|Year : 2020 | Volume
| Issue : 1 | Page : 59
Screen time activities and aggressive behaviors among children and adolescents: A systematic review
Mojtaba Keikha1, Mostafa Qorbani2, Maryam Sadat Kazemi Tabaee3, Shirin Djalalinia4, Roya Kelishadi5
1 Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
2 Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj; Chronic Disease Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
3 Isfahan Health Center, Isfahan University of Medical Sciences, Isfahan, Iran
4 Non-communicable Disease Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences; Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
5 Pediatrics Department, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
|Date of Submission||17-Feb-2020|
|Date of Acceptance||25-Feb-2020|
|Date of Web Publication||19-May-2020|
Pediatrics Department, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan
Non-communicable Disease Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran
Source of Support: None, Conflict of Interest: None
Background: Aggressive behaviors have increasing trend in children and adolescents all over the world. This study aimed to perform a systematic review on the association between screen time activities and aggressive behaviors. Methods: A systematic search was conducted through PubMed, Institute of Scientific Information (ISI), and Scopus, until 2017. Moreover, related unpublished studies (grey literature, thesis project and congress paper), considered for further data availability. Data extraction and quality assessment conducted by two independent experts. Results: Through searching processes, 4381 publications were found, from them. 483 papers were from PubMed database and others were from ISI/WOS (1724) and Scopus (1938). Following the excluding of non-relevant and duplicated studies, 19 studies remained for further analyzing. Findings of the present study showed that children and adolescents who share most of their time for watching of television are at greater risk for violent behaviors including physical fighting, victim and bully. Conclusion: This review found that children and adolescents who share most of their time for watching of television are at greater risk for violent behaviors including physical fight, victim and bully.
Keywords: Adolescents, aggressive behaviors, children, screen time
|How to cite this article:|
Keikha M, Qorbani M, Kazemi Tabaee MS, Djalalinia S, Kelishadi R. Screen time activities and aggressive behaviors among children and adolescents: A systematic review. Int J Prev Med 2020;11:59
|How to cite this URL:|
Keikha M, Qorbani M, Kazemi Tabaee MS, Djalalinia S, Kelishadi R. Screen time activities and aggressive behaviors among children and adolescents: A systematic review. Int J Prev Med [serial online] 2020 [cited 2020 Jul 16];11:59. Available from: http://www.ijpvmjournal.net/text.asp?2020/11/1/59/284602
| Introduction|| |
Aggressive behaviors become an important priority in health promotion of children and adolescents all over the world. It is documented that at least 8% of children around the world are affected from bully behaviors and about 50% of them involve aggression.,, Behavioral problems such as juvenile misbehavior, adulthood violence and criminal behavior might root from experiences of aggressive behaviors of the first years of life.,
In spite of the related investigations, there are still obvious gaps in evidence that focus on aggressive bullying behaviors and its predisposing factors. The results of studies of adolescents aggression behaviors' have discussed on different interactive factors which contributes from different domains of cognitive stimulation, emotional support and television exposure., Recently, most of the children and adolescents spend a considerable part of their time using visual and auditory devices, including television, computer games, cell phones, tablets and personal computers.,, Along with these situations, the American Academy of Pediatrics (AAP) recommends that in daily program of under 2 years children, entertainment media time should be limited to 1-2 hours.
The AAP also warns about the television setting in children's bedrooms. Despite of these recommendations, related investigations on daily activities of children and adolescents show that, yet most of them spend more than two hours for television watching, and about 36% of 6-year-old children have televisions in their bedroom.
Over the past decade, many adverse health outcomes and complications have been attributed to patterns of screen time activities.,, Recent evidence confirmed that time spent using devices such as a computer, television or games directly raises the risk of the adverse health outcomes.
Although some of published researches about relationship between aggression in children and use of visual devices show a direct relationship, there are still a few studies that present different results,,,, Furthermore, there are some studies that have not been able to reach to a clear inference.
Considering the obvious gaps of required evidence for better policy making and aimed to provide the most comprehensive overview of problem, present study as a well-developed systematic review, summaries the results of published studies in scope of association of screen time activities and aggressive behaviors.
| Methods|| |
This is a systematic review on association of Screen Time (ST) and violent behaviors' in children and adolescents through which we targeted two main objectives as follow:
- Assessment of association between screen time and violent behaviors;
- Assessment of heterogeneity and finding the sources of differences.
