Mental Health And Childhood Obesity

Evidence Based Practice, Proposal, Scholarly Paper

N5555 Nursing Research: Evidence Based Practice

APA 7th edition*, maximum of 15 pages**. Range of 12 – 15 pages for the body of the paper. Double space per APA; no extra line spacing between paragraphs. In-text references for the scholarly paper content.

Theory/Change Model

The primary selected theory for the EBP project and how theory directly applies to the EBP project 2 pts

Childhood Obesity is one of the most challenging public health problems facing both developed and developing countries worldwide. According to the CDC from 2017-2000 the prevalence of obesity was 19.7% and affected about 14.7 million children and adolescents. With this severe problem it is important to find a model to guide our steps to identify the issues, research possible causes and solutions, and implement changes. The model I have chosen for my research is the Iowa Model.

The reason I chose this model because in order to change the statistics we have make it a priority and form a team to look at the evidence and do studies to see which interventions are supported by the data. The Iowa Model focuses on making sure that we integrate and sustain the practice change with every visit when we see our pediatric patients (Melnyk, & Fineout-Overholt, 2019). Another reason I like this model is because the ultimate goal is to change our practice and get as many people on board as possible and to “hardwire people” to ask the difficult questions to improve the quality of the pediatric patient (Buckwalter et al., 2017). To improve childhood obesity in this country and to get providers, dieticians, parents on board we have to accomplish it purposefully within our organization and community and to be aware that change take time.

References:

Buckwalter, K. C., Cullen, L., Hanrahan, K., Kleiber, C., McCarthy, A. M., Rakel, B., Steelman, V., Tripp-Reimer, T., Tucker, S., & Authored on behalf of the Iowa Model Collaborative (2017). Iowa Model of Evidence-Based Practice: Revisions and Validation. Worldviews on evidence-based nursing, 14(3), 175–182. https://doi.org/10.1111/wvn.12223 (Links to an external site.)

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice (4th ed.). Wolters Kluwer.

.

 

Methods

IRB approval, site approval, funding 2 pts

 

Study Design

Quantitative or qualitative study and specific type of design associated with measuring impact of EBP intervention on primary outcome. 2 pts

 

Participants and Setting 2 pts

The project setting, state and describe

The participants with projected number and inclusion and exclusion criteria.

EBP Intervention and Implementation 15pts

The EBP intervention, state and describe. The intervention steps (narrative paragraph format and avoid a list). Sequential flow from recruitment and consent (if applies) through EBP intervention participant involvement with data collection on outcomes measure(s). Include a timeline as well.

Internal and External Validity 5 pts

Internal validity (extent to which the EBP intervention causes the change in the primary outcome and results not due to other factors). External Validity (extent to which can generalize the EBP project findings to the target population and same or similar geographic location or setting, Address expected participant number and time length impact)

Methods of Evaluation

Primary outcome concise statement and secondary outcome statement, if secondary outcome applies.

Measurement Instruments 3 pts

Instrument(s) to measure each stated outcome(s). An instrument could be physical measure, data from health record, and/or another instrument. State the reliability and validity of the instrument(s). State time involved in participant completion of the instrument and method of completion (web, other), as applies. State permission of instrument or public domain, as applies. Quality of Data

Data collection processes to assure quality and adequacy of data. 3 pts Analysis Plan

Statistical analysis to be used and rational for use.

Comparison to published benchmark or specific research study outcomes.

Anticipated degree and direction of impact of the EBP intervention on the primary outcome. Participant number and EBP project length impact(s). Likelihood that gains may weaken over time and plan to maintain the improvement. 3 pts

Conclusion

The EBP intervention with projected outcome, restate. The practical usefulness of the EBP intervention. Further implementation and outcome studies. 3 pts

 

References (new page)

Fifteen to 20 research study references. May have additional non-study references, especially for topic and significance section and theory section.

Appendix or Appendices (new page)

**deduction of 3 pts on paper grade for each page over 15 pages (title page, abstract page, references section pages, and appendices, images are not included.)

 

EVIDENCE BASED TABLE FORM

Samuel Allen

 

Article number Title of article, Author, Year

 

Setting Sample Size and Type Level of Evidence Study Findings Limitations Outcomes Other info
1 Combinations of physical activity, sedentary time, and sleep duration and their associations with depressive symptom and other mental health problems in children and adolescents: a systematic review

 

Year: 2020

 

Authors: Sampasa-Kanyinga, H., Colman, I., Goldfield, G. S., Janssen, I., Wang, J., Podinic, I., Tremblay, M. S., Saunders, T. J., Sampson, M., & Chaput, J.-P.

 

School of Epidemiology and Public Health & Healthy Acute Living and Obesity Research Group in Canada 13 cross sectional studies. Involved 115,540 children and adolescents in 12 countries.

 

Inclusion criteria involved all three:

Physical activity, sedentary time, and sleep duration

1 If they met all three inclusion criteria it was associated with significantly lower odds of depression among adolescents compared with meeting one or any combination of two of them.

 

Excessive screen time and mental health problems may be direct or indirect. Direct pathways can affect interpersonal relationships or direct cognitive effects creating low emotional stability. Indirect pathways could be observed through insufficient sleep, and unhealthy eating habits.

The articles used for this study were only published in English or French.

 

Many of the studies only used a single item measure of mental health problems (e.g., depressive symptoms) which could raise validity and reliability issues.

 

The quality of evidence assessed using GRADE was “very low” quality mainly because of cross sectional nature.

