME
COMBINATIONS AND SO WE CAN SEE
THAT HAVING MEDIUM TO HIGH
SCREEN TIME IS ASSOCIATED WITH
HIGHER BMI PERCENTILE AND THERE
SEEMS TO BE A DOSE RESPONSE
RELATIONSHIP. IF WE JUST LOOK
AT PHYSICAL ACTIVITY, SIMILARLY
LOWER STEPS AND THEN MEDIUM
STEPS COMPARED TO HIGH, THERE
ALSO SEEMS TO BE A DOSE RESPONSE
RELATIONSHIP AND THEN IN THIS
THIRD MODEL WHEN WE PUT PHYSICAL
ACTIVITY AND STEPS AND SCREEN
TIME IN THE SAME MODELS WHO ARE
SORT OF INCLUDING BOTH OF THEM
AS INDEPENDENT RISK FACTORS THIS
DOSE RESPONSE RELATIONSHIP SEEMS
TO HOLD. THERE ARE ALSO SIMILAR
RESU
RESULTS WHEN WE LOOK AT OBESITY
BASED ON THE BMI CATEGORIES.
ONE THING I WANTED TO HIGHLIGHT
IS WE THEN LOOKED AT DIFFERENT
COMBINATIONS OF SCREENS AND
STEPS AND SO HERE WE CAN SEE
THAT IF YOU HAVE LOW SCREEN
TIME, ACTUALLY HAVING THE LOW
CATEGORY OF STEPS STILL MATTERS.
THE AMOUNT OF STEPS YOU TAKE IN
THE MEDIUM AND LOW SCREEN TIME
CATEGORIES CAN BE ASSOCIATED
WITH DIFFERENT SHL RISK FOR BMI
OR OBESITY. SO IF YOU HAVE MORE
THAN EIGHT HOURS OF SCREEN TIME
TODAY, IT ACTUALLY DOESN'T
MATTER WHAT STEP CATEGORY YOU'RE
IN. IT SEEMS THAT THERE IS
STILL THE HIGHER RISK OF HIGHER
BMI OR OBESITY REGARDLESS OF THE
NUMBER OF STEPS. AND SO I THINK
THAT'S KIND OF INTERESTING ABOUT
THESE COMBINATIONS THAT IN THE
SORT OF LOW TO MEDIUM SCREEN
RANGE LEVELS, YOU KNOW, STEPS
STILL MATTER, BUT THEN IN THE
HIGH GROUP, IT PERHAPS DOESN'T.
AND SO THIS STUDY DID LOOK AT --
FOUND DOSE RESPONSE
RELATIONSHIPS WITH SCREEN TIME
AND BMI AND FOUND THAT
COMBINATIONS WITH PHYSICAL
ACTIVITY DOES MATTER
PARTICULARLY WITH THE LOW AND
MEDIUM SCREEN TIME GROUPS BUT IN
THE HIGH SCREEN TIME CATEGORY
PHYSICAL ACTIVITY WAS NOT
ASSOCIATED. WE DID A SIMILAR
ANALYSIS LOOKING AT
HYPERTENSION, DIABETES AND
CHOLESTEROL IN THE ABCD STUDY
AND SO THESE ARE THE PREVALENCE
OF THOSE OUTCOMES AT YEAR TWO.
THE SAME CATEGORIES. AND
OVERALL WE FOUND THAT ACTUALLY
HIGHER SCREEN TIME WAS
ASSOCIATED WITH HIGHER DIASTOLIC
BLOOD PRESSURE PERCENTILE
ALTHOUGH IT WAS NOT ASSOCIATED
WITH SYSTOLIC BLOOD PRESSURE
PERCENTILE AND HIGHER SCREEN
TIME WAS ASSOCIATED WITH LOWER
HDL CHOLESTEROL. AND THAT'S THE
GOOD CHOLESTEROL SO LOWER IS NOT
GOOD. AND INTERESTINGLY, WHEN
WE LOOKED AT THE DIFFERENT
SCREEN AND STEP CATEGORIES FOR
HDL, WE ALSO FOUND THAT THE
COMBINATIONS DID MATTER. SO
THIS IS THE -- THESE ARE THE
SCREEN TIME CATEGORIES AND THESE
ARE THE PHYSICAL ACTIVITY
CATEGORIES, BUT EVEN WITH THE
HIGH SCREEN TIME CATEGORIES THE
DIFFERENCE WITH BMI IS ACTUALLY
IT DOES SEEM THAT STEPS DO STILL
MATTER EVEN IF YOU'RE HAVING
MORE THAN EIGHT HOURS OF SCREEN
TIME. SO IN THAT SETTING,
ACTUALLY HAVING LOW PHYSICAL
ACTIVITY, STILL CAN BE MORE
DETRIMENTAL TO HAVING LOW HDL
CHOLESTEROL. BUT AS I
MENTIONED, THERE WERE NOT
ASSOCIATIONS WITH SYSTOLIC BLOOD
PRESSURE, DIABETES IS MEASURED
BY HEMOGLOBIN A1C OR TOTAL
CHOLESTEROL SO IT DID SEEM IT
WAS MOSTLY WITH DIASTOLIC BLOOD
PRESSURE AND HDL CHOLESTEROL. I
HAD MENTIONED THAT ONE OF THE
POTENTIAL MECHANISMS FOR A
HIGHER BMI IS THROUGH NUTRITION
AND SO THE ABCD STUDY DID
MEASURE THE MIND DIET WHEN
STANDS FOR THE MEDITERRANEAN
DASH DIET. AND THIS WAS
ASSESSED AT THE FIRST YEAR OF
THE ABCD STUDY SO WE LOOKED AT
BASELINE SCREEN TIME AND THE
MIND DIET ONE YEAR LATER AND
PARTICULARLY ADHERENCE TO THE
MIND DIET IN A SIMILAR ANALYSIS
AS WE DID FOR THE BMI STUDY.
