Journal: Preventive medicine reports
Previous research on associations between screen time and psychological well-being among children and adolescents has been conflicting, leading some researchers to question the limits on screen time suggested by physician organizations. We examined a large (n = 40,337) national random sample of 2- to 17-year-old children and adolescents in the U.S. in 2016 that included comprehensive measures of screen time (including cell phones, computers, electronic devices, electronic games, and TV) and an array of psychological well-being measures. 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. 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. Moderate use of screens (4 h/day) was also associated with lower psychological well-being. Non-users and low users of screens generally did not differ in well-being. Associations between screen time and lower psychological well-being were larger among adolescents than younger children.
To identify what features of online social networks can increase physical activity, we conducted a 4-arm randomized controlled trial in 2014 in Philadelphia, PA. Students (n = 790, mean age = 25.2) at an university were randomly assigned to one of four conditions composed of either supportive or competitive relationships and either with individual or team incentives for attending exercise classes. The social comparison condition placed participants into 6-person competitive networks with individual incentives. The social support condition placed participants into 6-person teams with team incentives. The combined condition with both supportive and competitive relationships placed participants into 6-person teams, where participants could compare their team’s performance to 5 other teams' performances. The control condition only allowed participants to attend classes with individual incentives. Rewards were based on the total number of classes attended by an individual, or the average number of classes attended by the members of a team. The outcome was the number of classes that participants attended. Data were analyzed using multilevel models in 2014. The mean attendance numbers per week were 35.7, 38.5, 20.3, and 16.8 in the social comparison, the combined, the control, and the social support conditions. Attendance numbers were 90% higher in the social comparison and the combined conditions (mean = 1.9, SE = 0.2) in contrast to the two conditions without comparison (mean = 1.0, SE = 0.2) (p = 0.003). Social comparison was more effective for increasing physical activity than social support and its effects did not depend on individual or team incentives.
Children’s body mass index (BMI) growth trajectories are associated with adult health outcomes, and vary by geography and epoch. Understanding these trajectories could help to identify high risk children and thus support improved health outcomes. In this review, we compare and quantitatively analyse BMI level and trajectory data published since 2010. We characterise recent growth in children aged 4-11 years, an age range most frequently targeted for BMI intervention, yet less studied than young childhood or infancy. Through searches in OVID, we identified 54 relevant texts which describe either post-2000 summary BMI values by age and gender in cohorts with sample sizes of over 1000 children, or the results of latent class analyses of BMI trajectories within the 4-11 year age range. Population level median growth curves were projected and visualised as weighted means. These BMI curves, based on data from 729,692 children, can be visually clustered into ‘high’ and ‘low’ charting groups with extreme outlying values. Within populations, latent class analyses converge on 3-4 individual child trajectories, two of which predispose adult overweight. These growth pathways diverge early in childhood, yet are not effectively distinguished via isolated BMI measurements taken between 4 and 11 years, meaning some high risk children may currently be poorly identified.
There is increasing evidence that gardening provides substantial human health benefits. However, no formal statistical assessment has been conducted to test this assertion. Here, we present the results of a meta-analysis of research examining the effects of gardening, including horticultural therapy, on health. We performed a literature search to collect studies that compared health outcomes in control (before participating in gardening or non-gardeners) and treatment groups (after participating in gardening or gardeners) in January 2016. The mean difference in health outcomes between the two groups was calculated for each study, and then the weighted effect size determined both across all and sets of subgroup studies. Twenty-two case studies (published after 2001) were included in the meta-analysis, which comprised 76 comparisons between control and treatment groups. Most studies came from the United States, followed by Europe, Asia, and the Middle East. Studies reported a wide range of health outcomes, such as reductions in depression, anxiety, and body mass index, as well as increases in life satisfaction, quality of life, and sense of community. Meta-analytic estimates showed a significant positive effect of gardening on the health outcomes both for all and sets of subgroup studies, whilst effect sizes differed among eight subgroups. Although Egger’s test indicated the presence of publication bias, significant positive effects of gardening remained after adjusting for this using trim and fill analysis. This study has provided robust evidence for the positive effects of gardening on health. A regular dose of gardening can improve public health.
Tobacco companies are restricted from engaging in many traditional forms of marketing. Direct marketing is one way tobacco companies can reach consumers while complying with regulation and avoiding negative public perception. There is little research on this type of opt-in marketing, which includes mail marketing, email marketing, web marketing, and mobile marketing, and its impact is not well understood. This study examined 6990 tobacco company emails received by individuals living in the state of Minnesota, US between January 2010 and May 2015 to determine email frequency by brand. These emails were gathered as part of ongoing surveillance of tobacco industry direct marketing. A subset of these emails received between October 2014 and May 2015 (n = 1646) were content analyzed to identify the purpose of the email communication along with type of product promoted. Tobacco companies use email to communicate with consumers on a regular basis. This communication was observed to be as frequent as nine times per month. Emails are most commonly used to promote contests (54.1%), content on tobacco company websites (39.1%), and tobacco coupons (15.7%). Email promotion of menthol-flavored tobacco products was common and was associated with promotion of coupons. Emails promoting menthol had a 1.9 times higher prevalence of also promoting coupons (95% CI: 1.52-2.37). Little is known about tobacco company email marketing and this study fills an identified research gap. A deeper understanding of this type of marketing is needed in order to counter tobacco industry messaging and advance tobacco control.
