Date of Award
Spring 2025
Language
English
Embargo Period
4-29-2025
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
College/School/Department
Department of Epidemiology and Biostatistics
Program
Public Health
First Advisor
Erin Bell
Committee Members
Allison Appleton, Christine Bozlak, Thomas O'Grady, Edwina Yueng, Diane Putnick, Akhgar Ghassabian
Abstract
In the modern digital era, children are increasingly engaging with digital media (i.e., screen time), and the health-related implications of increased screen time are not fully understood. Excessive screen time in early childhood is increasingly recognized as a potential contributing factor to adverse health outcomes, including increased body mass index (BMI) and disrupted sleep patterns. Despite American Academy of Child and Adolescent Psychiatry recommendations for limiting screen time, studies indicate that many children surpass these guidelines, leading to concerns about reduced physical activity and disrupted sleep. Sedentary behaviors associated with screen time have been linked to increased risk of obesity, compounded by exposure to unhealthy food advertising. Insufficient sleep, which is often attributed to screen time, can have detrimental effects on children’s cognitive and physical development and can act through time displacement and biological effects of blue light. However, findings remain mixed regarding the independent and interactive associations between screen time, sleep, and childhood obesity. This dissertation synthesizes findings from three distinct aims using data from the Upstate KIDS cohort to examine the multifaceted relationships between screen time, childhood obesity, and sleep patterns in toddlerhood and middle childhood. In Chapter 2, we investigated the association between screen time during toddlerhood (12-24 months of age) and BMI-for-age percentiles (24-36 months of age) in 1,691 children. Analyses showed that children in the highest screen time tertile exhibited a modest increase in BMI-for-age and 1.5 times higher odds of being overweight or obese compared to those in the lowest screen time tertile. However, these associations were attenuated after adjusting for confounders. Maternal pre-pregnancy BMI, parental age, and child race and ethnicity were strongly associated with BMI-for-age percentiles and increased odds of overweight and obesity, underscoring the influential role of family health and sociodemographic factors. Chapter 3 focused on the relationship between screen time and sleep in middle childhood (7-9 years of age) among 1,296 children. While there was not a significant prospective association between screen exposure in toddlerhood and sleep duration in mid-childhood, cross-sectional analyses indicated that additional screen time in middle childhood was associated with a reduction in sleep duration. Most notably, we observed a substantial 30.6-minute reduction in sleep duration per additional hour of screen time among children with consistently low screen use from toddlerhood through childhood, suggesting that children who are less accustomed to high screen exposure may be more sensitive to its sleep-disrupting effects. In Chapter 4, the investigation is extended to BMI-for-age percentiles in mid-childhood using data from 1,267 children. Although cross-sectional analyses at ages 7-9 years did not show a direct association between screen time and BMI or odds of overweight and obesity, higher screen time in toddlerhood was significantly associated with increased screen use later in childhood and was associated with a 1.52-2.11 percentage point increase in BMI-for-age percentiles. Collectively, these studies highlight that early screen exposure is linked to subsequent behavioral patterns and modest increases in BMI, with its impact on sleep varying. The attenuation of associations after controlling for familial and sociodemographic factors emphasizes the need for early interventions based on individual family context. Considering the rapidly evolving digital landscape, these findings underscore the necessity for ongoing research that adapts to new technologies and addresses a broader spectrum of health outcomes related to screen use in childhood.
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
Recommended Citation
Turcotte, Brooke, "Associations of Screen Time, Growth, and Sleep in the Upstate KIDS Study" (2025). Electronic Theses & Dissertations (2024 - present). 202.
https://scholarsarchive.library.albany.edu/etd/202