AND OVERALL WE DID FIND IN TERMS
OF THE PROSPECTIVE ANALYSIS, SO
SCREEN TIME AT YEAR ZERO AND
THEN MIND DIET AT YEAR ONE,
OVERALL THERE WAS A LOWER
ADHERENCE TO THE MIND DIET FOR
MORE SCREEN EXPOSURE AND THEN WE
ALSO RAN THE ANALYSIS CROSS
SECTIONALLY AND THE FINDINGS
WERE A LITTLE BIT STRONGER.
THERE WERE MORE MODALITIES THAT
WERE ASSOCIATED. FINALLY, IN
ADDITION TO JUST GENERAL
ADHERENCE TO NUTRITION, I THINK
ONE OF THE OTHER INTERESTING
FINDINGS THAT WE FOUND USING THE
MENTAL HEALTH QUESTIONNAIRES IS
THAT THERE WAS MEASURES OF
EATING DISORDERS AND
PARTICULARLY BINGE EATING
DISORDER AND BINGE EATING
DISORDER CAN INVOLVE EATING
LARGE VOLUMES OF FOOD WITH A
LOSS OF CONTROL AND THEN
POTENTIALLY FEELING GUILTY
AFTERWARDS AND SO THERE WAS A
QUESTIONNAIRE THAT SORT OF ASKED
SOME OF THE QUESTIONS THAT
REALLY LINE UP TO THE DIAGNOSIS
OF BINGE EATING DISORDER AND WE
FOUND THAT LOOKING AT YEAR ONE
EXPOSURE TO SCREEN USE AND THEN
BINGE EAT DISORDER AT -- OR
BASELINE SCREEN USE, BINGE
EATING DISORDER ONE YEAR LATER,
CONTROLLING FOR BASELINE BING
EATING DISORDER, SOCIAL MEDIA
WAS AT HIGHER OTDS OF BINGE
EATING DISORDER ONE YEAR LATER
FOR EVERY ADDITIONAL HOUR AS
WELL AS TEXTING AND TOTAL SCREEN
TIME. NOW, LINKS BETWEEN SOCIAL
MEDIA AND EATING DISORDERS CAN
BE REALLY COMPLEX, BUT IN
GENERAL, HAVING CONSTANT
COMPARISONS TO UNOBTAINABLE BODY
IDEALS THAT ARE BEING POSTED OR
SHARES AND THEN ALSO THE FILTERS
AND EDITING CAN LEAD TO
EFFECTIVELY SELECTION BIAS SO
YOU'RE ONLY SEEING A VERY SMALL
SAMPLING OF WHAT PEOPLE'S DAYS
ARE ACTUALLY ARE LIKE BUT YOU'RE
SEEING THE MOST GLORIOUS OR THE
MOST, YOU KNOW, THE MOST
PROMOTING SORT OF IMAGES. AND
THEN ALSO SOCIAL MEDIA UNIQUELY
I THINK AFFORDS PRESSURES ON
TEENS TO DISPLAY THEIR OWN
BODIES IN ORDER TO GAIN LIKES
AND FOLLOWERS. AND THERE MAY
ALSO BE JUST OVERT EATING
DISORDER CONTENT THAT'S POSTED
ON SOCIAL MEDIA PLATFORMS AND SO
THOSE ARE ALL POTENTIAL REASONS
WHY SOCIAL MEDIA COULD
EXACERBATE POOR BODY IMAGE AND
EATING DISORDERS AND I'LL TALK
ABOUT THAT A LITTLE BIT LATER.
