E278: Here's how screen time affects our kids' eating, activity, and mental health
Interview Summary So, you two, along with a number of other people in the field, wrote a chapter for a recently published book called The Handbook of Children and Screens. We discussed that book in an earlier podcast with its editors, Dmitri Christakis and Kris Perry, the executive director of the Children and Screens organization. And I'd like to emphasize to our listeners that the book can be downloaded at no cost. I'd like to read a quote if I may, from the chapter that the two of you wrote. 'Screen time continues to evolve with the advent of continuous and immersive video reels, voice activated assistance, social media influencers, augmented and virtual reality targeted advertising. Immersive worlds where children can virtually shop for food and beverages, cook or work in a fast-food outlet from a smartphone, a tablet, a computer, or an internet connected tv and more.' So as much as I follow the field, I still read that and I say, holy you know what. I mean that's just an absolutely alarming set of things that are coming at our children. And it really sounds like a tidal wave of digital sophistication that one could have never imagined even a short time ago. Amanda, let's start with you. Can you tell us a little bit more about these methods and how quickly they evolve and how much exposure children have? I think you're right, Kelly, that the world is changing fast. I've been looking at screen media for about 20 years now as a researcher. And in the earlier years, and Tom can attest to this as well, it was all about TV viewing. And you could ask parents how much time does your child spend watching TV? And they could say, well, they watch a couple shows every night and maybe a movie or two on the weekend, and they could come up with a pretty good estimate, 1, 2, 3 hours a day. Now, when we ask parents how much time their children spend with media, they have to stop and think, 'well, they're watching YouTube clips throughout the day. They're on their smartphone, their tablet, they're on social media, texting and playing all these different games.' It really becomes challenging to even get a grasp of the quantity of screen time let alone what kids are doing when they're using those screens. I will say for this book chapter, we found a really great review that summarized over 130 studies and found that kids are spending about three and a half or four hours a day using screens. Yet some of these studies are showing as high as seven or eight hours. I think it's probably under-reported because parents have a hard time really grasping how much time kids spend on screens. I've got a one-year-old and a five-year-old, and I've got some nieces and nephews and I'm constantly looking over their shoulder trying to figure out what games are they playing and where are they going online and what are they doing. Because this is changing really rapidly and we're trying to keep up with it and trying to make sure that screen time is a safe and perhaps healthy place to be. And that's really where a lot of our research is focused. I can only imagine how challenging it must be to work through that landscape. And because the technology advances way more quickly than the policies and legal landscape to control it, it really is pretty much whatever anybody wants to do, they do it and very little can be done about it. It's a really interesting picture, I know. We'll come back later and talk about what might be done about it. Tom, if you will help us understand the impact of all this. What are the effects on the diets of children and adolescents? I'm thinking particularly when Amanda was mentioning how many hours a day children are on it that three to four hours could be an underestimate of how much time they're spending. What did kids used to do with that time? I mean, if I think about when you and I were growing up, we did a lot of different things with that time. But what's it look like now? Well, that's one of the important questions that we don't really know a lot about because even experimental studies that I can talk about that look at reducing screen time have not been very good at being able to measure what else is going on or what substitutes for it. And so, a lot of the day we don't really know exactly what it's displacing and what happens when you reduce screen time. What replaces it? The assumption is that it's something that's more active than screen time. But, you know, it could be reading or homework or other sedentary behaviors that are more productive. But we really don't know. However, we do know that really the general consensus across all these studies that look at the relationship between screen time and nutrition is that the more time children spend using screens in general, the more calories they consume, the lower the nutritional quality of their diets and the greater their risk for obesity. A lot of these studies, as Amanda mentioned, were dominated by studies of television viewing, or looking at television viewing as a form of screen use. And there's much less and much more mixed results linking nutrition and obesity with other screens such as video games, computers, tablets, and smartphones. That doesn't mean those relationships don't exist. Only that the data are too limited at this point. And there's several reasons for that. One is that there just haven't been enough studies that single out one type of screen time versus another. Another is what Amanda brought up around the self-report issue, is that most of these studies depend on asking children or the parents how much time they spend using screens. And we know that children and adults have a very hard time accurately reporting how much time they're using screens. And, in fact when we measure this objectively, we find that they both underestimate and overestimate at times. It's not all in one