The Effects of Screen Time on Health

Extract of an article by Dr. Gadi Lissak, Behavioral Medicine Psychologist & Biofeedback Specialist, on the
effects of screen time on the health of infants, children and adolescents.

Introduction

The variety of devices enabling media consumption is constantly increasing, and there is constant
improvement in their technological capabilities. This advancement allows for a large number of stimuli
to be compressed into the user experience, and at an accelerated pace. The growth in the number of
websites and social networks has also attracted children and adolescents to spend more time on a
device or computer screen. As a result, there has been a steady increase in screen time for children and
youth in many western countries, of an average of about seven hours a day. Many studies in recent
years have found a correlation between prolonged multimedia exposure and health problems among
children. While there is significant public awareness about the possible effect of mobile phones
radiation, the public is less aware of the other effects of screen time on health which can include harm to
the endocrinal, cardio-vascular and neurological systems, as well as lead to difficulties with vision and
posture.

Effects on the Endocrine System

Melatonin Hormone

Studies of children have found that prolonged exposure to screens- even passive viewing- causes sleep
disorders, and thereby affect levels of the melatonin hormone, which regulates sleep and plays an
important role in strengthening the immune system. Sleep deprivation thus damages the immune
system and may be considered an indirect cause creating risk of cancer and other illnesses.

Cortisol Hormone and the Effects of Screen Time on Functioning Under Stress
The cortisol hormone helps the body function under stressful situations by increasing blood sugar levels
and reducing the response of the immune system. Studies have shown that children using
computers/devices at an average of three hours a day possessed lower cortisol levels, which can
gradually damage to the body's ability to cope with stressful situations. Studies also found that children
who did not use computers/devices at all, or for less than an hour a day, possessed a higher level of
cortisol.

Insulin Hormone

The insulin hormone plays a vital role in the metabolism and control of energy storage in the body.
Dysfunction in the secretion of insulin can damage the body's ability to absorb glucose to produce
energy. In a 2010 study of 496 sixteen year olds, those teens who spent over two hours a daily using
computers/devices possessed higher insulin levels than those spending less time, and the higher insulin
levels put them at greater risk of diabetes, to atherosclerosis, and to metabolic disorder and obesity,
both which contribute to the formation of heart disease.

The Impact of Screen Time on Obesity and on the Cardio-Vascular System

Studies have found that among children and adolescents, screen time is linked to obesity due to
unhealthy eating habits such as snacking while watching TV, or viewing TV during dinner time. Like
television, video games may also contribute to obesity since they increase food consumption by
adolescents immediately after a game irrespective of actual sense of hunger.

Various studies have found that sitting during video games is linked to an increase in blood pressure, to
irregular cholesterol levels, and to the narrowing of the arteries reaching the eyes, a phenomenon
known as an indicator of future risk of heart disease. The research has also found that children
participating in physical activities possessed wider arteries reaching the eyes, reducing the risk of heart
disease.

Other studies of pre-pubescent children found a high correlation between computers/devices time and
high blood pressure (systolic and diastolic). In contrast, activities such as drawing were not found to
effect changes in blood pressure.
Risk of cardiovascular disorders such as hypertension and stroke are created by the existence of
extended physical arousal (sympathetic). A 2010 study in Finland of 478 children aged 10-14 examined
the effects of exposure to information and communication technology (ICT) on the balance between the
sympathetic and the parasympathetic nervous systems during sleep. The study found that larger
consumption of information and communication technology through multimedia (mobile phones,
computer games, web browsing, email, chat rooms) increased physical arousal during sleep, which may
harm the quality of sleep.

Neurological Effects

The development of screen media is based on the rapid presentation of material on the screen ("screen
novelty"). This phenomenon is most evident in computer games content and in TV program content for
children, and it is a major factor in media consumption. "Screen novelty" affects dopamine, an important
neurotransmitter influencing arousal, attention ability, and response to new stimuli. Dopamine is also
considered a key element in the creation and maintenance of addiction. One study found an increased
and faster release of dopamine in young adults (over 18) during video games. In light of this finding,
there is an increasing concern that intensive computer games use may cause long-term changes in the
brain to the point of addiction to the production of dopamine, essentially simulating a situation of
substance dependence.