Several randomized controlled trials have shown a benefit of high-dose intensive statin treatment in reducing risk of death and second cardiovascular disease (CVD) events in patients previously diagnosed with an acute coronary syndrome (ACS). Non-randomized studies in clinical settings support these findings, but large, long-term, observational studies addressing CVD and non-CVD endpoints are lacking. In this retrospective longitudinal study, we followed ACS patients in Sweden during 2001-2012 using national health registry and medical record data. A total of 49,857 patients were identified, of whom 10,092 (20.2%) received high dose statins and 21,174 (42.7%) received no statins. Royston-Parmar parametric time-to-event models were implemented to model hazard for second CVD events and death, stratified by gender and diabetes diagnosis. We found that risk of a second CVD event developed similarly in both treatment groups, but was much higher in the no statin group. Risk of CVD-related death remained relatively constant for the high-statin group, while it increased over time for the no-statin group. Interestingly, males had higher mortality rates in the no-statin group, but not in the high-statin group. All-cause mortality and non-CVD-related death followed similar trends to those observed for CVD-related death. This work provides additional real-world evidence for effect of statins in CVD-related mortality. The hazard functions presented here can provide a basis for future survival modeling and health economic evaluation.
Aspirin therapy has been shown to be an effective prevention measure to reduce the risk of new or recurring cardiovascular events. The aim of this study was to provide an epidemiological analysis of low-dose aspirin use for primary and secondary CVD prevention from 2012 to 2015. Estimates of self-reported low-dose aspirin use for primary and secondary CVD prevention were obtained from the National Health Interview Survey for the years 2012-2015. Temporal changes in the prevalence of aspirin use for primary and secondary CVD prevention were assessed using logistic regression. During 2012-2015, 23.3% of respondents self-reported as taking aspirin for primary CVD prevention, decreasing from 23.7% in 2012 to 21.8% in 2015. Also during this period, 8.4% self-reported as taking aspirin for secondary CVD prevention, decreasing from 8.9% in 2012 to 8.2% in 2015. Overall, the prevalence of aspirin use for CVD prevention declined from 32.6% in 2012 to 30.0% in 2015. This study shows that over 30% of the adult population self-reports as taking low-dose aspirin for primary or secondary CVD prevention. Despite the decline in this prevalence over the previous four years, aspirin therapy remains a highly-utilized means of preventing CVD.
Fragranced consumer products-such as air fresheners, cleaning supplies, and personal care products- pervade society. This study investigated the occurrence and types of adverse effects associated with exposure to fragranced products in Australia, and opportunities for prevention. Data were collected in June 2016 using an on-line survey with a representative national sample (n = 1098). Overall, 33% of Australians report health problems, such as migraine headaches and asthma attacks, when exposed to fragranced products. Of these health effects, more than half (17.1%) could be considered disabling under the Australian Disability Discrimination Act. Additionally, 7.7% of Australians have lost workdays or a job due to illness from fragranced product exposure in the workplace, 16.4% reported health problems when exposed to air fresheners or deodorizers, 15.3% from being in a room after it was cleaned with scented products, and 16.7% would enter but then leave a business as quickly as possible due to fragranced products. About twice as many respondents would prefer that workplaces, health care facilities and professionals, hotels, and airplanes were fragrance-free rather than fragranced. While 73.7% were not aware that fragranced products, even ones called green and organic, emitted hazardous air pollutants, 56.3% would not continue to use a product if they knew it did. This is the first study in Australia to assess the extent of adverse effects associated with exposure to common fragranced products. It provides compelling evidence for the importance and value of reducing fragranced product exposure in order to reduce and prevent adverse health effects and costs.
This study examines Americans' preferences regarding smart guns. The study builds on prior research by including previously unexamined factors, specifically victimization and comfort sharing gun ownership status with a doctor. Further, this study examines differences in preference patterns among gun owners and non-owners. Data were obtained from a nationwide online survey with 524 respondents in February 2016. The study finds that, among non-owners, older respondents and those with pro-gun attitudes are less likely to prefer smart guns to traditional firearms. Among gun owners, those with moderate political views, those with a history of victimization, and those residing in the Northeast are all more likely to prefer smart guns. Males and those with pro-gun attitudes are less likely to prefer smart guns. Education, income, race, marital status, presence of children in the home, and comfort discussing gun ownership with a doctor had no significant association with smart gun preference. Practical implications of these findings are discussed.
The purpose of this study is to investigate how the use of flavored e-cigarettes varies between youth (12-17 years old), young adults (18-29 years old), and older adults (30 + years old). Cross-sectional surveys of school-going youth (n = 3907) and young adult college students (n = 5482) in Texas, and young adults and older adults (n = 6051) nationwide were administered in 2014-2015. Proportions and 95% confidence intervals were used to describe the percentage of e-cigarette use at initiation and in the past 30 days that was flavored, among current e-cigarette users. Chi-square tests were applied to examine differences by combustible tobacco product use and demographic factors. Most e-cigarette users said their first and “usual” e-cigarettes were flavored. At initiation, the majority of Texas school-going youth (98%), Texas young adult college students (95%), and young adults (71.2%) nationwide said their first e-cigarettes were flavored to taste like something other than tobacco, compared to 44.1% of older adults nationwide. Fruit and candy flavors predominated for all groups; and, for youth, flavors were an especially salient reason to use e-cigarettes. Among adults, the use of tobacco flavor at initiation was common among dual users (e-cigarettes + combustible tobacco), while other flavors were more common among former cigarette smokers (P = 0.03). Restricting the range of e-cigarette flavors (e.g., eliminating sweet flavors, like fruit and candy) may benefit youth and young adult prevention efforts. However, it is unclear what impact this change would have on adult smoking cessation.