The findings are favorable between meeting all three recommendations and better mental health among children and adolescents when compared with meeting none of the recommendations.

 

Meeting the screen time and sleep duration recommendations appeared to be associated with more mental health benefits then meeting the physical activity recommendation.

n/a
2 Screen time and Mental Health Among Adolescents Implications of the Rise in Digital Environment in South Africa

 

Year: 2022

 

Authors: Ranjit, K., Ntlantsana, V., Tomita, A., & Paruk, S.

Three public school in South Africa 187 students of whom most were female (142) from grades 8 to 11.

 

Cross sectional study, descriptive, quantitative, self-administered questionnaire.

IV Fifty participants (27.9%) reported depressive symptoms with PHQ-9 of 5-9, 29 (16.2%) had scores from 10-14, and 21 (11.7%) had scores of 15 or more indicating severe depression.

 

Found higher overall screen time to be significantly associated with greater likelihood of depression

 

Mean screen time during the weekdays were 2.1 hours/day and mean screen time during the weekend was 4.7 hours/day

Include the cross sectional design which only assessed screen use at one point but may change with circumstances, such as the pandemic lockdown period.

 

Sample size was limited and a low response /attrition rate.

 

Self-reporting by participates may be subjective and include underreporting or over reporting of screen time and depressive symptoms

Found a significant role of screen time during the weekend on depression and conduct symptoms.

 

Also found out that greater weekend cell phone use was significantly associated with lower prosocial behaviors.

n/a
3 Association of Children’s Physical Activity and Screen Time with Mental Health During the COVID-19 Pandemic

 

Year: 2021

 

Authors: Tandon, P.S., Zhou, C., Johnson, A. M., Gonzalez, E. S., & Kroshus, E.

A market research company (YouGov)

By the institutional review board of Seattle Children Hospital in Seattle Washington

1000 school aged children from 11-17

 

A cross – sectional study using the test-retest reliability

IV Average age of the study was 11 with 517 (52.6%) being boys and 467 (47.4%) girls.

 

Overall 143 children (13.7%) were diagnosed or undergoing evaluation for anxiety; 110 (10.4%) for depression; 160 (15.0%) for ADHD & 116(11.4%) a behavioral problem.

 

Only 24% of children in this study met the recommendation for 60 minutes per day of physical activity.

Include the fact that all data were collected by the parent or child report and are subject to biases

 

Unable to discern whether mental health diagnoses started before or during the pandemic.

More physical activity and less screen time were associated with better mental health for children accounting for the stressors of the pandemic.

Children who were exposed to more pandemic related stressors engaged in less physical activity and more screen time then peers who were less exposed.

n/a
4 Screen Time Use Among US Adolescents During the COVID- 19 Pandemic

 

Year: 2022

 

Authors: Jason Nagata MD, Catherine Cortez, Chloe Cattle, Kyle Ganson PHD, Puja Iyer, Kirsten Bibbins-Domingo PHD & Fiona C. Baker PHD.

Online; COVID-19 Response Research Release from the Adolescent Brain Cognitive Development obtained from the University of California, San Diego 5412 adolescents included in the sample

Including 50.7% female and 49.3% male as well as racial and ethically diverse.

 

A cross sectional study

IV Adolescents reported a mean of 7.70 (5.74) hours/day of screen use, mostly spent on watching or streaming videos, movies or television shows (2.45 hours/day), multiple player gaming (2.21 hours/day, and single player gaming (1.82 hours/day).

 

 

Limitations involve whether this greater mental health disparities are partly driven by assess to financial resources and digital media education.

 

Limitations also include the use of self-reported data.

Poorer mental health and greater perceived stress were associated with higher total screen use, while more social support and coping behaviors were associated with lower total screen use. n/a
5 Impact on adolescent mental health of replacing screen-use with exercise: A prospective cohort study

 

Year: 2022

 

Authors: AaronKandola, Borja del Pozo Cruz, Joseph F. Hayes Neville Owen David W. Dunstan, & Mats Hallgren

 

They used time-use diary data at age 14 to estimate daily screen use (television, social media, & video games) and exercise (team sport and individual exercise). The outcome

was emotional distress at age 17, assessed using the emotional symptoms subscale of the

Strengths and Difficulties Questionnaire.

4,599 adolescents (55% female)

at the age of 14 years old.

 

A prospective cohort/

longitudinal study

IV Theoretically replacing 60 minutes of total screen time with exercise at age 14 was associated

with a 0.05 (95%CI -0.08, -0.02) score reduction on the emotional symptoms’ subscale at 17in fully-adjusted models. Replacing 60 minutes of television or social media use with team

sports was associated with a reduction of 0.17 (95%CI, -0.31, -0.04) and 0.15 (95%CI, -0.29,

-0.01) in emotional symptom scores, respectively. We found no change in emotional

symptom scores when replacing video game or general computer use with team sport, or when replacing any screen time with individual exercise.

No direct measure of depressive symptoms at follow-up. Replacing any screen time with exercise could reduce emotional distress, but the largest effect sizes were associated with replacing time in television watching and social media with team sports. Recommendations to limit screen-use in adolescents may require a nuanced

approach for protecting mental health.

n/a
6 Associations between screen time and lower psychological well-being among children and adolescents: Evidence from a population-based study.