Although interactive computer games are thought to trigger more stimulants than watching TV or a DVD
movie, the study found that computer games actually generate limited neurological activity. In 2011 The
World Federation of Neurology reported about a Japanese study mapping the brains of children playing
computer games, and of children solving repetitive and simple math exercises. The children playing
computer games presented brain activity in only one the cerebral lobe associated with vision and
movement. However, the children performing the math equations presented brain activity in both
frontal lobes related to learning, memory and emotions affecting social behavior. With this in mind, the
message from the study is that computer games may delay the development of the frontal lobes and the
development of the ability to control social behavior. In light of this study, the World Federation of
Neurology recommends reducing the use of computer games, and the encouragement of children to
play outside with children and to interact socially with others as much as possible. An additional
conclusion that can be deduced is that there is an advantage to computer games requiring a
combination of two players together in the same location, and to computer games that require deeper
thinking.

Vision
Sitting for hours in front of a screen causes eye fatigue and impairment in visual acuity, focus, ability to
concentrate, and may cause headaches and neck and shoulder pain. Symptoms appearing after
prolonged periods in front of screens are dryness and myopia. Adapting one's work environment,
wearing glasses, adjusting appropriate lighting, along with scheduled breaks from the computer, will
maintain one's health and enhance one's ability for comfortable viewing.

Posture

Sitting for long hours, especially in front of touch devices, may adversely affect posture, causing neck and
shoulder pain, pain in the hands, and lead to the development of early scoliosis. Extensive use of touch
devices, keyboards and mice that are not adjusted properly can cause strain and lead to pain and
inflammation in the arms and hands and wrists.

Summary and Conclusions

Today consensus in developed countries exists that there is an increase in risk factors as screen time
exceeds two hours per day, and even less for younger ages. Reduction in screen time can lead to
significant improvements in children's health and development. There is no need to fear that the lack of
young children's exposure to screen technologies put them at a developmental and educational
disadvantage; they can easily and gradually acquire computer skills in a more safe fashion as they age.

Parental rules and restrictions on screen time, and the removal of computers/devices from the bedroom,
effectively reduce children's screens viewing time. Additionally, a negative dose-response relationship
was found between weekly physical activity and the risk of exceeding recommended screen time limits.
Parental modeling is another important component, and children living in homes with parents/siblings
consuming much media will increase likely do the same.

Children should be encouraged to engage in alternative activities such as sports or creative activities
(e.g., problem solving games, logic games) to develop additional skills. Parents' playing with children is
highly recommended, as is reading books to them.
The present reality in Israel is such that parents and authorities in the health and education sectors are
simply unaware of the health hazards of screen time, and it imperative to educate them first about the
risks. The Ministry of Health has issued vague recommendations as general guidelines for reducing
screen time.

A 2013 position paper of the Association of Dietitians and Nutritionists in Israel recommends limiting
screen time and avoiding eating while viewing screens. The paper emphasizes the correlation between
screen time and high intake of high-calorie foods, and recommends avoiding eating in front of screens,
since this leads to eating foods of poor nutritional quality such as snacks and sweets. Another negative
aspect of sitting in front of screens is their advertisements that encourage consumption of snacks and
sweets. The paper made reference to studies showing a correlation between reduced screen time and
reduced energy consumption, and thereby lower obesity.

Recommendations for Parents to Prevent Injuries to Health, and Instructions for the Safe Use of Media

Encourage parents to monitor and control the time their children spend in front of screens.

Raise parents' awareness that their viewing habits are a source of emulation and may affect their
children's habits; backgrounds of passive media also can influence health.

Encourage parents to develop a comprehensive user plan for all types of media at home, including
content type and time management.

Reduce as much as possible the use of media devices during meals, an hour before sleep, and during
sleep.

Establish frequent breaks when using devices.

Suggested daily total viewing time for all screens:

Ages 0-2: Refrain from any viewing. No studies demonstrate benefits of watching TV or videos at
this age; many studies stress the importance of human contact with infants.

Ages 3-7: 0.5-1 hours a day

Age 7-12: 1 hour a day

Age 12-15: 1.5 hours a day

Age 16+: 2 hours a day

Situate the home computer in a central room accessible to all members of the family; refrain from
allowing the use of any Internet-connected device in bedrooms, both to monitor content and time use,
and to prevent sleep disorder.

For young children, select media that possess a slow change rate of screen content, such as storytelling
and children's performance programs, arts and crafts activities, games that require thinking and logic,
and relatively older movies which possess fewer stimuli as new ones.

Be sure to ergonomically structure the computer/device workspace environment (e.g., adjust the height
of chair, table, screen, etc.)

Create a "device free" space in your home, such as in the kitchen or at the dinner table.

Refrain depending on multimedia as a babysitter.

Encourage sports and cultural activities that are not computer/device based.

