For More Info:

Associations Between Media Parenting Practices and Early Adolescent Screen Use, in Nature

Resources Mentioned:

American Academy of Pediatrics Media Plan

Hillary Wilkinson: (00:02)

In this era of technology and digital media, there has been growing concerns surrounding the effects of screen use behaviors in children and adolescents. As parents play key roles during childhood and adolescence, child, parent relationships, parenting styles and home environments have been identified as factors that may contribute to children's screen use patterns. So I'm reading from an article titled, Associations Between Media Parenting Practices and Early Adolescent Screen Use published in a recent article in the Journal of  Pediatric Research published by Nature earlier this year. It's so validating and exciting to see research funding and most importantly, data supporting the fields of digital wellness and parent education. Today I went right to the source and I'm speaking with the lead author on this article. Welcome to Healthy Screen Habits, Dr. Jason Nagata.

Dr. Jason Nagata: (02:13)

Thank you so much for having me,

Hillary Wilkinson: (02:15)

Jason. You are really kind of a really big deal with over 300 articles having been published in academic journals. Your research is covered by major media outlets like the New York Times, NPR, CNN, and now most excitingly Healthy Screen Habits. Seriously, you, you're an absolute powerhouse and I'm gonna take a little Simon Sinek moment here and ask you what's your why? What drives you, why do you do what you do?

Dr. Jason Nagata: (02:54)

Yeah. Thank you so much for having me. And yeah, it's really great to, uh, join this esteemed podcast. Uh, I actually have to say that my background is, uh, as a pediatrician, I specialize in adolescent health. And actually more specifically, um, I care for adolescents with eating disorders. Um, and unfortunately, sometimes these teenagers, um, will restrict their food intake so much, um, that they actually can have pretty significant medical consequences and have to be hospitalized. Clinically I work in our inpatient unit for eating disorders where we have, um, some of the unfortunately sickest children and adolescents with eating disorders who have to be hospitalized for medical instability. And I will say that actually that was my primary research focus for many, many years. Um, and when the pandemic hit, we did see a doubling of eating disorder cases, unfortunately with, you know, the perfect storm of social isolation and disruption of activities.

Dr. Jason Nagata: (03:56)

And I think there were also a lot of weight concerns. When children were kind of in lockdown and unable to do a lot of in-person activities, we also found that screen time more than doubled. And, um, and I really saw how screens in particular, um, both worsened some of our patients with eating disorders and also some of our patients with eating disorders, um, really used screens and social media and devices in a way that really impeded their care. Um, we would actually have teenagers in the hospital who were really significantly ill who would use their phones and devices to try to share tips on how to game the system to try to continue to, um, you know, hide food to, um, you know, really disrupt their medical care. And it, I think was a big wake up call for me, um, for some of the ways that screens can really harm our youth, and particularly those already with preexisting mental health conditions like eating disorders. Um, and so that really, um, drove me to better understand links particularly on screens and social media and eating disorders. But then I've more recently brought into other mental health and physical health, um, sort of areas.

Hillary Wilkinson: (05:15)

Yeah. Yeah. Well, I'm grateful you made that jump from seeing what you were seeing in kind of like, you know, the physical, physical health realm and then linking it with the screen usage. 'cause I just, I, I'm so grateful, like I said, for the data and the research coming out now. And, um, you, you referenced the in-person clinic. Can you share where you're at?

Dr. Jason Nagata: (05:44)

Um, so yeah, I'm a pediatrician and a professor at the University of California San Francisco. So I practice at UCSF Benioff Children's Hospital in San Francisco.