 

Year: 2018

 

Authors: Jean Twenge & Keith Campbell

Based on the 2016 census random families were selected and survey was administered online or in paper. 44, 734 children between the ages of 2-17 years of age

 

It is cross sectional randomized population based study

IV Among 14- to 17-year-olds, high users of screens (7+ h/day vs. low users of 1 h/day) were more than twice as likely to ever have been diagnosed with

depression (RR 2.39, 95% CI 1.54, 3.70), ever diagnosed with anxiety (RR 2.26, CI 1.59, 3.22), treated by a mental health professional (RR 2.22, CI 1.62, 3.03) or have taken medication for a psychological or behavioral issue (RR 2.99, CI 1.94, 4.62) in the last 12 months. M

First, screen time was

reported by caregivers and not the children or adolescents themselves.

 

Also, the well-being

measures may be influenced by caregivers’ perceptions and may under-

report issues that children do not disclose to their parents.

After 1 h/day of use, more hours of daily screen time were associated with lower psychological well-being,

including less curiosity, lower self-control, more distractibility, more difficulty making friends, less emotional stability, being more difficult to care for, and inability

to finish tasks.

n/a
7 The relationship between screen time and mental health in young people: A systematic review of longitudinal studies.

 

Year: 2021

 

Authors: Tang, S., Werner-Seidler, A., Torok, M., Mackinnon, A. J., & Christensen, H.

Black Dog Institute, University of New South Wales, Sydney, Australia. 35 studies.

 

They all met the eligibility criteria, which included a longitudinal design and published in a peer-reviewed journal, participants aged 10-24 years, screen-time use frequency or duration provided, provided internalizing symptoms of mental health problems, and published between 2005 and 2020.

I There was small positive association between total screen time and depressive symptoms.

 

There was strong evidence associating internet/computer and mobile phone use and depression.

 

There was limited evidence associating total screen time and higher anxiety symptoms.

 

There was limited evidence associating total screen time and self-esteem.

 

There was no evidence associating total screen time and general internalizing symptoms.

 

Social media had a positive association with internalizing problems.

 

The models used omitted some paths that may have led to biased estimates of the relationship between variables in either direction.

 

The articles defined screen time differently.

 

Most of the studies included lacked statistical rigor.

 

All the studies relied on self-reports and only one had objective screen data.

The weak association between total screen time and internalizing problems indicate that total screen time may not be an appropriate measure of the effect of screen use on internalizing symptoms.

 

The findings indicated a varied relationship between screen time and internalizing symptoms across different devices.

 
8 The relationship between physical activity, mental wellbeing and symptoms of mental health disorder in adolescents: a cohort study.

 

Year: 2019

 

Authors: Bell, S. L., Audrey, S., Gunnell, D., Cooper, A., & Campbell, R.

Six secondary schools in the UK.

 

928 students aged between 12-13-year-old.

 

It was a prospective cohort.

 

IV The findings indicated negative association between mental wellbeing and symptoms of mental health problems.

 

No evidence associating physical activity with mental wellbeing.

 

Increased physical activity was associated with lower emotional problems.

 

 

Some confounders were not measured on baseline such as drinking and smoking behaviors and could have affected the relationship between variables.

 

There were no baseline measures for mental wellbeing.

The study provided limited evidence on the relationship between physical activity, symptoms of mental health problems, and mental wellbeing.

 

The level of physical activity could influence emotional problems.

 

 

n/a
9 The longitudinal associations between mental health indicators and digital media use and physical activity during adolescence: A latent class approach.

 

Year: 2022

 

Authors: Engberg, E., Hietajärvi, L., Maksniemi, E., Lahti, J., Lonka, K., Salmela-Aro, K., & Viljakainen, H.

Folkhalsan Research Center, and the University of Helsinki, Finland. 1285 participants aged 11 years old.

 

A prospective cohort.

IV 20% of the participants reported high usage of digital media and moderate leisure time physical activity (LTPA).

31% of the participants reported high LTPA and moderate use of digital media.

26% of participants reported high LTPA and high usage of digital media.

23% of the participants reported low LTPA and high passive usage of digital media.

 

The use of digital media and LTPA was not associated with depressive and anxiety symptoms.

 

Increased perception of athletic competence was associated with moderate use of digital media and high LTPA.

 

The reliance on self-reported data increased the risk of bias as there were no objective data measurement tools.

 

The pilot study had a 14% response rate which may limit the applicability of the findings.

 

The education level of parents whose children participated in the follow-up was higher than that of those whose children did not which may limit the generalization of the findings across low income adolescent populations.

The relationship between increased perception of athletic competence and moderate usage of digital media and high leisure time physical activity suggests that higher level of physical activity could be used to reduce digital media usage in adolescents. n/a
10 Psychological symptoms are associated with screen and exercise time: a cross-sectional study of Chinese adolescents.

 

Year: 2020

 

Authors: Zhang, F., Yin, X., Bi, C., Ji, L., Wu, H., Li, Y., … & Song, G.

 

 

North, Central South, Northwest, Northeast, East, and Southwest regions of China. 7200n participants aged 7-18 years.

 

A cross-sectional study.

IV The symptoms of psychological problems detection rate was 21.4%.

Participants that had 1-2h/day of screen time and those who had an exercise time of 30-60 minutes per day had the lowest detection rate of symptoms of psychological problems.

Psychological symptoms were higher among participants that had more than 2 hours of screen time and less than 30 minutes of exercise per day.

 

 

 

The design of the study prevented establishment of causal relationships.

 

The study relied of self-reported data which can be inaccurate.

 

The study did not identify the type of physical activities or exercises that participants engaged in, as some activities may have greater impact on mental health than others.