direction, although our assumption is that they underestimate most of the time, we find it goes in both directions. That means that in addition to sort of not having that answer about exactly what the amount of screen time is, really makes it much tougher to be able to detect relationships because it adds a lot of error into our studies. Now there have been studies, as I mentioned, that have tried to avoid these limitations by doing randomized controlled trials. Including some that we conducted, in which we randomized children, families or schools in some cases to programs that help them reduce their screen time and then measure changes that occur in nutrition, physical activity, and measures of obesity compared to kids who are randomized to not receive those programs. And the randomized trials are really useful because they allow us to make a conclusion about cause-and-effect relationships. Some of these programs also targeted video games and computers as well as television. In fact, many of them do, although almost all of them were done before tablets and smartphones became very common in children. We still don't have a lot of information on those, although things are starting to come out. Most of these studies demonstrated that these interventions to reduce screen use can result in improved nutrition and less weight gain. And the differences seen between the treatment and control groups were sometimes even larger than those commonly observed from programs to improve nutrition and increased physical activity directly. Really, it's the strongest evidence we have of cause-and-effect relationships between screen use and poor nutrition and risk for obesity. Of course, we need a lot more of these studies, particularly more randomized controlled studies. And especially those including smartphones because that's where a lot of kids, especially starting in the preteen age and above, are starting to spend their time. But from what we know about the amount of apparent addictiveness that we see in the sophisticated marketing methods that are being used in today's media, I would predict that the relationships are even larger today than what we're seeing in all these other studies that we reviewed. It's really pretty stunning when one adds up all that science and it looks pretty conclusive that there's some bad things happening, and if you reduce screen time, some good things happen. So, Amanda, if you know the numbers off the top of your head, how many exposures are kids getting to advertisements for unhealthy foods? If I think about my own childhood, you know, we saw ads for sugar cereals during Saturday morning cartoon televisions. And there might have been a smattering if kids watch things that weren't necessarily just directed at kids like baseball games and stuff like that. But, and I'm just making this number up, my exposure to those ads for unhealthy foods might have been 20 a week, 30 a week, something like that. What does it look like now? That is a good question. Kelly. I'm not sure if anyone can give you a totally accurate answer, but I'll try. If you look at YouTube ads that are targeting children, a study found that over half of those ads were promoting foods and beverages, and the majority of those were considered unhealthy, low nutritional value, high calorie. It's hard to answer that question. What we used to do is we'd take, look at all the Saturday morning cartoons, and we'd actually record them and document them and count the number of food ads versus non-food ads. And it was just a much simpler time in a way, in terms of screen exposure. And we found in that case, throughout the '90s and early 2000s, a lot of food ads, a lot of instances of these food ads. And then you can look at food placement too, right? It's not an actual commercial, but these companies are paying to get their food products in the TV show or in the program. And it's just become much more complicated. I think it's hard to capture unless you have a study where you're putting a camera on a child, which some people are doing, to try to really capture everything they see throughout their day. It's really hard to answer, but I think it's very prolific and common and becoming more sophisticated. Okay, thanks. That is very helpful context. Whatever the number is, it's way more than it used to be. Definitely. And it also sounds as if and it's almost all for unhealthy foods, but it sounds like it's changed in other ways. I mean, at some point as I was growing up, I started to realize that these things are advertising and somebody's trying to sell me something. But that's a lot harder to discern now, isn't it with influencers and stuff built in the product placements and all that kind of stuff. So, to the extent we had any safeguards or guardrails in the beginning, it sounds like those are going to be much harder to have these days. That's right. It really takes until a child is 6, 7, 8 years old for them to even identify that this is a commercial. That this is a company that's trying to sell me something, trying to persuade. And then even older children are having to really understand those companies are trying to make money off the products that they sell, right? A lot of kids, they just look at things as face value. They don't discriminate against the commercial versus the non-commercial. And then like you're suggesting with social influencers, that they're getting paid to promote specific products. Or athletes. But to the child that is a character or a person that they've learned to love and trust and don't realize, and as adults, I think we forget sometimes too. That's very true. Amanda, let me ask about one thing that you and Tom had in your chapter. You had a diagram that I thought was very informative and it showed the mechanisms through which social media affects the diet and physical activity of children. Can you describe what you think some of the main