Hillary Wilkinson: (05:56)

Excellent. And because of your proximity to Silicon Valley, I think it's important to recognize that the funding for your research is not affiliated with any tech platforms. In fact, I kind of double clicked on your, on your research and your funding has come from the NIH, Doris Duke Charitable Foundation, and you use data from the ABCD study, which is a study on Adolescent Brain Cognitive Development, which collects annual data on the health and cognitive development of over, over 11,000 close to 12,000 adolescents from 21 different geographically diverse sites across the US. And I mentioned this as we were speaking earlier before I hit record, because anytime I talk about tech and the Bay Area, people often make a leap toward assuming you know where funding is getting. So I wanted to clear the runway for your research. Um, one of the things I was really excited to see in your article is its focus on adolescents. Cause this age group has a tendency to kind of get overlooked and there's a big focus on early child development and teens, but not necessarily this middle group. So when we're talking about adolescence, what, what specific ages are we talking about?

Dr. Jason Nagata: (07:26)

Yeah, I, first of all, thank you so much for highlighting the under-recognition of adolescents and the formal definition of adolescence from the World Health Organization is really 10 to 19 years. Um, but I will note that the ABCD study, this Adolescent Brain Cognitive Development study starts with nine to 10 year olds, so really right when they're about to be, become adolescents, um, and follows them every year. Um, but it's still ongoing. So we actually only have data from the first five years of the study that we've published on. Um, so these studies are really focused on early adolescence. Um, so really like 10 to 14. And I do think that this is a really important period, um, you know, because we do know that the use of this is often the time period when children get access to their first phones or devices.

Dr. Jason Nagata: (08:16)

Um, we also do know that the minimum age requirements for social media are 13 years. So around that time is when a lot of people start getting their social media accounts. Although we also know there are many youth who, even younger than that, have accounts. Um, but I do think that this early adolescent period, um, that we're studying is so important because, um, yeah, of all those factors and also just with nor normal growth and development, you know, people are starting puberty, there's a little bit more sensitivity to their peers, to their own body image. Um, and so it's a really important time when, you know, there's a lot of growth and development, but there's a lot of risks related to, you know, body image and mental health.

Hillary Wilkinson: (08:53)

Yeah, yeah. What, what was it that drove you to focus on this developmental stage specifically? 

Dr. Jason Nagata: (09:01)

Uh, yeah, I do think that it's because this is the time period when people usually get their first devices when they're usually starting their own social media accounts. Um, so it's really, um, important I think to try to guide adolescents and their parents when they first start, because we also know that oftentimes the be the screen habits behaviors that, um, you know, people start off with are the ones that persist into adulthood.

Hillary Wilkinson: (09:25)

Mm-Hmm, . Okay. When we come back, we're gonna talk about tweens, screen use and healthy, helpful habits. 

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Hillary Wilkinson: (09:42)

I'm speaking with Dr. Jason Nagata. He researches the health consequences of adolescent technology and digital media use, including eating disorders, cardiovascular disease risk and sleep disturbance. He's the recipient of the American Academy of Pediatrics, Emerging Leader in Adolescent Health Award. And today is teasing apart some of the details in a recent article in the Journal of  Pediatric Research published by Nature. So let's talk about how media parenting practices influence problematic adolescent screen use. So kind of a lot of words there, but I, so I feel like first we know what, oh, I feel like we all know what problematic adolescent screen use looks like, but because I kind of strive for clarity and I don't wanna make assumptions, can you define, based upon what your re what, you know, what you wrote, can you define problematic screen use in adolescence?

Dr. Jason Nagata: (11:04)

Yes, actually that's a really great question and one that actually isn't so clear. I will say that, um, you know, there's not a formal definition for social media or screen addiction, you know, in the medical community. Um, and so, um, it is actually something that is a source of a lot of debate and discussion right now because social media and phones are relatively new. We don't have these really well established diagnoses like we do, um, perhaps for like, um, you know, substance use disorders. But I do think that there are some, um, parallels. Um, I will say that, um, there actually is a formal diagnosis, um, related to addictive behavior for gambling disorder and gaming disorder. Um, each of these, um, have internet as a sort of specifier as a diagnosis, but this doesn't exactly capture problematic screen use. Um, so I will say that in general, um, when I think of screen use, that becomes a problem.