Engaging in a 30-60 minute-exercise sessions per day as well as less than 2-hour screen time per day can be used to improve mental health outcomes.

Increasing level of physical activity and reducing the time spent on the screen can be used to improve mental health.

n/a
11 Less screen time and more frequent vigorous physical activity is associated with lower risk of reporting negative mental health symptoms among Icelandic adolescents.

 

Year: 2018

 

Authors: Hrafnkelsdottir, S. M., Brychta, R. J., Rognvaldsdottir, V., Gestsdottir, S., Chen, K. Y., Johannsson, E., … & Arngrimsson, S. A.

 

Six elementary schools in metropolitan Reykjavık, Iceland. 315 students in the 10th grade, with a mean of 15.8 years.

 

A cross-sectional study.

 

 

IV The findings indicated that less that 5.3 h/day screen time and frequent vigorous physical activity were associated with decreased symptoms of anxiety, depression, life satisfaction and low self-esteem.

 

Less frequent vigorous physical activity and less screen time was associated with lower life dissatisfaction and viceversa.

 

There is no evidence of the associated between physical activity and mental health wellbeing.

 

The study relied on self-reported data which are subject to reporting and recall biases.

 

The cross-sectional design does not allow determination of causal relationships between the variables.

Screen time higher than 5.3 h/day could lead to poorer mental health outcomes.

 

Less screen time and increased participation in vigorous physical activity could be used to lower the risk of negative mental health outcomes.

 

 
12 Less screen time, more frequent fruit and vegetable intake and physical activity are associated with greater mental wellbeing in adolescents.

 

Year: 2022

 

Authors: Davison, J., Bunting, B., Connolly, P., Lloyd, K., Dunne, L., & Stewart-Knox, B.

All post-primary schools in Northern Ireland. Time one: 1618 participants aged 13-14 years.

 

Time two: 1558 participants, aged 15-16 years.

 

This was a survey.

IV The predictors of mental wellbeing tested were physical activity, social media, religion, vegetable and fruit intake, family affluence, and sleep.

 

Religion and frequent physical activity were associated with improved mental wellness among females in both times one and two.

 

Greater use of social media was associated with poor mental health in females in time one.

 

Frequent physical activity and increased vegetable and fruit intake was associated with improved mental health in males in both times one and two.

 

 

The survey design made it difficult to establish causal relationships between physical activity, vegetable and fruit intake or social media usage and mental wellbeing.

 

The self-reported data is subject to bias towards socially acceptable outcomes and inaccurate recall.

 

 

The association between frequent physical activity and improvement of mental wellbeing in both females and males indicates that increased physical activity can be a contributing factor to improvement of mental health among adolescents.  
13 Effects of screentime on the health and well-being of children and adolescents: a systematic review of reviews.

 

Year: 2018

 

Authors: Stiglic, N., & Viner, R. M.

 

 

N/A 13 articles met the eligibility criteria, which included systematic reviews that used prespecified protocols to search for articles, inclusion of adolescents aged 0-18 years, reported screentime, and examined impact on adolescents or children.

 

 

V The findings indicate strong evidence associating television screentime with increased adiposity.

 

Television screentime is moderately associated with high energy intake and intake of less healthy diets.

 

Television screentime is moderately associated with depressive symptoms.

 

There is limited evidence associated less than 2 hour-screentime daily with depressive symptoms.

 

There is limited and weak evidence associating television screentime and cardiorespiratory health.

 

Increased screentime is associated with poor cognitive development in children.

The review had only one high-quality article. Most of the studies did not examine publication bias in the primary studies reviewed.

 

Data was only extracted by one researcher, which affects the reliability of the data.

 

The studies did not examine how screentime affects health outcomes.

The evidence suggests that increased screentime could lead to poorer health outcomes and wellbeing.

 

Adolescent health and wellbeing could be improved by reducing screentime.

 

 

 
14 Systematic review and meta-analysis of the effects of exercise on depression in adolescents.

 

Year: 2022

 

Authors: Wang, X., Cai, Z. D., Jiang, W. T., Fang, Y. Y., Sun, W. X., & Wang, X.

 

 

N/A 15 articles met the inclusion criteria.

 

The inclusion criteria was inclusion of adolescents aged 12-18 years with depression based on DSM-V, an exercise intervention, a control group with no exercise intervention, a recognized scale for measuring depressive symptoms, randomized controlled trial, or original peer-reviewed English or Chinese papers.

V The findings indicated that aerobic exercise moderately alleviates depressive symptoms.

 

The effect of aerobic exercise was significant at 6-8 weeks.

 

30 minutes and 75-120 minutes of aerobic exercise significantly reduced depressive symptoms.

 

Exercising 3-4 times a week significantly reduced depressive symptoms.

 

Moderate to high aerobic exercise significantly reduced depressive symptoms in adolescents.

 

Only English and Chinese articles were included, and no randomized controlled trials. So, the search may not have been comprehensive.

 

Only one article applied blinding in assessment.

 

The articles had self-reported subjective data which lacked objectivity.

 

The studies were highly heterogeneous.

 

The studies lacked uniform standards of the intensity of the exercises.

 

 

 

The positive effect of aerobic exercise in reducing depressive symptoms indicates that physical activity could be used to alleviate depressive symptoms in adolescents.

 

Exercising 4 times per week for 6 weeks, maintain 30 minutes per session, or 75-120 minutes per session, 3 days per week, for 8 weeks of moderate to high intensity exercise could be effective in improving depressive symptoms.

