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Screen time: The good, the healthy and the mind-numbing

Researchers at Stanford Medicine are exploring the impact of screen time and how to create solutions that support health.

Thomas Robinson, MD, professor of pediatrics and of medicine, has been studying the effect of watching mobile and video screens since the early 1990s. But before your thoughts go to Tamagachis and Gameboys, Robinson took an interest in screens for their potential to support (and undermine) one's health.

"Even back then, well before smartphones, children were already spending more time watching screens than they were spending in school or doing any other single activity," Robinson said. "Adults were watching even more."

Robinson suspected that even if the daily effects on health and well-being are relatively small, over the course of months and years, those hours accumulate to something that has a major impact on health and development. As a pediatrician, Robinson believes it's crucial to understand the effects of such a major activity in the lives of children and families.

In the following Q&A, Robinson discusses the controversies over screen time and usage, how screens affect health, and his approach to studying such a complicated topic, among other matters.

Your research prioritizes approaches that yield solutions, something you've dubbed the "solution-oriented research paradigm." What does that mean? Can you give an example?

A lot of research is focused on discovering causes, risk factors and correlates of diseases, but it does not directly tell us how to prevent or treat them -- that is, solutions. Changing how one frames research questions and designs studies can get to solutions more directly. For example, in our early screen media research, it was hypothesized that screen time caused obesity, aggression and other problems.

Many epidemiological studies, including our own, found relatively weak associations between screen time and these outcomes but they were limited by the difficulty of measuring screen time accurately. The media industry, arguing that the studies did not show cause and effect, blocked practice and policy initiatives. But even if one could prove, with experimental studies, that screen viewing caused health problems, the findings still wouldn't tell us what to do about it.

Instead, we designed behavioral interventions to help reduce children's screen time, and we tested the approaches in a series of randomized controlled trials to observe the effects. We showed that children who receive our interventions to reduce screen time -- which helped the children stay under weekly screen time budgets -- gained less weight, were less aggressive to their peers and asked their parents to buy them fewer advertised products, compared with kids who did not receive the intervention.

We didn't have to first prove the ill effects of screen viewing -- we were able to prove the benefits of an intervention to reduce screen time, directly discovering a solution that could be applied.

There's quite a bit of controversy about how screens affect kids - what do we know and what are the big unknowns still to decipher?

It seems obvious that screens, particularly smartphones, are affecting kids -- and adults. The list of suspected effects is long: It is not unusual to hear digital media blamed for everything from mental and physical health problems to impaired brain development and social skills to the downfall of democracy, but it's also credited with improving lives by helping kids stay safe and in touch with distant family members. Many of these impacts are backed up with plausible mechanisms and observations.

Unfortunately, after literally thousands of studies, we have very few clear answers. Some of this stems from problems of measuring screen use and of differences among children and how they use screens. Those are problems we are trying to help solve with our Human Screenome Project. But what we know from studies of screens before smartphones, such as television and video games, still holds. Kids learn behaviors -- such as aggression and gender and racial stereotypes -- from what they see portrayed in media. The time spent on screens can displace time spent doing other activities, such as time with family, playing outside and schoolwork. And while we're waiting for research to catch up, we can base our parenting, school and public policies on what we know from research on earlier media, along with the impacts that seem obvious to us.

Tell me about the Human Screenome Project, and what you aim to do with it.

With my colleagues Byron Reeves, professor of communication, and Nilam Ram, professor of communication and of psychology, and many other collaborators across campus, we are trying to address some of the limitations of past media research by measuring exactly what people are seeing and doing on their screens.

Consented volunteer participants use an app on their devices that unobtrusively records a screenshot every few seconds, encrypts the image and accompanying data and securely sends it to our research servers. Machine learning and analytics software identify what's on each screen -- all the words, images and other screen characteristics. We called it the screenome, like the genome, because it creates a record of individuals' unique experiences on their screens. It feels like what it must have felt like to invent the electron microscope or MRI, to be able to observe a part of life that has been, up until now, invisible.

To date, we have collected screenomes and accompanying surveys for up to one year from several hundred adults and adolescents and their parents. It immediately became apparent that no two people share similar screenomes and that no person's two days or two hours in a day are the same. Our goals for this project are to obtain the first detailed understanding of how people are using their screen devices and what they are seeing; to test relationships between the many hypothesized health, psychological and social effects of screen media and specific screen exposures and behaviors, such as social media, misinformation or jumping from screen to screen; and to design and test precision interventions based on specific moment-to-moment screen experiences.

What advice do you have to help parents manage their child's screen use, especially mobile phones?

For infants and young children, I recommend avoiding screens altogether. Young children benefit from more face-to-face time with their parents and other family members. That means it is also important for parents to limit their own screen use when they are with their children. I also recommend delaying children's use of screens as they grow.

We recently published a study that followed kids from as young as 7 to as old as 15 as they received their first phone. We found, on average, getting a phone at a younger age was no better or worse than getting it at an older age, in terms of depressive symptoms, sleep and school grades. Although some children experienced negative changes after getting a phone, the age of receiving a phone did not appear to be a key factor in determining these outcomes. It is possible that parents are matching their decisions about when to give their child a phone with their child's readiness and their child's and family's needs.

I recommend parents wait to give their child a phone until they are mature enough to regulate their own use and not allow it to distract them from sleep, homework, family time, and playing and socializing with other kids in the real world. Parents must also be aware that once their child has a phone they may be exposed to cyber bullying, body shaming, discrimination and racism, violence, pornography, predatory advertising and other content they may not want their child to experience.

I also suggest families have rules about screen use, such as limiting kids' time on screens, limiting the shows they are allowed to watch and apps they are allowed to use, creating phone-free activities (like spending time with family, eating meals, doing homework and sleeping) and creating phone-free spaces, like bedrooms. There are parental controls and apps to help parents enact some of these limits. And, I tell parents it's OK to take away a child's phone if they do not demonstrate sufficient responsibility to follow the rules.

Lastly, instead of simple screen ownership and screen time, we believe the key is how children and adults use their phones - what they see and do on their phones. We are studying this now in our Human Screenome Project.

Photo by Farknot Architect

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