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      The mediating effect of after-midnight use of digital media devices on the association of internet-related addictive behavior and insomnia in adolescents

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          Abstract

          Background

          There is evidence that overexposure to digital media devices (DMD) can not only lead to addictive patterns of internet use, but also cause insomnia symptoms. The aim of this cross-sectional study among adolescents is to provide an estimate of the prevalence of sleep impairments and to explore the mediating role of after-midnight use of DMD between internet-related addictive behavior (IRAB) and insomnia.

          Methods

          2,712 school students from Styrian schools participated in a population-representative online survey in a supervised school setting in spring 2022. School students were screened using established and validated scales. Data analysis was carried out using multiple imputation, linear multilevel regression and mediation analysis.

          Results

          Prevalence estimation indicates high proportions of clinically relevant moderate [12.6% (11.3%; 14.1%)] and severe [3.6% (2.9%; 4.4%)] insomnia, with an additional 30.6% (29.0%; 32.2%) at subthreshold level. DMD are typically used after midnight an average of 1.66 (1.58; 1.75) evenings with subsequent school day per school week. Linear multilevel regression analysis shows significant associations for sleep disparities as outcome variable e.g., with generalized anxiety [ b = 0.329 (0.287; 0.371)], after-midnight use of DMD [b = 0.470 (0.369; 0.572)] and IRAB [ b = 0.131 (0.097; 0.165)]. Mediation analysis shows a mediated proportion of 18.2% (13.0%; 25.0%) of the association of IRAB and insomnia by after-midnight use of DMD [Indirect effect: b = 0.032 (0.023; 0.040), direct effect: b = 0.127 (0.083; 0.170)].

          Conclusions

          Although the cross-sectional nature of this study limits causal inference, the results indicate a need for policies, which are already in preparation in Styria as part of a respective action plan.

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          Most cited references69

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          A general and simple method for obtainingR2from generalized linear mixed-effects models

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            Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population.

            The 7-item Generalized Anxiety Disorder Scale (GAD-7) is a practical self-report anxiety questionnaire that proved valid in primary care. However, the GAD-7 was not yet validated in the general population and thus far, normative data are not available. To investigate reliability, construct validity, and factorial validity of the GAD-7 in the general population and to generate normative data. Nationally representative face-to-face household survey conducted in Germany between May 5 and June 8, 2006. Five thousand thirty subjects (53.6% female) with a mean age (SD) of 48.4 (18.0) years. The survey questionnaire included the GAD-7, the 2-item depression module from the Patient Health Questionnaire (PHQ-2), the Rosenberg Self-Esteem Scale, and demographic characteristics. Confirmatory factor analyses substantiated the 1-dimensional structure of the GAD-7 and its factorial invariance for gender and age. Internal consistency was identical across all subgroups (alpha = 0.89). Intercorrelations with the PHQ-2 and the Rosenberg Self-Esteem Scale were r = 0.64 (P < 0.001) and r = -0.43 (P < 0.001), respectively. As expected, women had significantly higher mean (SD) GAD-7 anxiety scores compared with men [3.2 (3.5) vs. 2.7 (3.2); P < 0.001]. Normative data for the GAD-7 were generated for both genders and different age levels. Approximately 5% of subjects had GAD-7 scores of 10 or greater, and 1% had GAD-7 scores of 15 or greater. Evidence supports reliability and validity of the GAD-7 as a measure of anxiety in the general population. The normative data provided in this study can be used to compare a subject's GAD-7 score with those determined from a general population reference group.
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              National Sleep Foundation’s sleep time duration recommendations: methodology and results summary

              The objective was to conduct a scientifically rigorous update to the National Sleep Foundation's sleep duration recommendations.
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                Author and article information

                Contributors
                URI : http://loop.frontiersin.org/people/2723226/overviewRole: Role: Role: Role: Role:
                URI : http://loop.frontiersin.org/people/523107/overviewRole: Role:
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                URI : http://loop.frontiersin.org/people/2643292/overviewRole: Role:
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                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                11 July 2024
                2024
                : 12
                : 1422157
                Affiliations
                [1] 1Institute of Social Medicine and Epidemiology, Medical University of Graz , Graz, Austria
                [2] 2Outpatient Clinic for Behavioral Addiction, Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz , Mainz, Germany
                [3] 3Center for Social Research, University of Graz , Graz, Austria
                [4] 4Department of Obstetrics and Gynaecology, Medical University of Graz , Graz, Austria
                Author notes

                Edited by: Wahyu Rahardjo, Gunadarma University, Indonesia

                Reviewed by: Kshitij Karki, Purbanchal University, Nepal

                Tomoko Nishimura, Hamamatsu University School of Medicine, Japan

                *Correspondence: Thomas Lederer-Hutsteiner thomas.lederer-hutsteiner@ 123456x-sample.at
                Article
                10.3389/fpubh.2024.1422157
                11269230
                39056075
                f6f4c305-a4f6-4bdb-b9c1-925579d7fbe9
                Copyright © 2024 Lederer-Hutsteiner, Müller, Penker, Stolz, Greimel and Freidl.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 25 April 2024
                : 28 June 2024
                Page count
                Figures: 4, Tables: 5, Equations: 0, References: 70, Pages: 14, Words: 10794
                Funding
                Funded by: Medizinische Universität Graz, doi 10.13039/501100010109;
                The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. We are grateful to the Doctoral School Sustainable Health Research of the Medical University of Graz for awarding a grant for publication costs.
                Categories
                Public Health
                Original Research
                Custom metadata
                Substance Use Disorders and Behavioral Addictions

                insomnia,internet-related addictive behavior,late night use of digital media devices,adolescents,prevention

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