To search for related resources and literature, we used more comprehensive electronic databases (Scopus, PubMed and ISI Web of Science). Moreover, related unpublished studies (grey literature, thesis project and congress paper) considered for further data availability [Table 1].
The primary keywords for developing the search strategy were including:
Violence: the use of physical force so as to injure, abuse, damage, or destroy.
Screen time: time spending on watching television (TV)/VCDs, personal computer (PC), or electronic games (EG).,
We included all of related descriptive and analytical studies (case control, cohort, cross-sectional) which were assessed the association of ST with violent behaviors in children and adolescents. There was no limitation for time of studies, time of publications and language of documents.
Quality assessment and data extraction
Quality of included documents were determined using quality assessment form which contains three main parts of; general information, sampling quality, and measurement quality. Using standardized data extraction sheet, data were extracted from eligible papers.
These processes of quality assessment and data extraction conducted by two independent researchers (Kappa statistic for agreement; 0.97). Probable discrepancy between them resolved based on third expert opinion (main investigator).
Protocol of study was approved by the ethical committee of Isfahan University of Medical Sciences. All of the included studies would be cited in future reports and publications.
| Results|| |
We refined data for association of screen time activities and aggressive behaviors, among children and adolescents. Through searching processes, 4381 publications were found, from them; 483 papers were from PubMed data base and other were from ISI/WOS (1724) and Scopus (1938). Following the excluding of non-relevant and duplicated studies, 19 studies remained for further analyzing [Figure 1].
|Figure 1: Papers search and review flowchart for selection of primary study|
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All of searched documents were in English language. Considering the type of studies, 13 investigations were followed as cross-sectional surveys; 3 studies were designed as cohort studies, 2 researches were run as national longitudinal surveys and one study was a community-based longitudinal investigation. Considering the scopes of researches; 11 studied targeted the watching TV, 3 researches were conducted on playing computer, video games or using computers and 3 studies only focused on video games. Most of results confirmed that watching television is associated with bullying and violence. The characteristics of including papers and the finding and extracted results presented in [Table 2].
|Table 2: The characteristics of including papers and the finding and extracted results|
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The topic of target studies were categorized as follows:
- Studying association between aggressive behavior and watching TV (5 articles);
- Studying association between Bullying and watching TV (6 articles);
- Studying association alcohol and drug use and watching TV (2 articles);
- Studying association of other behaviors and watching TV (6 articles).
Results of qualitative synthesis
- Studying association between aggressive behaviors and watching TV
A total of 5 articles (including 2 cross-sectional and 3 prospective cohort studies) had reported the results of assessments of linear regression analysis or coronation evaluations between aggressive behavior and watching TV [Table 2]. All of these researches reported that watching TV is associated with aggressive behaviors. They mostly focused on different aspects of physical aggressive behaviors
In this regard, a prospective cohort study through 30 to 50 months (mean, 36 months) follow up of 3128 participants (mothers) cleared that 65% of children watch television for more than two hours per day. This investigation confirmed that watching television is significantly associated with childhood aggression, even when controlling for other factors
Based on a cross-sectional survey on 581 (332 female, 249 male) participants with mean age of 13.5 ± 0.7 (12-16 years); the mean duration of watching TV was 2.32 ± 1.77 hours/day. In this study, there was a significant association between socio-economic status and aggressive score (P = 0.016)
Another related community-based longitudinal investigation on children show a significant association between the amounts of time spent on watching television and aggressive behaviors. The researchers emphasized on the association between watching TV and consequences, including beatings, physical violence, theft, and crime
Two other prospective longitudinal study on 2707 participants with two time point of at both 30 to 33 months and 5.5 years for follow up explained that 16% of children watched TV for more than 2 hours. They finally concluded that, sustained watching TV could act as a risk factor for mental health. Another prospective longitudinal study with 1314 participants shown that, one hour of watching TV lead to 10% increased risk of physical conflict with Classmate (95% CI, 0.01 to 0.05).