pathways of influence might be? That figure was pretty fun to put together because we had a wonderful wealth of knowledge and expertise as authors on this chapter. And people provided different insight from the scientific evidence. I will say the main path we were trying to figure out how does this exposure to screen really explain changes in what children are eating, their risk for obesity, the inactivity and sedentary behavior they're engaging in? In terms of food, really what is I believe the strongest relationship is the exposure to food advertisement and the eating while engaging in screen time. You're getting direct consumption while you're watching screens, but also the taste preferences, the brand loyalty that's being built over time by constantly seeing these different food products consistently emerge as one of the strongest relationships. But we identified some other interesting potential mechanisms too. While kids are watching screens or engaging in screens, there's some evidence to indicate that they're not able to read their body as well. Their feelings of hunger, their feelings of satiety or fullness. That they're getting distracted for long periods of time. Also, this idea of instant gratification, just like the reward process of instant gratification with using the screen. They're so interactive. You can go online and get what you want and reach what you want. And the same thing is happening with food. It becomes habitual as well. Children get off of school and they go home, and they grab a snack, and they watch tv or they watch their YouTube clips or play their games. And it becomes an eating occasion that may not have otherwise existed. But they're just associating screen time with eating. There's some evidence even on screen time impacting inhibition and controlling impulse and memory. And that's more emerging, but it's interesting to just consider how this prolonged screen time where you're not interacting with someone in person, your eyes are focused on the screen, might actually be having other cognitive impacts that we may not even be aware of yet. If we ask the question why Is screen time having a bad impact on children and their diets? It's almost let us count the ways. There are a lot of possible things going on there. And speaking of that, there's one question in particular I'd like to ask you, Tom. Certainly marketing might affect what kids prefer. Like it might make them want to have a cereal or a beverage A or snack food B or whatever it happens to be. But could it also affect hunger? How much kids want to eat? I mean, you think, well, hunger is biological, and the body sends out signals that it's time to eat. How does that all figure in? The research suggests it can. Advertising in particular but even non-advertising references or images of food can trigger hunger and eating whether or not you felt hungry before you saw them. And I'm guessing almost everyone's experienced that themselves, where they see an image of food, and all of a sudden, they're craving it. It can be as simple as Pavlov's dogs, you know, salivating in response to cues about food. In addition, I think one of the mechanisms that Amanda brought up is this idea that when you're distracted with a screen, it actually overruns or overwhelms your normal feelings of fullness or satiety during eating. When distracted, people are less aware of how much they're eating. And when you're eating while using a screen, people tend to eat until they've finished the plate or the bag or the box, you know? And until that's empty, till they get to the bottom, instead of stopping when they start to get full. Well, there's sort of a double biological whammy going on there, isn't there? It is affecting your likelihood of eating in the first place, and how hungry you feel. But then it also is affecting when you stop and your satiety happening. And you put those two together there's a lot going on, isn't there? Exactly. And it's really one of the reasons why a lot of our programs to reduce weight gain and improve nutrition really put a lot of emphasis on not eating in front of screens. Because our studies have shown it accounts for a large proportion of the calories consumed during the day. Oh, that's so interesting. Amanda, you mentioned influencers. Tell us a little bit more about how this works in the food space. These social influencers are everywhere, particularly Instagram, TikTok, et cetera. Kids are seeing these all the time and as I mentioned earlier, you often build this trusting relationship with the influencer. And that becomes who you look to for fads and trends and what you should and shouldn't do. A lot of times these influencers are eating food or cooking or at restaurants, even the ones that are reaching kids. As you analyze that, oftentimes it's the poor nutrition, high calorie foods. And they're often being paid for the ads too, which as we discussed earlier, kids don't always realize. There's also a lot of misinformation about diet and dieting, which is of concern. Misinformation that could be harmful for kids as they're growing and trying to grow in a healthy way and eat healthy foods. But kids who may look to overly restrict their foods, for example, rather than eating in a healthier manner. So that's definitely a problem. And then also, oftentimes these social influencers really have these unattainable beauty standards. Maybe they're using a filter or maybe they are models or whatnot. They're projecting these ideal body images that are very difficult and sometimes inappropriate for children to try to attain. Now, we've seen this in other forms, right? We've seen this in magazines going back. We've seen this on websites. But now as soon as a kid turns on their smartphone or their tablet and they're online, it's in front of them all the time. And, and they're interacting, they're liking it, they're commenting and posting. I think the social