 

 

 

 
15 Effects of school-based physical activity interventions on mental health in adolescents: The School in Motion cluster randomized controlled trial.

 

Year: 2020

 

Authors: Åvitsland, A., Leibinger, E., Resaland, G. K., Solberg, R. B., Kolle, E., & Dyrstad, S. M.

29 Norwegian lower secondary schools. 2084 participants aged 14-15 years.

 

A randomized controlled trial.

II The results indicated that there were no significant effects between the intervention (M1) and the control (M2) groups.

 

There was a slight increase in the physical activity outcomes in the control group.

 

The participants in both groups had normal psychological difficulty levels and experienced beneficial effects, which can be attributed to reduced emotional problems, hyperactivity, or conduct problems.

Exercise was included in both groups which made it difficult to have a significant difference in the outcomes.

 

Participation of the schools was voluntary and the findings may not be generalizable to schools that did not participate.

 

The control group had high attrition rate which could have affected the results.

 

There are potential mediating factors that may be difficult to control in the school context which may affect the findings.

The school-based physical activity intervention had beneficial effects on both groups, which indicates that physical activity could be effective in alleviating psychological difficulties.

 

The physical activity interventions could have clinically significant effects which could reduce the chances of developing mental health problems.

 
                 
                 

 

 

 

 

 

References

Åvitsland, A., Leibinger, E., Resaland, G. K., Solberg, R. B., Kolle, E., & Dyrstad, S. M. (2020). Effects of school-based physical activity interventions on mental health in adolescents: The School in Motion cluster randomized controlled trial. Mental Health and Physical Activity, 19, 100348. https://doi.org/10.1016/j.mhpa.2020.100348

Bell, S. L., Audrey, S., Gunnell, D., Cooper, A., & Campbell, R. (2019). The relationship between physical activity, mental wellbeing and symptoms of mental health disorder in adolescents: a cohort study. International Journal of Behavioral Nutrition and Physical Activity16(1), 1-12. https://doi.org/10.1186/s12966-019-0901-7

Davison, J., Bunting, B., Connolly, P., Lloyd, K., Dunne, L., & Stewart-Knox, B. (2022). Less screen time, more frequent fruit and vegetable intake and physical activity are associated with greater mental wellbeing in adolescents. Child Indicators Research, 1-23. https://doi.org/10.1007/s12187-022-09924-6

Engberg, E., Hietajärvi, L., Maksniemi, E., Lahti, J., Lonka, K., Salmela-Aro, K., & Viljakainen, H. (2022). The longitudinal associations between mental health indicators and digital media use and physical activity during adolescence: A latent class approach. Mental health and physical activity22, 100448. https://doi.org/10.1016/j.mhpa.2022.100448R

Hrafnkelsdottir, S. M., Brychta, R. J., Rognvaldsdottir, V., Gestsdottir, S., Chen, K. Y., Johannsson, E., … & Arngrimsson, S. A. (2018). Less screen time and more frequent vigorous physical activity is associated with lower risk of reporting negative mental health symptoms among Icelandic adolescents. PloS one, 13(4), e0196286. https://doi.org/10.1371/journal.pone.0196286

Kandola, A. Pozo Cruz, B., Hayes, J. F., Owen, N., Dunstan, D. W. & Hallgren, M. (2021). Impact on adolescent mental health of replacing screen-use with exercise: A prospective cohort study. Journal of Affective Disorders 301, 240-247. https://doi.org/10.1016/j.jad.2021.12.064

Nagata, J. M., Cortez, C. A., Cattle, C. J., Ganson, K. T., Iyer, P., Bibbins-Domingo, K., & Baker, F. C. (2022). Screen Time Use Among US Adolescents During the COVID-19 Pandemic: Findings From the Adolescent Brain Cognitive Development (ABCD) Study. JAMA Pediatrics, 176(1), 94–96. https://doi.org/10.1001/jamapediatrics.2021.4334

Ranjit, K., Ntlantsana, V., Tomita, A., & Paruk, S. (2022). Screen Time and Mental Health Among Adolescents: Implications of the Rise in Digital Environment in South Africa. Journal of Nervous & Mental Disease, 210(6), 454–461. https://doi.org.10.1097/NMD.0000000000001509

Sampasa-Kanyinga, H., Colman, I., Goldfield, G. S., Janssen, I., Wang, J., Podinic, I., Tremblay, M. S., Saunders, T. J., Sampson, M., & Chaput, J.-P. (2020). Combinations of physical activity, sedentary time, and sleep duration and their associations with depressive symptoms and other mental health problems in children and adolescents: a systematic review. International Journal of Behavioral Nutrition & Physical Activity, 17(1), 1–16. https://doi.org.10.1186/s12966-020-00976

Stiglic, N., & Viner, R. M. (2019). Effects of screentime on the health and well-being of children and adolescents: a systematic review of reviews. BMJ open, 9(1), e023191. http://dx.doi.org/10.1136/bmjopen-2018-023191

Tandon, P. S., Zhou, C., Johnson, A. M., Gonzalez, E. S., & Kroshus, E. (2021). Association of Children’s Physical Activity and Screen Time With Mental Health During the COVID-19 Pandemic. JAMA Network Open, 4(10), e2127892. https://doi.org./10.1001/jamanetworkopen.2021.27892