Recommendations to Reduce Damage to the Eyes

Reduce screen brightness

Take scheduled breaks

Use proper lighting

Wear glasses as needed

Though research is not fully conclusive, there exist concerns about the harm of radiation emitted by
electronics and wireless communications devices. It is wise to take precautions by initiating breaks, by
minimizing use of cellphone/WiFi devices close to the body, by distancing WiFi modems from users, and
by sufficiently ventilating the room in which a WiFi device is situated.

General Recommendations
Raise the awareness of the health and education systems about the effects of screen time on health.

Encourage government officials to launch an informational campaign about effects of screen time on
health, similar to those launched to fight road accidents and protect endangered wildflowers. The
campaign may include broadcasts summarizing the dangers prolonged exposure to screens, basic
guidelines for safe media use, and how to obtain more information.

At medical visits doctors and nurses should routinely inquire about patients' screen use habits to when
assessing the overall health of their patients, in particular children prone to obesity or ADHD.

SCREEN AND THE STRESS RESPONSE

Screens are a form of environmental stress

Source: YL Photographies/Fotolia

I just returned from an inspirational week-long conference on the science and application of integrative
medicine. Highly informative, the theme heard again and again was that mitigating stress through a
combined approach of mind-body work, proper sleep, exercise, reducing toxin load, and eating a
nutritious diet was highly effective in combating illness — and had a much greater impact on prognosis
than traditional western medical treatments — whether that “illness” be mental or physical.

What I didn’t hear much of (or at least not enough of) was the impact of screen time on stress and
illness severity, particularly in regards to mental disorders, which are highly sensitive to stressors of any
kind. A primary goal of the integrative medicine approach is to take the body out of fight-or-flight mode
and into healing mode as much as possible. How can we ignore the impact of screens, which assault us
daily? Screen time has a lot of negative health effects, but this post will focus on studies that link screen
time to stress markers.

Study Findings on Electronic Screen Media Associated With Physiological Stress Markers

1. Computer game playing assessed as valid psychological stressor to induce physiological effects of
stress, including changes in autonomic tone (heart rate and blood pressure), EMG (muscular activity),
Galvanic Skin Response (skin conductivity), and cortisol levels (Sharma et al., 2006).
2. Computerized games can impair blood sugar control and delay digestion (Blair et al., 1991).

3. Attention can be impaired via the stress hormones norepinephrine and cortisol following psychological
stress (video game used as stressor) (Skosnik et al., 2000).

4. Screen time is associated with narrowed vasculature of the retina (narrowed vessels at the back of the
eye, a cardiovascular risk) in children, while time spent outdoors is associated with healthy retinal
vasculature (Gopinpath et al., 2011).

5. Screen time is associated with metabolic syndrome (high blood pressure, blood sugar dysregulation,
high lipids, obesity) in adolescents independent of physical inactivity (Kang et al., 2010).

6. Video game playing is associated with increased food intake in adolescents (Chaput et al., 2011).

7. Exposure to EMFs (electromagnetic fields) from cell towers is associated with perceptual speed
increase and accuracy decrease (consistent with a fight-or-flight response), as well as sleep problems
(Hutter et al., 2006).

8. Cell phone use and texting is associated with faster, but less accurate, cognitive responses in teens
(Abramson et al., 2009).

Hopefully these studies provide some food for thought. Advising parents to severely limit screen time is
often met with resistance, and part of that resistance, I believe, is due to an under-appreciation of screen
time’s potent effects on the stress response. Looking at evidence clearly linking screens to stress markers
can help fill that gap and push all of us to remember that strict limitation of screen time should be an
essential component of an integrative approach to mental wellness.

act

Despite the positive impact of information and communication technology (ICT) on an individual,
organizational, and societal level (e.g., increased access to information, as well as enhanced performance
and productivity), both scientific research and anecdotal evidence indicate that human-machine
interaction, both in a private and organizational context, may lead to notable stress perceptions in users.
This type of stress is referred to as technostress. A review of the literature shows that most studies used
questionnaires to investigate the nature, antecedents, and consequences of technostress. Despite the
value of the vast amount of questionnaire-based technostress research, we draw upon a different
conceptual perspective, namely neurobiology. Specifically, we report on a laboratory experiment in
which we investigated the effects of system breakdown on changes in users’ levels of cortisol, which is a
major stress hormone in humans. The results of our study show that cortisol levels increase significantly
as a consequence of system breakdown in a human-computer interaction task. In demonstrating this
effect, our study has major implications for ICT research, development, management, and health policy.
We confirm the value of a category of research heretofore largely neglected in ICT-related disciplines
(particularly in business and information systems engineering, BISE, as well as information systems
research, ISR), and argue that future research investigating human-machine interactions should consider
the neurobiological perspective as a valuable complement to traditional concepts.