influencers have just really become quite pervasive in children's lives. Somebody who's an influencer might be recording something that then goes out to lots and lots of people. They're eating some food or there's some food sitting in the background or something like that. And they're getting paid for it, but not saying they're getting paid for it. Probably very few people realize that money is changing hands in all of that, I'm suspecting, is that right? Yes, I do believe they're supposed to do hashtag ad and there are different indicators, but I'm not sure the accountability behind that. And I'm also not sure that kids are looking for that and really understand what that means or really care what that means. Okay. Because they're looking to sense what's popular. But there's an opportunity to perhaps further regulate, or at least to educate parents and kids in that regard that I think would be helpful. Tom, while we're on this issue of conflicts of interest, there was recent press coverage, and then there were reports by reporters at the Washington Post and The Examination showing that the food industry was paying dieticians to be influencers who then posted things favorable to industry without disclosing their funding. How big of a problem do you think this is sort of overall with professionals being paid and not disclosing the payments or being paid even if they disclose things. What kind of a negative impact that's having? Yes, I find it very concerning as you would guess, knowing me. And I believe one of the investigations found that about half of influencers who were being paid to promote foods, drinks, or supplements, didn't disclose that they were paid. It was quite a large magnitude. It goes throughout all types of health professionals who are supposed to be sources of quality information and professional organizations themselves which take advertising or take sponsorships and then don't necessarily disclose it. And you know in this day when we're already seeing drops in the public's trust in science and in research, I think this type of information, or this type of deception just makes it a lot worse. As you know, Kelly, there's quite a bit of research that suggests that being paid by a company actually changes the way you talk about their products and even conduct research in a way that's more favorable to those products. Whether you think it does or not, whether you're trying to be biased or not. Tom, just to insert one thing in my experience. If you ask people in the field, does taking money from industry affect the way scientists do their work and they'll almost always say yes. But if you say, does it influence your work, they'll almost always say no. There's this unbelievable blind spot. And one might conclude from what you were telling us is that disclosure is going to be the remedy to this. Like for the half of people who didn't disclose it, it would be okay if they took the money as long as they disclosed it. But you're saying that's obviously not the case. That there's still all kinds of bias going on and people who are hearing some disclosure don't necessarily discount what they're hearing because of it. And it's still a pretty bad kettle of fish, even if disclosure occurs. It's especially pernicious when it doesn't, but it seems even when disclosure happens, it's not much of a remedy to anything. But you may not agree. No, I definitely agree with that. And that's only, you know, part of it too because there's the other side of the audience that Amanda brought up as well. And in particular what kids, but also adults, how they react to disclosures. And, while it's been possible to teach people to recognize potential bias, you know, when there's a disclosure. And to make people aware, which is a good thing, we want disclosure, I guess, so people are aware to be more vigilant in terms of thinking about what biases may be in the messages. There's not much evidence that teaching people that or making them aware of that changes their behavior. They still believe the advertising. Right. They still act in the same way. It's still just as persuasive to them. One more little editorial insertion. The thing that has always puzzled me about disclosure is that it implies that there's something bad going on or else, why would you have to disclose it? And the solution seems not to disclose it, but not to do the bad thing. And it's like, I could come up and kick you in the leg, but it's okay if I disclose that I kick you in the leg. I mean, it just makes no sense to me. But let me move on to something different. Amanda, I'd like to ask you this. I assume the food industry gets a lot more impact and reach per dollar they spend from when the only option was to run ads on national television and now, they're doing things at much less expense, I think, that can have, you know, orders of magnitude more impact and things. But is my perception correct? And how do you think through that? I think of it like the Tupperware model, right? You're building these trusted local or national celebrities, spokespeople for kids. Oftentimes these young adults or teenagers who are doing funny things and they're engaging, and so you're building this trust like you did with the Tupperware. Where you go and train people to go out to people's homes and their neighbors and their friends and their church and sell the product. It's really similar just in an online space. I think you're right; the cost is likely much less. And yet the reach and even the way these influencers are paid is all about the interaction, the likes, the comments, that sort of thing. The reposts. It's become quite sophisticated, and clearly, it's effective because companies are doing this. And one other thing to mention we haven't talked about yet is the food companies themselves have hired young people who use humor as a way to create a following for the different brands or products. It's