Tang, S., Werner-Seidler, A., Torok, M., Mackinnon, A. J., & Christensen, H. (2021). The relationship between screen time and mental health in young people: A systematic review of longitudinal studies. Clinical Psychology Review86, 102021. https://doi.org/10.1016/j.cpr.2021.102021

Twenge, J. M., & Campbell, W. K. (2018). Associations between screen time and lower psychological well-being among children and adolescents: Evidence from a population-based study. Preventive Medicine Reports, 12, 271–283. https://doi.org/10.1016/j.pmedr.2018.10.003

Wang, X., Cai, Z. D., Jiang, W. T., Fang, Y. Y., Sun, W. X., & Wang, X. (2022). Systematic review and meta-analysis of the effects of exercise on depression in adolescents. Child and Adolescent Psychiatry and Mental Health, 16(1), 1-19. https://doi.org/10.1186/s13034-022-00453-2

Zhang, F., Yin, X., Bi, C., Ji, L., Wu, H., Li, Y., … & Song, G. (2020). Psychological symptoms are associated with screen and exercise time: a cross-sectional study of Chinese adolescents. BMC public health, 20(1), 1-12. https://doi.org/10.1186/s12889-020-09819-7

 

Running Head: REPLACING SCREEN TIME 1

REPLACING SCREEN TIME 3

Replacing Screen Time with Daily Activity to Improve Mental Health in Adolescents

Samuel Allen

University of Missouri-Kansas City

N5555 Nursing research

Dr. Lindholm

07/17/2022

Abstract

Exposure to screen media has been associated with the development of mental health problems. Screen use is higher among children and adolescents with sedentary lifestyles, who are also most likely to be obese. Screen time exposes children and adolescents to other intermediate factors that lead to the development of mental health problems including obesity, due to poor eating habits, and lack of physical activity. Children with high exposure to screen media are more likely to develop serious mental health problems that affect their physical functioning as well as academic performance. The purpose of this evidence-based scholarly paper is to establish whether replacing screen time with 30-minute exercise could improve overall mental health in adolescents compared with adolescents with a sedentary lifestyle. This paper utilizes a quasi-experimental study design to measure the effect of the intervention on the participant’s mental health. The participants of the project will include adolescents with high exposure to screen media who have been diagnosed with a mental health problem to determine the effect of the intervention on mental wellbeing. Replacing screen time with 30-minute activity is expected to lower the symptoms of mental health problems. The findings of the project would be used to help adolescents with mental health problems and also address other issues associated with a sedentary lifestyle such as childhood obesity.

Keywords: screen time, screen media, mental health, physical activity, adolescents

Replacing Screen Time with Daily Activity to Improve Mental Health in Adolescents

Significance of the Topic

Screen media has been closely associated with mental health problems, behavioral problems, lower self-esteem, and lower health-related quality of life. Childhood obesity is a major health concern among adolescents with a sedentary lifestyle that increases the risk of developing serious mental health problems at a younger age. Current evidence associates screen media exposure with the development of childhood obesity, which affects children’s physical health, as well as emotional and social well-being (Stiglic & Viner, 2018). Studies have established that obese children are more likely to be affected by multiple psychological problems than their healthy peers, which could be worsened by stigma, bullying, and teasing, and seriously impact the performance of their physical and emotional health. The association between screen time and mental health has been extensively studied. Due to the technological developments taking place in the modern world, the exposure of children to screen media is increasing. With the increasing use of digital media by children and adolescents, the risk of developing mental or behavioral disorders is also increasing, which creates the need for interventions to address the issue in primary settings. Mental health problems in children with increased screen media use include unhealthy diet, sedentary lifestyle, sleep deprivation as well as other physiological and psychological factors (Sampasa-Kanyinga et al., 2020; Davison et al., 2022). The diversity considerations that would be considered in the target population include the socioeconomic status of the family, race or ethnicity, and age. The use of a diverse sample would increase the applicability of the findings to the general population.

Problem and Purpose Statements

Sagar and Gupta (2018) explained that childhood obesity is a threat to mental health in adolescents and children. Although not all obese children develop mental health problems, some specific groups of children and adolescents such as children with chronic and severe obesity and clinically obese groups, and adolescent females were found to be at a high risk of developing multiple psychiatric problems. Screen time is a significant factor that contributes to obesity in children due to increased food intake when viewing, intake of low-nutrient beverages and foods and foods with high calories, and sleep deprivation (Robinson et al., 2017). Screen media exposure increases children’s exposure to the marketing of unhealthy foods and beverages that influences their consumption habits, purchase behavior, and their food preferences.

The purpose of this evidence-based scholarly is to establish whether replacing screen time with physical activity would improve the overall mental health of children and adolescents. Physical activity is associated with the improvement of mental health outcomes and could help obese children by reducing their weight. Weight reduction is one of the strategies used to tackle obesity, which is mostly associated with a sedentary lifestyle. Increased screen time promotes a sedentary lifestyle which increases the risk of obesity. There is a need to identify interventions to address the mental health challenges that face obese adolescents. The findings of the study will be used to assist obese adolescents with increased exposure to screen media by increasing their activity level and reducing their screen time.

Facilitators and Barriers

The success of the project will be influenced by both facilitators and barriers. The main facilitators of the project include knowledge in evidence-based practice, availability of existing literature on the topic in peer-reviewed journals available in various nursing and medical databases that can be accessed through the university library, well-designed research protocols, resources, time, and academic training. The barriers include lack of adequate human resources, time constraints, resource shortages, and the high cost of the project.