SO OVERALL, THE GOAL OF THIS
RESEARCH IS REALLY TO TRY TO
PROVIDE MORE GUIDANCE FOR
PARENTS AND ADOLESCENTS. THERE
IS CURRENT GUIDANCE FROM THE
AMERICAN ACADEMY OF PEDIATRICS
AND THEN THE SURGEON GENERAL
ACTUALLY ISSUED AN ADVISORY
EARLIER THIS YEAR PARTICULARLY
ON SOCIAL MEDIA AND MENTAL
HEALTH IN ADOLESCENTS. AND SO
I'LL JUST BRIEFLY SAY THAT THESE
ARE THE MOST RECENT AMERICAN
ACADEMY OF MEDIA USE GUIDELINES.
THE MAIN THING I THINK THAT IS
IMPORTANT IS THAT THESE ARE SORT
OF THE AGE BASED
RECOMMENDATIONS, BUT FOR FIVE TO
18 YEARS OLD WHICH IS A PRETTY
LARGE RANGE, THE PREVIOUS
RECOMMENDATION WAS TO LIMIT
SCREEN TIME TO LESS THAN TWO
HOURS PER DAY. BUT THAT WAS
ACTUALLY REPLACED IN 2016
BECAUSE SO FEW ADOLESCENTS
ACTUALLY MEET THIS GUIDELINE AND
SO NOW THEY RECOMMEND A FAMILY
MEDIA USE PLAN WHICH IS MORE
INDIVIDUALIZED AND THAT CAN
INVOLVE REGULAR DISCUSSIONS WITH
FAMILY, SCREEN FREE TIMES LIKE
BEDTIMES OR FAMILY MEALS AND
FREE SCREEN ZONES AS WELL AS
BALANCING MEDIA WITH OTHER
ACTIVITIES AND EMPHASIZING
DIGITAL PRIVACY AND SAFETY. IN
THE STUDY WE ACTUALLY LOOKED AT
THE PARENT MEDIA PRACTICES AND
FOUND THAT -- THAT THE -- THESE
VARIOUS PARENT MEDIA PRACTICES
WERE ACTUALLY ASSOCIATED WITH
SCREEN USE, SO PARENTS' OWN
SCREEN USE, HAVING MEAL TIMES
BETWEEN USE AND BEDROOM SCREEN
USE WAS ASSOCIATED WITH MORE
PROBLEMATIC SCREEN USE. SO THIS
KIND OF REENFORCES THE AAP
GUIDELINES. AND THEN ALSO
PARENT MONITORING OF SCREEN USE
WAS ASSOCIATED WITH LOWER
PROBLEMATIC SOCIAL MEDIA AND
MOBILE PHONE USE AND SO IS
PARENTAL RESTRICTION. THESE ARE
FOR EARLY ADOLESCENTS AND IT
WILL BE INTERESTING TO LOOK AT
THESE FINDINGS AS THE COHORT
AGES TO MIDDLE AND LATE
ADOLESCENCE. FINALLY I'LL SAY
THAT THE SURGEON GENERAL
ACTUALLY JUST THIS YEAR RELEASED
A REPORT ON SOCIAL MEDIA AND
MENTAL HEALTH AND DID PROVIDE
SOME GUIDANCE FOR CHILDREN
ADOLESCENTS AS WELL AS PARENTS
AS WHAT CAN BE DONE. AND I WILL
SAY THIS IS MOSTLY FOCUSED ON
MENTAL HEALTH. AND SO SOME OF
THE GOALS THAT I HAVE FOR THIS
RESEARCH IS TO ALSO REALLY
INCORPORATE WAYS IN WHICH
GUIDANCE CAN BE PROVIDED TO
OPTIMIZE PHYSICAL HEALTH
INCLUDING, YOU KNOW,
CARDIOVASCULAR HEALTH AND
PHYSICAL ACTIVITY. SO MY
OVERALL SORT OF FUTURE RESEARCH
DIRECTION IS TO USE THE THE ABCD
STUDY ESPECIALLY AS THE COHORT
AGES INTO MIDDLE AND LATE
ADOLESCENCE TO REALLY TRY TO
UNDERSTAND MECHANISMS AS TO HOW
DIGITAL TECHNOLOGY CAN IMPACT
MENTAL AND CARDIOVASCULAR HEALTH