Dr. Jason Nagata: (12:02)

I think of, you know, an inability to stop, uh, maybe use that, um, leads to neglect of other important life areas. So if it starts to impair schoolwork or homework or, um, you know, just daily functioning, um, and if there's sort of symptoms of withdrawal, kind of like there could be for other substance uses. Um, and specifically for our study, um, there were actually six questions that we used to assess problematic social media use. Um, so one was that, um, kids spend a lot of time thinking about social media apps or planning their use, um, if they feel they need to use social media apps more and more, um, if they are using it to forget about other other problems, um, if they try to use it less but aren't able to stop if it leads to additional stress or being upset, um, if they can't use their apps. Um, and if it's starting to have a bad effect on their school, work, or job. So there were sort of six questions that assessed different aspects of, um, problematic social media use. And those were for social media, but we also had similar parallel questions for video games and for mobile phones.

Hillary Wilkinson: (13:10)

Okay. I really appreciate you listing those out. 'cause I feel like those could also serve as maybe, I don't know, kind of a pick list for parents if they're, if they've got some red flags going, you know, yes. They can go back and look at that and go, okay, where are we at with that? So, um, one, one of the things that I liked about the article is that you really took a deep dive into parent, parent media use. And did you find specific, um, or not even specific, but did you find areas or places of parent screen use that had sort of long lasting implications on the overall health and wellness of adolescents?

Dr. Jason Nagata: (13:52)

Um, yeah, I do think that one of the biggest findings from this study was that one of the biggest predictors of these pre-teen screen use was their own parents screen use. Mm-Hmm. . So I do think it's a really important message that parents should act as role models for their adolescents and really practice what they preach. Um, and so one of the recommendations of the American a Academy of Pediatrics is to have a family media use plan, which involves having regular discussions with the whole family, you know, all the children and parents, uh, everyone in the household about certain rules, um, that you might abide by for your household. And I think one of the pillars of this family media use plan is that it's not just a plan for the kids, it's also a plan for the adults. And so adults really need to follow suit as well.

Hillary Wilkinson: (14:37)

Yeah, we, um, actually have a free downloadable resource on our website called the Family Tech Plan, which also is, it's a five part plan. It serves as a conversational springboard that families can use to kind of develop their own family philosophy around tech. The thing I really like about the American Academy of Pediatrics, um, tech plan, I'm using our phrase, but I think they call it a media use plan, I'm not sure. Yeah. But yeah, is that, uh, you can go in and customize per individual with, uh, with ours it's more, it's kind of a broader stroke. It's a broader brush stroke. But if you really, uh, you know, I feel like every, every family's gonna know their own needs. And if you are just starting out, maybe you can use those broad brush strokes. If you're somebody who's like, oh, we really need to get a handle and dial down in on this, and maybe I have three or four kids in my family ranging from ages, from single digits all the way through later teen use, it's gonna have a lot of different needs. So I really like that about the American Academy of Pediatrics one.

Dr. Jason Nagata: (15:53)

Yeah, I think that's right. I, I, I appreciate, um, the different types of tech use or media use plans, and I do think that you focused on a key area, which is that you really have to consider your child's developmental stage. The rules that you would have for a five-year-old are very different than the rules you might have for an 18-year-old. I think it's more appropriate to have more supervision, more restrictions for younger kids, but you know, ultimately as kids transition to adulthood, they're gonna be making these own decisions for themselves. And so you do want to allow them a little bit more autonomy such that, you know, when they go off to college or living on their own, they're able to have these tools to make, you know, their own informed decisions. Um, and not just, you know, the moment they turn 18 or go off to college, you know, rebel from everything that you've provided. So I do think that, um, yeah, developmentally appropriate kind of use plan is a good one.