Review of Evidence

PICOT

The primary PICOT statement is “in adolescents ages 10-16, how does replacing screen time with 30 minutes of activity daily compared to children with sedentary lifestyle behaviors improve their overall mental health in a 3-month period?”

Search 

The database used to search for evidence was PubMed available through the university library. The search terms and phrases used in the search process were derived from the PICOT question. These included adolescents, screen time, physical activity, sedentary lifestyle, screen media, and mental health. The initial search produced 678 articles, which were too many to identify the relevant ones. Therefore, some refinement decisions were applied to narrow down the search results. These included using Boolean operators “OR” and “AND” and additional filters such as limiting the publication date to the last five years, and selecting articles with full text available in PDF.

The final search results included 31 articles after refining the search strategies, out of which 15 articles were found to be the most relevant to the study. Among the articles, there were 11 quantitative single-study articles, 4 systematic reviews, and no qualitative single-study article was selected. The articles selected provided relevant evidence for the evidence-based project. The evidence provided in the articles was critically analyzed and appraised before the articles were selected for use in the project.

Synthesis of the Evidence 

After analyzing the evidence from the 15 articles selected for the evidence-based project, the following themes were developed including the association between physical activity and mental health problems, the association between screen time and mental wellbeing, the mediators of the impact of screen media use, and physical activity on mental health, and the effect of replacing screen time with physical activity on mental health symptoms. The themes are discussed below in a series of sub-topics that represent each of the themes. The evidence supporting the various sub-topics is analyzed and integrated into the evidence-based intervention.

The Association Between Physical Activity and Mental Health Symptoms

Davison et al. (2022) established that increased frequency of physical activity improved the mental well-being of adolescents aged between 13 and 16 years old. Wang et al. (2022) found that an aerobic exercise lasting 30 minutes, carried out 4 times per week for 6 weeks significantly improved depressive symptoms among adolescents. Similar findings were reported when adolescents participated in 75-120 minutes of aerobic exercise, 3 times per week for 8 weeks (Wang et al., 2022). Tandon et al. (2021) identified suggested that physical activity led to a decrease in the number of symptoms of mental health disorders in children. However, other studies found no strong evidence supporting the effect of physical activity on mental well-being in adolescents (Bell et al., 2019). Nevertheless, the authors suggested that physical activity could lead to the improvement of emotional problems, which could reduce depressive and anxiety symptoms. However, the positive association between physical activity and improvement of mental health outcomes indicates that physical activity can be used as an intervention to address the issue of mental health problems in adolescents.

The Association Between Screen Time and Mental Wellbeing 

Davison et al. (2022) found that prolonged use of social media led to lower mental health and well-being in adolescents. Similar findings were shared by Twenge and Campbell (2018) who revealed that more than one hour of screen time per day led to lower psychological wellbeing, which was characterized by lower emotional stability, distractibility, lower self-control, and less curiosity. Tang et al. (2021) stated that there was limited evidence that associated screen time with depressive symptoms. Nagata et al. (2022) suggested that poorer mental health was associated with high screen use. Twenge and Campbell (2018) associated screen time and lower psychological well-being. Another study associated higher screen time with an increased likelihood of developing severe depression and lower prosocial behavior (Ranjit et al., 2022).

Sampasa-Kanyinga et al. (2020) explained that excessive screen time may have direct or indirect effects on mental health, by directly affecting interpersonal relationships and emotional stability, or indirectly influencing intermediate factors such as eating behaviors, sleep, or body weight. Stiglic and Viner (2018) found that screen time was significantly associated with obesity and depressive symptoms. The evidence from the articles indicated that higher screen time could lead to mental health problems. However, some studies did not establish the direction of the association between screen time and mental health problems. The positive association between screen time and mental health symptoms indicates that adolescents’ mental health could be improved by reducing screen time.

Mediators of the Impact of Screen Media Use and Physical Activity on Mental Health

There are some factors that influence the association between both physical activity and screen media use and mental health such as age, duration, devices used, and gender. Tandon et al. (2021) identified an association between increased screen time and more symptoms of mental health problems in both younger and older children. Twenge and Campbell (2018) identified the duration of screen use as a significant factor that influenced psychological wellbeing since high screen use was associated with more than twice the likelihood of depression diagnosis, while the effect of moderate screen use did not differ with no use in participants’ wellbeing. Also, older adolescents had lower psychological well-being due to screen use than younger children (Twenge & Campbell, 2018). Tang et al. (2021) found that devices influenced the association between screen time and symptoms of depression among adolescents. On the aspect of sex, Davison et al. (2022) found that females had significantly lower mental health well-being scores than males after participating in the same level of physical activity. The mediating factors should be considered to get the accurate effect of the intervention. If the factors are not controlled, they could influence the outcome of the intervention and produce inaccurate results.

The Impact of Replacing Screen Time with Physical Activity

Current evidence suggests that replacing screen time with physical activity is associated with the improvement of mental health. In one of the studies, Kandola et al. (2022) found that replacing one hour of total screen time with exercise reduced emotional problems, but there was no change if only one video game was replaced with individual exercise. The researchers established that replacing screen time with exercise could lead to a reduction in emotional distress in adolescents, which could have a protective effect on mental health. Tandon et al. (2021) found that less screen time and more physical activity led to improvement of mental health in children while considering the effect of other stressors. Zhang et al. (2020) found less than 2 hours of screen time and more than 30 minutes of exercise per day were associated with higher psychological wellbeing. In another study,

Hrafnkelsdottir et al. (2018) associated less screen time and a higher frequency of vigorous physical activity (at least 4 times a week) with reduced depression, life dissatisfaction, low self-esteem, and anxiety symptoms. The evidence from the articles suggests that replacing or reducing screen time and increasing physical activity could lead to better mental health outcomes.

