Supporting healthy media use in school-aged children

About This Grant

ABSTRACT Unhealthy and problematic use of technology and digital media (TDM) in childhood and adolescence have increased in prevalence over the past 20 years, with negative consequences for sleep, physical activity, in- person socializing, emotional health, and family relationships. However, interventional research is a major gap in the literature; no evidence-based approaches exist to support healthy TDM use in children. This proposal is conceptually grounded in the Interactional Theory of Child Problematic Media use, which posits that drivers of unhealthy TDM use include: 1) psychosocial factors such as family stress, 2) parent-child factors such as mood dysregulation, parenting self-efficacy, and maladaptive coping, and 3) technology factors such as engagement-prolonging design. Therefore the proposed randomized controlled trial will test two interventional components: Problem-Solving Education (PSE), an evidence-based cognitive-behavioral strategy that teaches parents problem solving skills as a means of managing parental stress, increasing self-efficacy and adaptive coping, and following through on goals; and TDM Settings assistance to enable parental controls on screen time, content, contacts, and reducing engagement-prolonging designs. These approaches leverage the expertise of the MPIs: Dr. Radesky is co-Medical Director of the American Academy of Pediatrics (AAP) Center of Excellence on Social Media and Youth Mental Health, through which she has created resources and guidance for healthy TDM use in families, while Dr. Kistin is an expert in community-based interventions to support problem-solving, self-efficacy, and positive parenting in stressed families. The application proposes to conduct a type 1 hybrid 2 x 2 randomized controlled trial design in 300 school-aged children (ages 6-10 years) and their parents, a developmental window when many children receive their first gaming console and/or mobile device, but parents still have some degree of control over TDM use. Parent-child dyads (N=300) will be randomized to the following study arms: 1) PSE only; 2) TDM Settings only; 3) PSE+TDM Settings; or 4) Control (AAP resources). Families will be followed for 4 months to assess the following Specific Aims: SA1) Primary outcomes: Test the effects of PSE alone, TDM Settings alone, and combined PSE+TDM Settings versus control on child mood dysregulation (externalizing/internalizing behaviors) and problematic media use symptoms. SA2) Secondary outcomes: Test the effects of PSE alone, TDM Settings alone, and combined PSE+TDM Settings versus control on child daily TDM duration, use of age-inappropriate content, bedtime media use, parent-child communication about media, and parent stress. SA2a) Exploratory outcomes: Measure intervention effects on the frequency of children’s in-person socializing, outdoor play, alternative activities, and positive family routines. SA3) Dissemination and implementation: Using the RE-AIM framework, evaluate intervention reach, adoption, fidelity, and other factors that impact future dissemination and sustainability in pediatric settings.