Hillary Wilkinson: (16:48)

Yeah. Yeah. So in reading your article, I thought the,  I was of particular interest in the findings on parental use of screens to control behavior and how, you know, that is like using screens either as reward or punishment. And can you talk a little bit about that? Because I thought I found this very interesting. We, we generally, it, it validated what our recommendations is, and we, our recommendation is to neither use screens as the, the carrot or the stick, you know, but please. Please elaborate .

Dr. Jason Nagata: (17:25)

Yeah, I did think that this was a surprising finding because, um, it, you know, I, I do think that a lot of parents do use screens as a reward or punishment. Um, and again, I will say that these folk, these results are really focused on the preteens. So kind of 11, 12, 13-year-old age group. Again, when, you know, early adolescents are becoming more independent, they're trying to have a little bit more autonomy. They're actually, in many ways trying to break free of their parents. Um, and so I do think it is this kind of interesting period where, yeah, we did find that especially, um, using screens as a form of punishment to like taking away screen use, um, as a punishment did seem to backfire a little bit. And it actually resulted in, um, greater overall screen use and greater problematic screen use among these preteens.

Dr. Jason Nagata: (18:15)

Um, and I do think that one thing that is important to note in this media use plan is it is important to really get buy-in from everyone if possible. Um, because, um, you know, teenagers are very tech savvy and in many cases more tech savvy than parents are. And so even if you do try to implement certain rules, um, especially the older teens, I think are oftentimes able to, um, you know, bypass parent monitoring or reg, you know, any kind of apps that you might have or are just able to access some of these devices. So I do think that, um, in some ways, getting their buy-in is really the best 'cause then if they can reflect and like, oh yeah, you know, I don't, I also personally don't want to be using my device, you know, after midnight or, you know, whatever rules may be, um, rather than them trying to find ways to sort of game the system and, um, and like, you know, surreptitiously or, or sneak past some of these rules.

Hillary Wilkinson: (19:11)

It was my understanding that what your findings were was that this, um, this use of of screens as reward or punishment actually led to greater amounts of time online for the kids. Am I, yes. Was I correct in interpreting that? Yeah.

Dr. Jason Nagata: (19:33)

Okay. Uh, specifically, um, with video game use, like trying to take away video game use as a reward or punishment led to higher video game use, ultimately.

Hillary Wilkinson: (19:42)

Oh, that's very interesting. So I am just kind of wondering, you know, lots of times when we're doing screen, uh, you know, Screen Ed type presentations, we will use a comparison with technology being as ubiquitous in our children's lives today as food. And knowing that you're the eating disorder guy, do you see a similarity? Do you recommend similar types of management for, 'cause what, what it sounds like to me is you restrict the, say the video game. So then to me it sounds almost like binging behavior, you know, do you see that similarity or am I just going?

Dr. Jason Nagata: (20:34)

Yeah. Um, very, there are lots of similarities, I think, um, I think the first similarity that you noted is that, yeah, to some extent tech, digital media is here and here to stay and is not gonna go away. So to some extent, um, for our children and ourselves to really be functioning members of society, we need to have some amount of digital literacy. We need to know how to use computers and phones. And it, they're kind of essential for communication, for homework, for regular work. And so it's not like we can completely eliminate them, you know, in most cases. And so I do think that people are going to have to figure out a balance in which, you know, they're really trying to maximize the benefits of screen use, like for communication for, you know, work and, um, you know, and ideally socialization. Um, but really try to mitigate the risks related to poor sleep or physical inactivity or body image issues or, uh, more isolation or more addiction.

Dr. Jason Nagata: (21:37)

Um, and so it is a, you know, to some extent, just like with nutrition, you aren't, you can't just not eat. You have to have some amount of food, but you're really trying to maybe optimize the healthy foods and avoid some of the less healthy foods. Um, I, I do think there are parallels with that. Um, but kind of on a different level of comparison, um, I do think that there are really interesting, um, parallels between say, screen addictions or overuse and just as you said, binge eating. And actually our main National Institutes of Health grant really looks at, um, linkages between social media and binge eating. So just like you, you know, now I think it's a pretty common phrase to say, I'm binge watching Netflix. You know, and I think it's much easier to do that with streaming services or YouTube where, you know, with traditional television, if you had your favorite television programming, it would be on, on Saturday night at 8:00 PM and you had to wait another week to watch the next episode.