AND THEN GUIDANCE MORE SPECIFIC
TO AGE RANGES TO INFORM CLINICAL
PRACTICE GUIDELINES. AND I HAD
MENTIONED THAT ONE OF OUR -- THE
LAST STUD DOY I MENTION TALKED
ABOUT SCREEN USE AND BINGE
EATING DISORDER AND SO IN
PARTICULAR, GIVEN MY INTEREST IN
EATING DISORDERS AND I THINK
RELEVANCE TO BINGE EATING IN
CARDIOVASCULAR RISK FACTORS, I'M
EXCITED THAT WE HAVE JUST GOTTEN
FUNDING FROM THE NATIONAL
INSTITUTES OF MENTAL HEALTH TO
ACTUALLY LOOK -- TAKE A DEEPER
DO I HAVE AT MECHANISMS LOOKING
AT SCREEN -- SOCIAL MEDIA
EXPOSURE AND BINGE EATING IN THE
ABCD STUDY AND THIS IS ALSO WHAT
I'LL BE WORKING ON FOR THE NEXT
FIVE YEARS. SO WITH THAT, I
JUST WANT TO THANK ALL OF THE
PARTICIPANTS, PARTICULARLY IN
THE THREE COHORT STUDIES THAT
I'VE MENTIONED AS WELL AS THE
INVESTIGATORS AND SCIENTISTS AND
FUNDERS. ALSO FOR MY NIH GRANT
I HAVE A LOT OF MENTORS AND
COLLABORATORS AN INSTITUTIONS
THAT HAVE BEEN INSTRUMENTAL IN
THIS RESEARCH AS WELL AS MY LAB
TEAM AT UCSF AND FUNDERS
INCLUDING FROM THE NIH AND SO
WITH THAT, I THINK I WILL TAKE
SOME QUESTIONS.
>> ALL RIGHT. WELL, THANK YOU
SO MUCH FOR THAT GREAT
PRESENTATION AND SO MUCH REALLY
RELEVANT INFORMATION SHARED WITH
ALL OF US VERY TIMELY AND GIVING
US A LOT OF INFORMATION VERY
RECENTLY FROM THE PANDEMIC. SO
JUST SO EVERYONE IS AWARE FOR
THOSE VIEWERS OUT THERE WE'RE
GOING TO PROBABLY GO ABOUT TEN
MINUTES PAST THE HOUR BECAUSE WE
HAD THOSE TECHNICAL
DIFFICULTIES. THAT WAY WE CAN
GET A FEW QUESTIONS IN SO THANKS
EVERYONE FOR HANGING ON,
REALIZING THAT SOME PEOPLE WILL
NEED TO DROP OFF BUT IF YOU CAN
AND WANT TO STAY, PLEASE DO. SO
I'LL GO AHEAD AND DIVE INTO THE
QUESTIONS AND MY FIRST ONE FOR
YOU, IS, SO I'M A MOM AND
DEFINITELY GUILTY OF RELAXING
THE SCREEN TIME RESTRICTIONS
DURING THE PANDEMIC AND WHAT I
WAS STRUCK WITH WAS THE GRAPH
THAT SHOWS THAT SCREEN TIME WENT
UP A LOT DURING THE PANDEMIC AND
FELL, BUT DIDN'T GO BACK TO THE
PREVIOUS. AND I REALIZE THAT
THAT'S LIKE, YOU KNOW, WASN'T TO
TODAY'S DATE AND SO MAYBE THINGS
HAVE CHANGED A LITTLE MORE, BUT
I'M WONDERING FOR YOU WHAT YOU
SEE OUT IN YOUR CLINIC AND IN
OTHER RESEARCH. DO YOU THINK
WE'RE EVER GOING TO GET TO THAT
PREPANDEMIC LEVEL? ARE WE GOING
TO BE ABLE TO PUT THAT BACK IN
THE BOTTLE OR ARE WE DEALING
WITH A NEW NORM AS PUBLIC
PROFESSIONALS AND NEEDING TO BE
SORT OF NIMBLE IN TRYING TO
DEVELOP INTERVENTIONS THAT CAN
ADDRESS THE FACT THAT WE WILL
ALWAYS HAVE MORE SCREEN TIME IN
OUR YOUTH?