not a person now, it's either the branded character or the actual company itself. And I think that has great influence of building some loyalty to the brand early in life. So that child is growing up and not only persuading their parents to purchase these products, but as they have more disposable income, they're going to continue purchasing the product. I wonder if Edward Tupper or I don't know if I remember his first name right, but I wonder if you could have ever imagined the how his plastic invention would permeate more of society than he ever thought? Tom, what about the argument that it's up to parents to decide and to monitor what their children are exposed to and the government needs to back off. Oh, it would be so nice if they were that easy, wouldn't it? If we could depend on parents. And I think every parent would love to be able to do that. But we're talking about individual parents and their kids who are being asked to stand up against billions, literally billions and billions of dollars spent every year to get them to stay on their screens as long as possible. To pay attention to their marketing, as Amanda was talking about the techniques they use. And to really want their products even more. If you could think of a parent with endless knowledge and time and resources, even they are really unable to stand up to such powerful forces working against them. Unfortunately, and this is not unique to the issues of screens in children's health, but really many of the issues around health, that in the absence of government regulation and really lack of any oversight, this really difficult job is dumped on parents. You know, not their choice, but it's sort of in their lap. We still try and help them to be better at this. While we're waiting for our elected representatives to stand up to lobbyists and do their jobs, we still in a lot of our interventions we develop, we still try and help parents as well as schools, afterschool programs, teachers, health professionals, develop the skills to really help families resist this pool of media and marketing. But that shouldn't be the way it is. You know, most parents are really already doing the best they can. But it's drastically unfair. It's really an unfair playing field. That all makes good sense. We've been talking thus far about the negative impacts of media, but Amanda, you've done some work on putting this technology to good use. Tell us about that if you will. I do enjoy trying to flip the script because technology is meant to help us, not harm us. It's meant to make our lives more efficient, to provide entertainment. Now with video chatting, to provide some social connection. A lot of my work over the past 20 years has been looking at what's commercially available, what kids are using, and then seeing let's test these products or these programs and can we flip them around to promote healthier eating? To promote physical activity? Can we integrate them for kids who are in a weight management program? Can we integrate the technology to really help them be successful? It doesn't always work, and we certainly aren't looking to increase screen time, but we also need to recognize that achieving zero hours of screen time is really unattainable pretty much universally. Let's try to evaluate the screen time that is being used and see if we can make it healthier. A few examples of that include when the Nintendo Wii came out about 18 years ago now. I was part of a group that was one of the first to test that video game console system because up until that point, most of the games you sat down to play, you held a remote in your hand. There were Dance Dance Revolution games and arcade halls so you could do a little bit of movement with games. But pretty much they were sedentary. Nintendo Wii came out and really changed a lot because now you had to get up off the couch, move your body, move your arms and legs to control the game. And we found it cut across all demographics. Men, women, boys, girls, different age groups. There was content available for a lot of different groups. These types of games became really popular. And I did some of the earlier studies to show that at least in a structured program that kids can engage in what we call moderate levels of physical activity. They're actually moving their bodies when they play these games. And over time, I and others have integrated these games into programs as a way to be an in with kids who may not be involved in sports, may not go outside to play, but they're willing to put on a video game and move in their living room at home. Building from that, we've developed and tested various apps. Some of these apps directly reach the parents, for example, teaching the parents. These are strategies to get your child to eat healthier. Prepare healthier meals, grocery shop, be more physically active as a family. We've looked at different wearables, wristwatches that can help kids and parents. Maybe they'll compete against each other to try to get the most steps of a day and that sort of thing. And then some of my recent work is now integrating chatbots and artificial intelligence as ways to provide some tailored feedback and support to kids and families who are looking to be more physically active, eat healthier. And then one study I'm really excited about uses mixed reality. This is virtual reality where you're putting on a headset. And for that study we are integrating children's homework that they would otherwise do on their Chromebook. And we're removing the keyboard and computer mouse so that they now have to use their body to click and point and drag and move the screen. And these are just a few examples. I do not think this is the magical solution. I think as Tom alluded to, there are different levels of government regulation, educating parents, working with schools. There's working with the food industry. There's a lot that we need to