Discover the world's research

Have you ever heard the term, “wired and tired?”

Even if you’re not familiar with the phrase, odds are you’ve experienced it. The dry, weary eyes after
staring at your desktop for too long. The brain melt that comes after watching too much television. The
head and neck aches and even the nausea that comes after too much computer use.

Yes, most of us know the physical and mental fatigue all too well that comes from using our computers,
TVs, tablets and phones for hours on end. According to a report by The Vision Council, more than 90% of
American adults spend two or more hours per day in front of some sort of screen, nearly 60% spend five
or more hours, and 30% said they look at screens more than nine hours per day.

It’s understandable — digital devices have become a critical part of our productivity and quality of life.
But what is this really costing us?

Electronic screens aren’t just leaving us wired and tired, they’re affecting our health in a very real and
very damaging way. Here’s how.

BLUE LIGHT

Most digital screens are backlit and emit blue light, or high-energy visible (HEV) light wavelengths.
Research has shown that overexposure to this light can contribute to eyestrain and discomfort, and even
lead to more serious conditions later on such as macular degeneration.
Blue light has also been shown to suppress melatonin — the sleep hormone — desynchronizing the body
clock and causing an artificial feeling of wakefulness. And this can lead to a number of other
complications, such as hormone imbalance, depression, and even brain inflammation.

THE CORTISOL HORMONE

The cortisol hormone helps the body manage stressful situations by increasing blood sugar levels and
reducing the response of the immune system. But research has shown that prolonged use of electronic
devices can overstimulate your cortisol production — which can have notable effects on the brain. Excess
cortisol levels can not only weaken your ability to control stress, but can actually cause your brain to
shrink, which compromises your ability to concentrate, make decisions, sound judgments and interact
socially.

PROBLEMS FOR CHILDREN

Many children are hooked on television and electronics. In fact, most American children spend about 3
hours a day watching TV. And when you factor in computers, tablets and gaming devices, that number
climbs to about 5 to 7 hours a day.

Because children are much more sensitive and malleable than many realize, it doesn’t take much
electronic stimulation to take its toll on their still-developing minds and bodies. And the ever-increasing
screen time has been shown to lead to sleep, mood, and cognitive issues including:

Sensory overload

Lack of restorative sleep

Hyper-aroused nervous system

Depressive states

Reduced physical activity levels

Fractured attention span

Depleted mental reserves

Desensitized brain reward system

Stunted emotional development

INSULIN LEVELS

In a study of nearly 500 sixteen year olds, those who spent more than two hours a day using computers
and other digital devices had higher insulin levels than those who spent less time in front of the screen.

Insulin plays a critical role in your metabolism and your blood sugar levels. When insulin becomes too
high for too long, the cells of your body start to ignore it, and your body becomes less and less effective
at absorbing glucose and producing energy. This means that most of what you eat will be converted into
fat, and your body begins to accumulate more of that fat in your liver. Other signs and symptoms of
chronically elevated insulin include abdominal obesity, elevated blood sugar, acne, hair loss and high
blood pressure.

Before you continue to read this, take a moment to observe those around you (if you happen to be in a
public space). Chances are, you see at least one person engrossed in his or her phone. Likely, it’s more
than just one person. And while most studies about screen time are focused upon its affect on children
and their development, it’s important to note that screen time can have negative effects in adults as
well.

There is no denying that an individual’s screen time has increased exponentially in the past decade. In
fact, a 2014 Nielsen report found that adults log a total of about 11 hours of screen time a day. Below
are various ways your health may be negatively affected by spending too much time tied to a screen.

More screen time = more weight

As little as two hours of TV a day can increase the risk of weight gain, diabetes, and heart disease in
adults. There are likely several factors to blame, including a sedentary lifestyle, less sleep, and generally
bad eating habits when engrossed into a screen.
Vision issues

Looking at a screen for extended periods of time can cause “computer vision syndrome.” The symptoms:
strained, dry eyes, blurred vision, and headaches.

Chronic neck and back pain

Poor posture when using screens combined with can cause chronic neck, shoulder, and back pain.

Poor sleep

Studies link heavy computer and smartphone use to increased sleeping issues. The blue light from
digital devices suppresses the sleep-promoting hormone melatonin, keeping us from having restful
sleep.

Impaired cognitive function

Cognitive imaging studies have found that spending too much screen time will lead less efficient
information processing.

You’re likely to die earlier

Studies have indicated that spending significant time with screens — whether it’s a TV, computer or
tablet, lowers your cardiovascular health and increases your mortality risk.

