Excessive screen time behaviors and cognitive difficulties among adolescents in the United States: Results from the 2017 and 2019 national youth risk behavior survey

Abstract

Background:

The widespread use of digital media by young people has generated speculations that their excessive use may have deleterious cognitive effects. Previous studies examining the association between screen time and cognitive deficits in youth have yielded mixed conclusions. We study this association using a nationally representative sample of school going adolescents in the United States.

Methods:

We queried data from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 17,076 adolescents was analyzed using binary logistic regression. Outcome variable was cognitive difficulties (difficulty in concentrating, remembering, or making decisions), and the explanatory variable was excessive screen-time behaviors.

Results:

Of the 17,076 adolescents, about one in three (34.1%) had cognitive difficulties, and 45% of adolescents engaged in excessive screen-time behaviors on an average school day. After adjusting for covariates, the odds were 1.28 times higher for adolescents who engaged in excessive screen-time behaviors to report serious cognitive difficulties compared to adolescents who did not engage in excessive screen-time behaviors (AOR = 1.28, p < .001, 95% CI = 1.18–1.40).

Conclusion:

Study results support the association between excessive screen behaviors and cognitive difficulties in adolescence. Findings of this study are discussed with implications for practice and research.

Dear Editor,

The rapid proliferation of technology in recent decades has ensured that today’s youth are highly immersed in both traditional and newer forms of digital media (Reid Chassiakos et al., 2016). This evolution in the use of digital devices has resulted in a marked increase in the prevalence of excessive screen-time behaviors among children and adolescents in the United States (Twenge et al., 2019).

Yet, the evidence on the impact of screen-time on both the physical and psychological well-being of young people remains inconclusive. Recent research including evidence from systematic reviews and meta-analysis have shown that screen-time in excess of the AAP’s recommended guidelines was not significantly associated with adverse health outcomes among youth (Ferguson et al., 2022).

An important area of pediatric research which has attracted empirical attention is the impact of excessive screen-time on adolescent cognition. Adolescence represents a critical and highly vulnerable transitional period for neurocognitive development. So far, the link between excessive screen-time and cognitive difficulties in adolescence remains controversial. Whereas there is some evidence to suggest that excessive screen-time in young people may be associated with diminished cognitive abilities in domains such as attention and memory (Firth et al., 2020), other literature has discussed how some forms of electronic media, such as video games, may actually improve some areas of cognition among children improve visual-spatial skills, attention, reading abilities, working memory, and problem-solving skills among children (Soares et al., 2021).

To bring new data to this debate, we drew from a national sample of adolescents in the U.S to explore the association between excessive screen-time behaviors and subjective cognitive difficulty. For this study, data from adolescent high school students from the 2017 and 2019 national YRBS were combined into a single dataset. The objectives, methodology, and sampling procedure for the YRBS have been described elsewhere (Underwood et al., 2020).

The outcome variable was subjective cognitive difficulties and was measured as a binary variable based on response to the question, “Because of a physical, mental, or emotional problem, do you have serious difficulty concentrating, remembering, or making decisions?” Response options were “Yes” or “No”. The main explanatory variable was screen-time behaviors and was measured based on the question, “On an average school day, how many hours do you play video or computer games or use a computer for something that is not schoolwork? (Count time spent on things such as Xbox, PlayStation, an iPad or other tablet, a smartphone, texting, YouTube, Instagram, Facebook, or other social media).” Response options for this item included: “none”, “Less than 1 hour per day”, “1 hour per day”, “2 hours per day”, “3 hours per day”, “4 hours per day”, and “5 or more hours per day.” Covariates of interest included age, sex, sexual identity, race, victim of school bullying, victim of cyberbullying, victim of sexual violence, symptoms of depression, and suicidal ideation.

Pearson chi-square test of association was used to examine the bivariate association between serious difficulty concentrating and the study variables. Multivariable logistic regression and linear regression were then employed to examine the association between excessive screen-time behaviors and subjective cognitive difficulty, while simultaneously controlling for covariates and demographic factors. Adjusted odds ratios (AOR) are reported together with their 95% Confidence Intervals (CI). Variables were considered significant if the p-value was less than .05. Stata’s “svyset” command was used to account for the weighting and complexity of the cluster sampling design employed by the YRBS. All analyses were performed using Stata version 15.

A total of 17,076 adolescents (50.2% females) were included in the study. The average number of hours of screen-time behaviors on an average school day was 4.11 (SE = 0.02). In the fully adjusted logistic regression model, adolescents who engaged in excessive screen-time behaviors had 1.28 times higher odds of having subjective cognitive difficulty when compared to their counterparts who did not engage in excessive screen-time behaviors (AOR = 1.28, p < .001, 95% CI = 1.18–1.40). Similarly, controlling for all other factors, each additional increase in the number of hours of screen-time behaviors increased the odds of subjective cognitive difficulties by 1.05 (AOR = 1.05, p < .001, 95% CI = 1.03–1.08).

These findings extend the debate on the impact of screens on adolescent cognition. Using a large nationally representative survey of in-school adolescents, we found evidence that adolescents who reported excessive recreational screen time use (>= 3hrs/daily) had significantly elevated odds of endorsing subjective cognitive concerns. To test the robustness of our findings, we performed linear regression models and observed that, each additional hour spent on screens was associated with a 5% increased odds of reporting subjective cognitive difficulty.

The mechanisms by which recreational screen time can affect cognition in youth is not entirely understood. There is emerging neurobiological evidence indicating that chronic sensory stimulation from screen exposure can induce structural brain changes with potentially negative cognitive consequences in the developing brain (Paulus et al., 2019). Impaired task switching from exposure to nearly constant divided attention related to the use of the Internet offers another potential source.

The high prevalence of excessive recreational screen time and its association with adverse cognition among youth should be a call to action for public health practitioners, educators, parents, clinicians, policymakers, and researchers to explore the real-world implementation and benefits of interventions specifically focused on reducing recreational screen time in youth. Although digital media and technology offer educational and social benefits for teens, these benefits depend on the duration, content, type, and purpose of screen media use. Pediatricians and family physicians can provide resources for families seeking advice on guidelines for adolescent screen media use. In addition, the school environment may also be an ideal setting to foster healthy screen time behaviors among teenagers.

Strengths of this study include the utilization of a nationally representative sample of adolescents which ensures that our findings are statistically powered to detect any differences. Study limitations include the use of self-report measures, cross-sectional data, and potential bias from residual confounding.