do to make this a healthier media space for kids. But I think this is something we should be open to, is figuring out if people are going to spend a lot of time using screens, what can we do to try to make those screens healthier? You make me smile when I'm hearing that because all these things sound really exciting and like there's plenty of potential. And you're right, I mean, if they're going to be on there anyway, maybe there can be some positive way to harness that time. And those all sound really important and really good. And let's hope that they spread enough to really touch lots and lots of children and their families. Tom, you and I keep caught up. We see each other at professional meetings or we just have periodic phone calls where we tell each other what we're up to. And you've been telling me over the past couple years about this really amazing project you're heading up tracking screen usage. Could you tell us a little bit about that? I'd love to. Really it addresses the problem that came up before, which is really how we measure what people are doing and seeing on their screens. Basically all the studies of media effects for the past a hundred plus years that the field has been studying media, has been dependent on people telling us what they do and what they saw. When in fact, we know that's not particularly accurate. So now we have technology that allows us to track exactly what people are doing and seeing on their screens. We call this screenomics, like genomics, except instead of studying how genes affect us, it's studying how screens affect us and how the screens we experience in our lives really are a reflection of our lives. The way we are doing this is we put software on your phone or your laptop, and it can be on other screens as well, and it runs in the background and takes a screenshot every five seconds. And it covers everything on the screen because it's just taking a picture of the screen. All the words, all the images. Then we use AI to help us decipher [00:34:00] what was on those screens. And so far, we've collected over 350 million screenshots from several hundred adults and teenagers who've participated in our studies for periods of six months to a year. Some of our most interesting findings, I think, is how much idiosyncrasy there is in people's screen use. And this has a huge impact on how we do research on the effects of screens, I believe. Because no two people really have the same screenomes, which is what we call the sequence of screenshots that people experience. And even for the same person, no two hours or days or weeks are the same. We're looking at both how different people differ in their screen use, and how that's related to their mental health, for example. But also how changes over time in a single person's screenome is related to their mental health, for example. Comparing your screen use this afternoon to your screen use this morning or yesterday, or last week or last month. And how that changes your health or is at least associated with changes in your health at this point. Eventually, we hope to move this into very precise interventions that would be able to monitor what your screen experience is and give you an appropriate either change in your screen or help you change your behavior appropriate to what you're feeling. One of our current studies is to learn really the details of what, when, how, why, and where foods and beverages appear in adolescent screenomes. And how these factors relate to foods and beverages they consume and their health. In fact, we're currently recruiting 13- to 17-year-olds all over the US who can participate in this study for six months of screenome collection and weekly surveys we do with them. Including detailed surveys of what they're eating. But this sort of goes back to an issue that came up before that you had asked us about how much is advertising? I can tell you that at least some of our preliminary data, looking at a small number of kids, suggests that food, it varies greatly across kids and what they're experiencing, especially on their phones. And, we found, for example, one young girl who 37% of all her screens had food on them. About a third, or more than a third of her entire screenome, had food in it. And it wasn't just through advertising and it wasn't just through social media or influencers. It was everywhere. It was pictures she was taking of food. It was influencers she was following who had food. It was games she was playing that were around food. There are games, they're all about running a restaurant or making food and serving and kitchen work. And then there were also videos that people watched that are actually fairly popular among where you watch other people eat. Apparently it's a phenomenon that came out of Korea first. And it's grown to be quite popular here over the last several years in which people just put on their camera and show themselves eating. I mean, nothing special, nothing staged, just people eating. There's all kinds of food exists everywhere throughout the screenome, not just in one place or another, and not just in advertising. Tom, a study with a hundred data points can be a lot. You've got 350 million, so I wish you the best of luck in sorting all that out. And boy, whatever you find is going to be really informative and important. Thanks for telling us about this. I'd like to end with kind of a basic question to each of you, and that is, is there any reason for hope. Amanda, let's, let's start with you. Do you see any reason to be optimistic about all this? We must be optimistic. No matter how we're facing. We have no choice. I think there's greater awareness. I think parents, policy makers, civic leaders are really recognizing this pervasive effective screen use on mental health, eating, obesity risk, even just the ability to have social interactions and talk to people face to face. And I think that's a good