>> YEAH. I THINK THAT'S SUCH
A -- THAT'S ONE OF THE LIKE KEY
QUESTIONS OF THE CONTEMPORARY
SORT OF SOCIETIES THAT THERE'S
SCREENS EVERYWHERE. OUR KIDS
ARE EXPOSED TO THEM. WE'RE
EXPOSED TO THEM AND I DO THINK
TO SOME EXTENT THE PANDEMIC, YOU
KNOW, REALLY CATALYZED A LOT OF
THAT. NOW WE HAVE SO MANY
THINGS ON ZOOM AND THAT'S REALLY
NORMALIZED AND SO I THINK ONE
THING THAT THE SURGEON GENERAL'S
REPORT NOTES IS THAT SCREEN USE
IN ITSELF IS NOT INHERENTLY BAD
OR GOOD. LIKE, IT'S JUST SORT
OF THE WAYS WE USE IT AND BEING
COGNIZANT OF POTENTIAL HEALTH
RISKS AND BENEFITS AND I THINK
THAT ONE OF THE CHALLENGES IN
THIS FIELD IS THAT IT'S ALMOST
IMPOSSIBLE TO COMPLETELY
ELIMINATE SCREEN TIME FROM OUR
LIVES INCLUDING OUR TEENAGERS'
LIVES THESE DAYS AND SO PART OF
THE REASON WHY THE AMERICAN
ACADEMY OF PEDIATRICS GOT RID OF
THEIR LIKE TWO HOUR LIMIT
GUIDELINE IS THAT JUST IN
TODAY'S DAY AND AGE, LIKE IT MAY
NOT BE POSSIBLE. THERE'S LIKE
SO MANY REASONS WHY YOU MIGHT
NOT NEED TO USE SCREENS AND SO I
DO THINK THAT IT DOES SEEM LIKE
THE TREND IS TO MORE SCREEN
EXPOSURE AND WHILE WE'RE NOT AT
THE SAME LEVELS AS AT THE HEIGHT
OF THE PANDEMIC I DO THINK THAT
SOME -- THE TRANSITION TO LIKE
REMOTE ACTIVITIES AND LEARNING
AND, YOU KNOW, EVEN
EXTRACURRICULARS HAS SORT OF
PUSHED THE NEEDLE TOWARDS THE
HIGHER EXPOSURES. AND SO I DO
THINK THAT PART OF IT -- THE
GUIDANCE THAT WE'RE HOPING TO
DEVELOP IS REALLY TRYING TO
FIGURE IN THIS CONTEMPORARY
SOCIETY WHERE WE DO HAVE THESE
SCREEN EXPOSURES, WHAT ARE WAYS
WE CAN REALLY MITIGATE THE RISKS
AND BE COGNIZANT OF THE TIME
THAT WE ARE SPENDING ON SCREENS
AND HOW THAT MIGHT DISPLACE
PHYSICAL ACTIVITY OR SLEEP AND
TRYING TO, YOU KNOW, IN THE REAL
WORLD TRYING TO FIGURE OUT HOW
TO BEST GUIDE PEOPLE TO MITIGATE
THE RISKS.
>> GREAT. THANKS FOR THAT
ANSWER. SO ANOTHER QUESTION
THAT CAME IN WAS ABOUT TIME USE
IN GENERAL DURING THE PANDEMIC.
SO YES, SCREEN TIME WENT UP BUT
PEOPLE TENDED TO HAVE MORE
HOURS. SO IS IT POSSIBLE THAT
POSITIVE THINGS LIKE MORE
PHYSICAL ACTIVITY CAN GO UP
DURING THE PANDEMIC OUTSIDE
ACTIVITY, FOR INSTANCE, EXERCISE
AND WHATNOT AND THEN ALSO SCREEN
TIME AND THEN MY QUESTION TO YOU
THEREIN IS, SOME OF THE RESEARCH
SHOWED THAT MIGHT NOT MATTER.
SO IT DOESN'T MATTER BECAUSE IF
YOU'RE GETTING THAT MORE SCREEN
TIME YOU'RE GETTING THAT HARMFUL
EFFECT WHETHER OR NOT THE OTHER
POSITIVES ARE ALSO GOING UP. SO
IF YOU COULD SPEAK TO THAT.
>> YEAH. I DO THINK THAT, YOU
KNOW, THE PANDEMIC ESPECIALLY
DURING LOCKDOWNS WAS A REALLY
UNIQUE TIME IN WHICH, YOU KNOW,
THERE JUST WERE NOT A LOT OF
OTHER OPTIONS AND SO EVEN THOUGH
THERE WAS A LOT OF SCREEN
EXPOSURE, JUST GIVEN THE LAWS
AND THE, YOU KNOW, THE SAFETY
LIKE I THINK IT'S -- IT'S
UNDERSTANDABLE WHY LIKE YOU
KNOW, SOME OF THAT HAPPENED JUST
BECAUSE THERE WEREN'T REALLY
SAFE ALTERNATIVES. BUT I DO
THINK THAT THERE ARE LIKE -- I
DO THINK THERE ARE SOME LESSONS
THAT CAN BE LEARNED FROM THAT
AND ONE IS THAT WHILE MOST
SCREEN TIME IN GENERAL IS
SEDENTARY IT DOESN'T HAVE TO BE.