References

Åvitsland, A., Leibinger, E., Resaland, G. K., Solberg, R. B., Kolle, E., & Dyrstad, S. M. (2020). Effects of school-based physical activity interventions on mental health in adolescents: The School in Motion cluster randomized controlled trial. Mental Health and Physical Activity, 19, 100348. https://doi.org/10.1016/j.mhpa.2020.100348

Bell, S. L., Audrey, S., Gunnell, D., Cooper, A., & Campbell, R. (2019). The relationship between physical activity, mental wellbeing and symptoms of mental health disorder in adolescents: a cohort study. International Journal of Behavioral Nutrition and Physical Activity16(1), 1-12. https://doi.org/10.1186/s12966-019-0901-7

Davison, J., Bunting, B., Connolly, P., Lloyd, K., Dunne, L., & Stewart-Knox, B. (2022). Less screen time, more frequent fruit and vegetable intake and physical activity are associated with greater mental wellbeing in adolescents. Child Indicators Research, 1-23. https://doi.org/10.1007/s12187-022-09924-6

Engberg, E., Hietajärvi, L., Maksniemi, E., Lahti, J., Lonka, K., Salmela-Aro, K., & Viljakainen, H. (2022). The longitudinal associations between mental health indicators and digital media use and physical activity during adolescence: A latent class approach. Mental health and physical activity22, 100448. https://doi.org/10.1016/j.mhpa.2022.100448R

Hrafnkelsdottir, S. M., Brychta, R. J., Rognvaldsdottir, V., Gestsdottir, S., Chen, K. Y., Johannsson, E., … & Arngrimsson, S. A. (2018). Less screen time and more frequent vigorous physical activity is associated with lower risk of reporting negative mental health symptoms among Icelandic adolescents. PloS one, 13(4), e0196286. https://doi.org/10.1371/journal.pone.0196286

Kandola, A. Pozo Cruz, B., Hayes, J. F., Owen, N., Dunstan, D. W. & Hallgren, M. (2021). Impact on adolescent mental health of replacing screen-use with exercise: A prospective cohort study. Journal of Affective Disorders 301, 240-247. https://doi.org/10.1016/j.jad.2021.12.064

Nagata, J. M., Cortez, C. A., Cattle, C. J., Ganson, K. T., Iyer, P., Bibbins-Domingo, K., & Baker, F. C. (2022). Screen time use among us adolescents during the covid-19 pandemic: findings from the adolescent brain cognitive development (ABCD) study. JAMA Pediatrics, 176(1), 94–96. https://doi.org/10.1001/jamapediatrics.2021.4334

Ranjit, K., Ntlantsana, V., Tomita, A., & Paruk, S. (2022). Screen Time and Mental Health Among Adolescents: Implications of the Rise in Digital Environment in South Africa. Journal of Nervous & Mental Disease, 210(6), 454–461. https://doi.org.10.1097/NMD.0000000000001509

Sampasa-Kanyinga, H., Colman, I., Goldfield, G. S., Janssen, I., Wang, J., Podinic, I., Tremblay, M. S., Saunders, T. J., Sampson, M., & Chaput, J.-P. (2020). Combinations of physical activity, sedentary time, and sleep duration and their associations with depressive symptoms and other mental health problems in children and adolescents: a systematic review. International Journal of Behavioral Nutrition & Physical Activity, 17(1), 1–16. https://doi.org.10.1186/s12966-020-00976

Stiglic, N., & Viner, R. M. (2019). Effects of screentime on the health and well-being of children and adolescents: a systematic review of reviews. BMJ open, 9(1), e023191. http://dx.doi.org/10.1136/bmjopen-2018-023191

Tandon, P. S., Zhou, C., Johnson, A. M., Gonzalez, E. S., & Kroshus, E. (2021). Association of Children’s Physical Activity and Screen Time With Mental Health During the COVID-19 Pandemic. JAMA Network Open, 4(10), e2127892. https://doi.org./10.1001/jamanetworkopen.2021.27892

Tang, S., Werner-Seidler, A., Torok, M., Mackinnon, A. J., & Christensen, H. (2021). The relationship between screen time and mental health in young people: A systematic review of longitudinal studies. Clinical Psychology Review86, 102021. https://doi.org/10.1016/j.cpr.2021.102021

Twenge, J. M., & Campbell, W. K. (2018). Associations between screen time and lower psychological well-being among children and adolescents: Evidence from a population-based study. Preventive Medicine Reports, 12, 271–283. https://doi.org/10.1016/j.pmedr.2018.10.003

Wang, X., Cai, Z. D., Jiang, W. T., Fang, Y. Y., Sun, W. X., & Wang, X. (2022). Systematic review and meta-analysis of the effects of exercise on depression in adolescents. Child and Adolescent Psychiatry and Mental Health, 16(1), 1-19. https://doi.org/10.1186/s13034-022-00453-2

Zhang, F., Yin, X., Bi, C., Ji, L., Wu, H., Li, Y., & Song, G. (2020). Psychological symptoms are associated with screen and exercise time: a cross-sectional study of Chinese adolescents. BMC public health, 20(1), 1-12. https://doi.org/10.1186/s12889-020-09819-7