Dr. Jason Nagata: (22:34)

Um, so there was already a built-in kind of mechanism that spaced out. So, you know, you couldn't just watch the same show for 10 hours straight. But now on Netflix, on YouTube, you have the ability to just watch, you know, some you to really binge watch. And, um, we have actually found some really interesting links between binge watching and binge eating. Um, and we do know that, um, people are more likely adults and children are more likely to actually overeat while they're distracted in front of screens. Um, they're also more likely to eat in the absence of hunger. So even if you're, your hunger cues are saying that you're full, if you're kind of distracted watching your favorite program, you might just keep on eating 'cause you're not really paying attention to those hunger cues. Um, and then of course there may be food advertisements that you're exposed to.

Dr. Jason Nagata: (23:23)

Um, and so, uh, yeah, there are kind of really interesting links I think, between the binging behaviors, whether it's binge watching and binge eating. Um, and uh, on the other hand, um, that's sort of on the overeating front and we actually have done studies in the ABCD study linking, um, unfortunately yeah, more social media and, uh, streaming, uh, to more higher risk of binge eating disorder for early adolescents. Um, and also, uh, linkages with basically more screen time and less nutritious foods. So you're more likely to eat junk foods, um, or sodas or sugar sweetened beverages. Um, and, you know, potentially due to the food advertising and some of those mechanisms. Um, but on the other hand, there's a lot of, um, weight loss/eating disorder content on social media that also leads to different types of pressures. Um, so for some teenagers to really be very conscious all about their bodies, even though we know teens are already, you know, more self-conscious as they're going through growth and development.

Dr. Jason Nagata: (24:29)

Um, and so, um, having constant comparisons to sort of unattainable body ideals, um, can also lead to people feeling worse about their bodies than engaging in disordered eating behaviors. Um, and sort of going in the opposite spectrum. And so I do think that there's also, um, kind of similarities whereas like with nutrition, there's issues with eating too much in excess. And there's also issues with too eating too little. And that I think, um, you know, I think sometimes with the media sort of with the media diet, there's a lot of people do excess and then people also try to go into these cycles where they're like gonna take a screen break and completely abstain from it for periods of time. Yeah.

Hillary Wilkinson: (25:07)

Do a fast or something. Yes. Yeah. Yeah, I agree. Um, yeah, we'll often use the analogy like when we're speaking with younger kids, we'll talk about like digital candy versus digital broccoli or digital protein, you know, and, and try and get kids to think about content as well. You know, I mean, that's the tricky part of it is it's not all screen time is equal, just like not all food is equal. So it kind of, it's very difficult. So you've, um, like I said, I've listed out all of your publications, your research, et cetera. And I, this is a really big question and I know we've got a little amount of time for it. So I’m just gonna ask you, and if it's too big you can say, uh, but, um, what, what would you say do you see as the biggest digital threat to healthy development for adolescents?

Dr. Jason Nagata: (26:08)

Um, I think that to me, one of the biggest, um, effects of screen use is sort of this displacement hypothesis, which is, you know, if we know in our ABCD study, we know that, um, on average during the pandemic, these preteens were spending eight hours of the recreational screen time, like on screens. Like, so that's not counting, schoolwork or homework. Um, and I think if you're spending that many hours in front of your device, um, even if the content is okay, um, you know, that's still time that you're not being physically active and it's also time that you're not sleeping. And so I think one of the biggest direct threats is really the impact on sleep. We already know that more than a third of teenagers don't get adequate sleep. Um, and I do think that that problem is being exacerbated, um, because devices, particularly use of devices at bedtime can really get kids to sleep later.