YOU CAN THINK ABOUT INSTANCES,
WHERE THERE WAS REMOTE PE
CLASSES OR YOU CAN WATCH
PHYSICAL ACTIVITY VIDEOS OR DO
GROUP CLASSES ON SCREENS AND
THERE'S EVEN LIKE SOME INVOLVE
INTERVENTIONS LIKE ON VIDEO
GAMING. YOU CAN USE VIDEO GAMES
AS AN EXERCISE, A WAY TO PROMOTE
EXERCISE SO I DO THINK THERE ARE
SPECIFIC USE CASES IN WHICH YOU
COULD TRY TO REVERSE THAT TREND
OR USE SCREENS TO ACTUAL
LEVERAGE PHYSICAL ACTIVITY OR
SOME OF THESE, YOU KNOW, OR
OTHER HEALTH PROMOTING BEHAVIORS
BUT I THINK ON ARVERAGE MOST
PEOPLE ARE MOSTLY SITTING AND SO
I DO THINK THAT -- BUT I DO
THINK THAT THIS SORT OF -- ONE
OF THE -- SO I THINK ONE OF THE
PRIMARY MECHANISMS BY WHICH
SCREEN CAN IMPACT SLEEP AND
PHYSICAL ACTIVITY IS LIKE
THROUGH THE DISPLACEMENT
HYPOTHESIS. IF YOU ARE SPENDING
EIGHT HOURS OF YOUR DAY IN FRONT
OF SCREENS THOSE ARE EIGHT HOURS
NOT BEING SPENT IN GENERAL DOING
ACTIVITY OR SLEEPING AND SO
TRYING TO THINK ABOUT, YOU KNOW,
LIKE GIVEN THAT WE ONLY HAVE 24
HOURS IN A DAY, IF YOU'RE GOING
TO BE SLEEPING IDEALLY FOR LIKE
EIGHT OR NINE HOURS, YOU KNOW,
AND THEN YOU'RE IN SCHOOL OR YOU
KNOW, FOR ANOTHER EIGHT HOURS,
THAT REALLY ONLY GIVES YOU, YOU
KNOW, EIGHT HOURS OTHERWISE TO
DO EVERYTHING ELSE AND SO HOW
ARE YOU USING THOSE REMAINING
EIGHT HOURS? AND I THINK THAT'S
SORT OF ONE WAY WE CAN KIND OF
THINK ABOUT IT.
>> YEAH. THANKS. THAT'S A
GREAT ANSWER. WE HAVE A COUPLE
OTHER QUESTIONS COMING IN THAT
ARE TALKING ABOUT SOME OF THE
COMPLEXITIES OF SCREEN TIME USE
IN GENERAL. AND SO ONE OF THEM
WAS WONDERING, IN GENERAL, BUT
ALSO SPECIFICALLY IN THE
MEASUREMENT OF ABCD, HOW DO YOU
ACCOUNT FOR THE SIMULTANEOUS
ENGAGEMENT OF MULTIPLE SCREEN
MODALITIES? SO IF THEY'RE
TEXTING WHILE THEY'RE STREAMING
DOES IT COUNT AS FOUR HOURS,
DOES IT COUNT AS TWO HOURS? DO
YOU THINK IT MATTERS IN TERMS OF
SOME OF THE OUTCOMES
PARTICULARLY CARDIOVASCULAR
OUTCOMES BUT ALSO MENTAL HEALTH
AND SORT OF BRAIN ENGAGEMENT AS
WELL. ?
>> YEAH, I THINK THAT'S ACTUALLY
A REALLY GREAT QUESTION. SO ONE
OF THE WAYS THAT -- SO THE ABCD
STUDY ASKS ABOUT EACH INDIVIDUAL
MODALITY AND LIKE THE TOTAL TIME
THAT AN ADOLESCENT SPENDS PER
DAY. AND SO ONE OF THE OTHER
KIND OF NOVEL PHENOMENON IS THIS
DIGITAL MULTITASKING I'M ON MY
ZOOM CALL BUT I HAVE MY PHONE ON
BUT I'M WATCHING NETFLIX VIDEO
AND YOU'RE VIDEO MULTITASKS SO
IF THEY WERE DOING THAT, WE
WOULD DOUBLE COUNT. SO IF
THEY'RE COUNTING THEIR TELEPHONE
TIME WHILE THEY'RE WATCHING A
VIDEO, THAT WOULD BE DOUBLE
COUNTED SO THERE ARE SOME
INSTANCES IN WHICH WE DO THINK
LIKE THERE MIGHT BE
OVERESTIMATES OF SCREEN TIME,
BUT I ALSO THINK THAT AT LEAST
FOR THE SELF-REPORTED PART,
THERE'S ALSO, YOU KNOW,
POTENTIALLY -- I THINK IN
GENERAL WE FIND THAT ADOLESCENTS
TEND TO UNDERREPORT THEIR SCREEN
TIME OVERALL AND YOU KNOW,
PERHAPS JUST BECAUSE THEY KNOW
THEY'RE NOT SUPPOSED TO BE ON IT
SO MUCH SO I THINK IT'S HARD TO
TELL AND THAT IS ONE OF THE
LIMITS OF SELF-REPORTED MEASURES
BUT I DO THINK THAT DIGITAL
MULTITASKING IS A NEW PHENOMENA.