sign. I've seen even in my own state legislature in Louisiana, bills going through about appropriately restricting screens from schools and offering guidance to pediatricians on counseling related to screen use. The American Academy of Pediatrics changed their guidelines a number of years ago. Instead of just saying, no screens for the really little ones, and then limit to fewer than two hours a day for the older ones. They recognized and tried to be more practical and pragmatic with family. Sit down as a family, create some rules, create some boundaries. Make sure you're being healthy with your screen use. Put the screens away during mealtime. Get the screens out of the bedroom. And I think going towards those more practical strategies that families can actually do and sustain is really positive. I'd like to remain optimistic and let's just keep our eyes wide open and talk to the kids too. And ask the kids what they're doing and get them part of this because it's so hard to stay up to date on the technology. Thanks. I appreciate that positive note. Tom, what do you think? Yeah, I agree with Amanda. I can be positive about several things. First of all, I think last year, there were two bills, one to protect child privacy and the other to regulate technology aimed at children. COPPA 2.0 (Children’s Online Private Protection Act) and KOSA (Kid’s Online Safety Act). And they passed the Senate overwhelmingly. I mean, almost unanimously, or as close as you can get in our current senate. Unfortunately, they were never acted upon by the house, but in the absence of federal legislature regulation, we've had, as Amanda mentioned, a lot of states and also communities where they have actually started to pass bills or regulate social media. Things like prohibiting use under a certain age. For example, social media warning labels is another one. Limiting smartphone use in schools has become popular. However, a lot of these are being challenged in the courts by tech and media industries. And sadly, you know, that's a strategy they've borrowed, as you know well, Kelly, from tobacco and food industry. There also have been attempts that I think we need to fight against. For the federal legislature or the federal government, congress, to pass legislation to preempt state and local efforts, that would not allow states and local communities to make their own laws in this area. I think that's an important thing. But it's positive in that we're hearing advocacy against that, and people are getting involved. I'm also glad to hear people talking about efforts to promote alternative business models for media. I believe that technology itself is not inherently good or bad, as Amanda mentioned, but the advertising business models that are linked to this powerful technology has inevitably led to a lot of these problems we're seeing. Not just in nutrition and health, but many problems. Finally, I see a lot more parent advocacy to protect children and teens, especially around tech in schools and around the potential harms of social media. And more recently around AI even. As more people start to understand what the implications of AI are. I get the feeling these efforts are really starting to make a difference. Organizations, like Fair Play, for example, are doing a lot of organizing and advocacy with parents. And, we're starting to see advocacy in organizing among teens themselves. I think that's all really super positive that the public awareness is there, and people are starting to act. And hopefully, we'll start to see some more action to help children and families. Bios Developmental psychologist Dr. Amanda Staiano is an associate professor and Director of the Pediatric Obesity & Health Behavior Laboratory at Pennington Biomedical Research Center at Louisiana State University. She also holds an adjunct appointment in LSU's Department of Psychology. Dr. Staiano earned her PhD in developmental psychology and Master of Public Policy at Georgetown University, followed by a Master of Science in clinical research at Tulane University. Her primary interest is developing and testing family-based healthy lifestyle interventions that utilize innovative technology to decrease pediatric obesity and its comorbidities. Her research has involved over 2500 children and adolescents, including randomized controlled trials and prospective cohorts, to examine the influence of physical activity and sedentary behavior on body composition and cardiometabolic risk factors. Thomas N. Robinson, MD, MPH is the Irving Schulman, MD Endowed Professor in Child Health, Professor of Pediatrics and of Medicine, in the Division of General Pediatrics and the Stanford Prevention Research Center at Stanford University School of Medicine, and Director of the Center for Healthy Weight at Stanford University and Lucile Packard Children's Hospital at Stanford. Dr. Robinson focuses on "solution-oriented" research, developing and evaluating health promotion and disease prevention interventions for children, adolescents and their families to directly inform medical and public health practice and policy. His research is largely experimental in design, conducting school-, family- and community-based randomized controlled trials to test the efficacy and/or effectiveness of theory-driven behavioral, social and environmental interventions to prevent and reduce obesity, improve nutrition, increase physical activity and decrease inactivity, reduce smoking, reduce children's television and media use, and demonstrate causal relationships between hypothesized risk factors and health outcomes. Robinson's research is grounded in social cognitive models of human behavior, uses rigorous methods, and is performed in generalizable settings with diverse populations, making the results of his research more relevant for clinical and public health practice and policy.
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