When I was a kid, the only warning we had been given about technology and our health focused on
televisions: "too much TV will make your eyes go square." But these days, as all kinds of screen-based
devices — tablets, iPods, laptops, mobile phones — are common in our everyday lives, scientists have
been focused on figuring out what screen time does to the body and brain. And even if you steer clear of
the hysteria and tabloid reporting on the issue, a lot of the facts don't look particularly good.

Most of the research on screen time focuses on kids, because, after all, that's where the biggest
difference in lifestyle is. Adults may stare at computers all day as a simple matter of course — you'd be
hard-pressed to find a standard 9-to-5 that doesn't involve a screen — but children are supposed to be
gleefully climbing trees, throwing apples at Nancy-Lou and engaging in other traditional manifestations
of childhood, not staring at a smartphone for hours on end. Being concerned about whether children are
spending too much time around screens is not exactly a new worry, but it's a field where some
interesting new conclusions have been found recently. But what about adults in dorm rooms and
bedrooms, scrolling Tumblr or texting until late at night? Are screens really causing prolonged physical
effects on them, too?

The answer, appears to be "yes, under certain circumstances." We all know about how excess device use
impacts our sleep — using bright devices before bed can cause poor quality sleep, according to medical
advice — but that appears to be only the beginning of the real effect. Reading on, and learn about five
ways your excessive screen time changes your body.

1. Your Brain Restructures

According to Psychology Today, one of the fundamental consequences that a large amount of screen
time has on adults is a restructuring of the matter that makes up your brain. (The brain consists of grey
matter, the heavy bit that makes up the folds, and white matter, which transmits messages between
neurons.) These results don't apply to everyone — they're all proven consequences of screen addiction,
which is a psychological condition based around severely excessive use of electronic devices — but folks
who aren't addicts but do use their devices heavily may experience some version of the same
restructuring. Too much screen usage seems to result in grey matter shrinkage, problems with white
matter's ability to communicate, a lot more cravings, and general poorer cognitive performance. Not
great news, guys.
2. You're More Vulnerable To Metabolic Syndrome

This particular finding comes from a 2008 study of adolescents, but its thinking still seems to hold true
for folks of other ages. Metabolic syndrome combines diabetes, obesity and high blood pressure; it's a
pretty toxic cocktail of poor health, apparently linked to an abnormally sedentary lifestyle. (You'll notice
a pattern in this; the bodily damage done by screen time often doesn't have much to do with the screen
itself, but rather hinges on the the fact that we sit still while binge-watching.) But the 2008 study found a
a pretty strong link between screen time and metabolic syndrome, even if the kids also did a bunch of
physical activity after the fact — so the effects of sitting still for hours can't be undone with a single brisk
walk.

3. You're More Vulnerable To Eye Strain

Yeah, yeah, my parents were right. My eyes may not have turned square, but it's pretty well-recognised
by the medical community that too much screen time is seriously bad for the peepers. Blue light from
screens isn't just keeping us awake; it may also damage the retina , and eye strain from too much device
use is increasing. A report by CBS had a few recommendations, including the 20-20-20 rule: after 20
minutes of staring at a screen, look at an object at least 20 feet away for 20 seconds. Plus, try to use the
dimmer switch on your devices rather than letting them burn brightly for hours.

4. You May Not Be As Able To Process Emotions As Previous Generations

This is an intriguing one. It's a contentious discovery in children — several places, including HBO and
NPR, have hosted controversial specials about whether screen time really inhibits the emotional
development of kids — but it may impact adults, too. Even if you didn't grow up with an iPad within
reach, lack of frequent face-to-face interaction, in favor of Facebook and other simulated emotional
connections, may actually impact on your ability to process emotion properly. The results for adults
aren't in yet, but it doesn't seem like such a far-flung idea; even late adopters can be seriously damaged
by a technology.

5. You're Likely To Die Earlier

For decades, studies have indicated that spending significant time parked in front of a screen — whether
it's a TV, computer or tablet — lowers cardiovascular health outcomes and increases mortality risk. And
the unfortunate thing about this is that exercising more doesn't seem to do much about it. If you're
trying to offset your days of playing Skyrim on the couch with healthy amounts of exercise each day, it
may not be enough; a 2011 study of 4500 adults showed that lots of screen time raised your likelihood
of death by up to 52 percent, while being a good exerciser only lowered that by about 4 percent. So it's
not just the sedentary lifestyle; it's something about screen viewing itself that causes our bodies to work
less well. If you want to live longer, get fitter, have a healthier heart and be able to talk to your friends
properly, it seems that logging off social media immediately and going for a long, long walk might be
your best option.