BACK IN THE '80S WHEN THERE WAS
MOSTLY TELEVISION WE DIDN'T HAVE
TO WORRY ABOUT THAT. BUT THAT
IS AN INTERESTING QUESTION.
>> YEAH, THAT'S A GOOD POINT AND
SORT OF HOW IT COULD COME OUT
AND SOME PEOPLE ARE
UNDERREPORTING, SOME PEOPLE MAY
BE OVERREPORTING, YOU KNOW, SO
IT CAN KIND OF VARY LIKE IN THAT
WAY. ANOTHER QUESTION WAS ABOUT
SPECIFICALLY BEDTIME SCREEN USE
AND WHETHER THAT WAS ASSOCIATED
WITH CBD RISK FACTORS IN
PARTICULAR OR DID YOU LOOK AT
THOSE DIFFERENT MODALITIES AND
TIMES OF USE OF SCREENS?
>> THAT IS A REALLY GREAT
QUESTION. WE HAVE NOT YET
LOOKED AT THE BEDTIME SCREEN USE
AND THE CBD RISK FACTORS BUT I
WILL TAKE A NOTE OF THAT AND WE
CAN RUN THOSE ANALYSIS AND GET
BACK TO YOU NEXT TIME. BUT
THAT'S A GOOD QUESTION.
>> NO, NO, NO. WE REALIZE THAT
YOU HAVE A LOT MORE TO MIND IN
ALL OF THIS SO YEAH, THAT CAN
DEFINITELY BE A FUTURE
DIRECTION. AND I THINK WE HAVE
TIME FOR ABOUT TWO MORE
QUESTIONS AND THEN WE'LL WRAP
UP. AND SO A QUESTION CAME IN,
CAN YOU EXPLAIN THE RELATIONSHIP
WITH THE MIND DIET AND SCREEN
TIME MAYBE A LITTLE BIT MORE
THAN YOU HAVE THUS FAR?
>> OH, YEAH. SO THE -- I WILL
SAY THAT THE MIND DIET WAS ONLY
ASKED AT YEAR ONE AND SO WE
WEREN'T ABLE TO DO LIKE AS MUCH
OF A, YOU KNOW, DETAILED
PROSPECTIVE ANALYSIS, BUT YEAH,
THE MIND DIET IS THE
MEDITERRANEAN DASH. IT'S
DIETARY APPROACHES TO STOP
HYPERTENSION AND THEN IT'S
INTERVENTION FOR
NEURODEGENERATIVE DELAY. I WILL
SAY THAT MY UNDERSTANDING IS
THAT THE MIND DIET WAS ACTUALLY
PRIMARILY -- OR HAS PRIMARILY
BEEN STUDIED MORE IN OLDER
ADULTS AND FOR LIKE COGNITIVE
SORT OF BENEFIT OR TO PREVENT
NEURODEGENERATIVE DELAY. IT IS
BASED OFF THE MEDITERRANEAN AND
DASH DIET. SO THE THINGS THAT
ARE RECOMMENDED IN IT ARE LIKE
GENERALLY GOOD FOR
CARDIOVASCULAR HEALTH SO WE DID
LOOK AT THAT ONE MEASURE. I
WILL SAY THAT SUBSEQUENTLY, THE
ABCD STUDY HAS ACTUALLY USED A
DIFFERENT DIETARY MEASURE, THE
BLOCK FOOD SCREENER WHICH IS A
LITTLE BIT MORE COMPREHENSIVE
AND HAS DIFFERENT FOOD
CATEGORIES AND DIFFERENT FOOD
GROUPS SO WE HAVE NOT ANALYZED
THAT YET SO I DO THINK THAT WILL
ALSO BE AN AREA OF FUTURE
RESEARCH. SO THE MIND DIET
QUESTIONNAIRE IS JUST ADHERENCE
TO THAT SPECIFIC DIET WHERE AS I
THINK THE QUESTIONNAIRE THAT IS
NOW INVOLVED HAS LIKE ALL THE
DIFFERENT FOOD GROUPS AND
DIFFERENT PARTS BUT IT'S ALSO
LIKE MANY NUTRITION, IT'S
COMPLEX TO ANALYZE BECAUSE
THERE'S SO MANY CATEGORIES.