- Studying association between Bullying and watching TV There are 6 studies mainly concentrated on bullying and watching TV. One of them designed as cross sectional and other followed through prospective cohorts
A population-based cohort on 5389, boy and girl relied on their teachers report of bullying involvement (N = 3423) mean = 6.8 years ± 3.03 months and peer/self-report of bullying involvement (N = 1176) mean = 7.6 years ± 8.95 months. This investigation revealed that watching TV could act as a risk factor for conflict with Classmate
Another cohort study on 9,672 Canadian youth shown that computer and video games associated with violent behaviors. Through this study, the average time spending for television, computer and video games were respectively 7, 9 and 7 hours/week. A cross-sectional survey on 1069 male and females from 8th grade confirmed that computer games is a significant dose-related, predictor of engaging in bullying and physical aggression
Other similar cross sectional study on 2425 participants confirmed this association. Through another experiences, 13,486 children and adolescents (50.8% boys), aged 6-18 years, with Mean (SD) age of 12.47 (3.36) years, studied for their physical fights, bullying and being bullied and their association with watching TV, using a computer, screen activity. Based on the results, the risk of physical fighting was associated with watching TV (OR 1.29, 95% CI 1.19-1.40) and computer games (OR 1.38, 95% CI 1.21-1.57)
Other research groups found that, in children 4 years old, each hour of watching TV could lead to increased risk for bullying and physical aggression (OR 1.06, 95% confidence interval, 1.02-1.11)
- Studying association alcohol and drug use and watching TV
There were two related studies in this field. Through one of them, 14041 students, in grades nine through 12, involved in a cross-sectional study. The proportion of watching TV and computer/video game were respectively; 35.4% (33.1-37.7%) and 24.9% (22.9-27.0%). Risky behavior, including involvement in physical fights and initiation of alcohol use before were significantly associated with frequent watching TV or frequent computer/video game. In another study, on 346 children with mean age of 11.5 years, there was found to be no significant association between the amount of time children spent on video games and aggressive behavior.
- Studying association of other behaviors and watching TV
Through 6 remained studies, discussed on different aspects of; verbal aggressive,, angriness, Murder, rape, robbery, sexual or physical assault, threatening and antisocial behavior aggressive behaviors [Table 2].
| Discussion|| |
To the best of our knowledge, the present study is the first study that examined the association of screen time and aggressive behaviors. The assessment categorized under four main line of aggressive behavior, bullying, alcohol and drug use and other behaviors. Following the excluding of non-relevant and duplicated studies, 19 studies remained for further analyzing.
Findings of present study showed that children and adolescents who share most of their time for watching of television are at greater risk for violent behaviors including; physical fighting, victim, and bully. These results consistent with previous studies that shown behavioral disorders are less common in children and adolescents who spend more time with their families and enjoy from the families supports.,, The role of family supports in decreasing of behavioral disorders especially emphasized in children who benefitting from emotional and social support of their parents.,, Related studies show that, more than 2 hours/day, screen time through which children engaging on watching TV or playing video games is associated with incidence, of violent behaviors.,,
Related investigation discussed that some related components such as higher socio-economic status of families, interactive communication skills, more attention to emotional needs of children and even higher educational levels of parents could be affect as factors that reduce the risk of violent behavior in children.,,
Considering the above, monitoring and supervising of these concern could greatly reduce the risk of violent behaviors in children and adolescents and even in their adulthood life., Required preventive and controlling strategies should be followed by the implementation of enhanced procedures developed based on reliable evidence. These approaches also turn on the paths of evaluation of corresponding interventional programs.,
Aim to design and implementation of such interventions, on time diagnosis of behavioral disorders is important subject that must be followed through multi-dimensional diagnostic approaches.,, Another discussed approach is screening the abused or neglected children, that could benefitting from effective coping strategies and appropriate psychological interventions.
The present study benefiting from many strengths. Considering the priority of problem, we conducted a comprehensive systematic review on association screen time activity and aggressive behaviors among children and adolescents that included all available data of eligible related studies. At the same time, present investigation has some limitations.
| Conclusion|| |
This is the comprehensive systematic review on association screen time activity and aggressive behaviors among children and adolescents. Our findings suggested that children and adolescents who share most of their time for watching of television are at greater risk for violent behaviors including physical fight, victim, and bully. These evidence could be used for development of interventional programs.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]