Dr. Jason Nagata: (27:03)

And then they get less sleep, they get poorer quality sleep, um, and that, you know, can impact their learning, their mood, um, and just their overall growth and development. Um, so I do think, um, one of the findings of this study was, um, that, you know, more, uh, parent allowance of screen use at bedtime was also related to greater problematic screen use. So I do think that within your tech plan or family media use plan, it might be a good, um, you know, one thing to consider would be to try to really, um, wind down screen use at least an hour before bedtime. And we actually did find that having devices outside of the bedroom entirely was the most effective. But if you have to have the device in the bedroom turning 'em completely off rather than just on silent and vibrate was even more effective. Um, 'cause I think even if they're on silent or vibrate, it's easy to check overnight. And, you know, if kids get messages overnight, then they're activated again and kind of messaging. Yeah,

Hillary Wilkinson: (28:00)

Yeah, yeah. And we, yeah, that actually speaks to, well, we have five core habits, and the, the first, first core habit is to give your phone a bedtime, which means, you know, power down at a certain time, and the fifth core habit is to charge outside of your bedroom. And we, um, yeah, we stand by that firmly. So I feel very validated having one of the lead researchers back us up on that , we have to take a short break, but when we come back, I'm going to ask Dr. Jason Nagata for his healthy screen habit.

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Hillary Wilkinson:

I'm speaking with Dr. Jason Nagata, whose own ongoing mission is to provide guidance for adolescents, parents, and pediatricians for optimizing adolescent screen use. Jason, on every episode of the Healthy Screen Habits Podcast, I ask my guests for a healthy screen habit. And this is going to be a tip or takeaway that listeners can put into practice in their own home. What's yours?

Dr. Jason Nagata: (30:45)

Uh, so we already talked a little bit about screen-free times, including right before bedtime. And I think another really important time to consider as a screen-free time is actually during family mealtime. Um, we've already talked about some of the linkages between screens and nutrition and potential eating disorders. And so I do think that, and this actually was backed up by the same study, we did find that the, um, less parents allowed for screen use at mealtime, um, that was associated with, um, less problematic screen use and less overall screen time. I do think that, um, there are a few benefits of having screen free meals. One, if you wanna really just have conversations and check in with your children, you know, mealtime is the perfect time to have a conversation, check in about the day. And if there are any screen issues that come up, like cyber bullying or body image issues, you know, it might be one of the key times when you actually can have a face-to-face conversation with your children about some of these issues.

Dr. Jason Nagata: (31:43)

Um, I think it also means that you're not likely to be distracted watching TV or, you know, other videos that, as we mentioned, could lead to overeating or undereating. Um, and then I think a sort of indirect benefit is that you actually can observe exactly what your kids are eating. Like if they're, you know, overeating or restricting their food intake, if you're at the meal, you know, at the table with them, then you can really observe that. I will say that with some of our patients with eating disorders, sometimes they eat by themselves in the room in front of a device, and you, you know, they, you have no idea actually what, how much they're eating. Sure. And so I do think that having the family meal together also just gives you a sense of how much your child is eating, what types of foods they're eating. Um, so I do think that there's a lot of benefits to having that for social reasons for, um, you know, nutrition reasons and um, also for just supervision.

Hillary Wilkinson: (32:36)

Yeah. Yeah. I so appreciate the different lenses that you're providing on these different areas. 'cause we typically come at it from one aspect. It's really, I really appreciate you bringing this depth of view on it. As always, you can find a complete transcript of this episode as well as a link to the article I've been referencing by visiting the show notes for this episode. Do this by going to healthy screen habits.org. Click the podcast button and find this episode. Jason, thank you so much for being here today and for having just such a passion for adolescents. That developmental window that gets a lot of shade and is deeply misunderstood and all that you're doing just to keep, keep our kids healthy.

Dr. Jason Nagata: (33:32)

Thank you so much for having me and for, um, really covering this important topic as well.