>> YEAH, I THINK THAT'S ALWAYS A
TOUGH THING WITH DIET RESEARCH
IS SORT OF GOING INTO THE
DIFFERENT FOOD GROUPS AND HOW
CAN WE PULL OUT WHAT WE REALLY
NEED FROM THAT. SO ONE LAST
QUESTION THAT HAS COME IN IS CAN
YOU SAY A LITTLE BIT MORE ABOUT
THE RECOMMENDED FUTURE
DIRECTIONS? BECAUSE YOU WERE
PRETTY BRIEF ON YOUR LAST SLIDE
WHEN YOU TALKED AS THOSE FUTURE
DIRECTIONS SO IF YOU WANTED TO
HIT ON A COUPLE MORE POINTS WE'D
ALL LIKE TO HEAR THEM.
>> OH, YES. I THINK OVERALL MY
GOAL IS -- AS I MENTIONED, THE
LAST OFFICIAL GUIDANCE FROM THE
AMERICAN ACADEMY OF PEDIATRICS
WAS PUBLISHED IN 2016 AND IT'S
ACTUALLY FOR ALL SCREEN USE, NOT
JUST SOCIAL MEDIA OR SPECIFIC
MODALITIES AND AS I MENTIONED
THE AGE RANGE SPANS 5 TO
18-YEAR-OLDS AND YOU CAN IMAGINE
WHAT YOU MIGHT RECOMMEND FOR A
5-YEAR-OLD WOULD BE VERY DIRN
THAN FOR AN 18-YEAR-OLD. AND SO
I THINK ONE OF THE GOALS OF THE
OUR ANALYSIS OF THE ABCD STUDY
IS TO REALLY LOOK AT THESE
REALLY IMPORTANT DEVELOPMENTAL
WINDOWS AND THEN MID ADOLESCENCE
AND THEN OLDER ADOLESCENCE AND
TRYING TO UNDERSTAND IF THERE
ARE SENSITIVE PERIODS FOR YOU
KNOW, SOCIAL MEDIA EXPOSURE OR
SOME OF THESE CON TEMPERATURE
RA
-- CONTEMPORARY EXPOSURES AND
CARDIOVASCULAR DISEASE. SO IF
YOU'RE A PARENT OF A YOUNG A
ADD -- ADOLESCENTS AND COMPARED
TO OLDER ADOLESCENTS SO AND SO I
THINK OUR GOAL IS TO CREATE MORE
AGE RANGE AND BY SPECIFIC SCREEN
MODALITY POTENTIALLY BECAUSE I
THINK A LOT OF THE EVIDENCE
CITED IN THE CURRENT GUIDELINES
IS BASED ON TELEVISION VIEWING
AND IT DOESN'T INCORP. RAUT THE
NEW EXPOSURES AND THE
DEVELOPMENTAL STAGES. SO I
THINK THAT'S ONE OF THE GOALS
FOR THIS RESEARCH IS TO LOOK AT
THE DIFFERENT STAGES AND RIGHT
NOW WE'VE FOCUSED ON EARLY
ADOLESCENCE BECAUSE THAT'S THE
DATA THAT'S AVAILABLE IN THE
ABCD STUDY. BUT AS THE COHORT
AGES HOPEFULLY WE'LL HAVE MORE
INFORMATION ABOUT THE LATER
ADOLESCENT AGES.
>> YEAH, GREAT. WELL, I WANT TO
THANK YOU SO MUCH FOR TAKING THE
TIME OUT OF YOUR DAY TO COME AND
TALK TO US AND SHARE THIS
INFORMATION ON THIS IMPORTANT
TOPIC. TO EVERYONE ELSE OUT
THERE, BEFORE WE CLOSE I JUST
WANT TO REMIND YOU THAT WE HAVE
OUR FINAL OBESITY NUTRITION AND
PHYSICAL ACTIVITY SEMINAR OF THE
YEAR, IT'S COMING UP ON
NOVEMBER 6TH ENTITLED THE
RELATIONSHIP BETWEEN BODY WEIGHT
ADIPOSITY AND CARDIOVASCULAR
RISK AMONGST SOUTH ASIAN
AMERICANS. AND SO PLEASE STAY
TUNED FOR MORE DETAILS. THEY'LL
BE AVAILABLE ABOUT THE TIMING OF
THAT SEMINAR. BUT SAVE THE DATE
FOR NOVEMBER 6TH. SO THANKS,
AGAIN, WE REALLY APPRECIATE YOUR
TIME AND TO EVERYONE ELSE WHO
TUNED IN, THANK YOU SO MUCH AND
HAVE A GREAT DAY.