title: Sleep duration, restfulness, and screens in the sleep environment.
abstract: OBJECTIVE
  Associations of inadequate sleep with numerous health outcomes among youth necessitate identifying its modifiable determinants. Television (TV) has been associated with sleep curtailment, but little is known about small screens (eg, smartphones), which can be used in bed and emit notifications. Therefore, we examined associations of different screens in sleep environments with sleep duration and perceived insufficient rest or sleep.
  
  
  METHODS
  Participants included 2048 fourth- and seventh-graders participating in the Massachusetts Childhood Obesity Research Demonstration Study in 2012 to 2013. Using linear and log binomial regression, we examined cross-sectional associations of small screens and TVs in sleep environments and screen time with weekday sleep duration and perceived insufficient rest or sleep in the past week.
  
  
  RESULTS
  Children who slept near a small screen (compared with never) reported 20.6 fewer minutes of sleep (95% confidence interval [CI], -29.7 to -11.4) and had a higher prevalence of perceived insufficient rest or sleep (prevalence ratio, 1.39; 95% CI, 1.21 to 1.60). Children who slept in a room with a TV (compared with no TV) reported 18.0 fewer minutes of sleep (95% CI, -27.9 to -8.1). TV or DVD viewing and video or computer game playing were associated with both sleep outcomes (P < .01). Some associations were stronger among Hispanic, non-Hispanic black, and older children (P < .05 for heterogeneity).
  
  
  CONCLUSIONS
  Sleeping near a small screen, sleeping with a TV in the room, and more screen time were associated with shorter sleep durations. Presence of a small screen, but not a TV, in the sleep environment and screen time were associated with perceived insufficient rest or sleep. These findings caution against unrestricted screen access in children's bedrooms.
authors.affiliation: Division of Community Health and Human Development, School of Public Health, University of California Berkeley, Berkeley, California; jfalbe@berkeley.edu.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Falbe
authors.affiliation: Departments of Nutrition and Social and Behavioral Sciences, and.
authors.forename: Kirsten K
authors.initials: KK
authors.lastname: Davison
authors.affiliation: Departments of Nutrition and Social and Behavioral Sciences, and.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Franckle
authors.affiliation: Departments of Nutrition and Technische Universität Berlin, Berlin, Germany;
authors.forename: Claudia
authors.initials: C
authors.lastname: Ganter
authors.affiliation: Social and Behavioral Sciences, and Prevention Research Center, Harvard School of Public Health, Boston, Massachusetts;
authors.forename: Steven L
authors.initials: SL
authors.lastname: Gortmaker
authors.affiliation: National Institute for Children's Health Quality, Boston, Massachusetts;
authors.forename: Lauren
authors.initials: L
authors.lastname: Smith
authors.affiliation: Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, Massachusetts; and.
authors.forename: Thomas
authors.initials: T
authors.lastname: Land
authors.affiliation: Departments of Nutrition and Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts.
authors.forename: Elsie M
authors.initials: EM
authors.lastname: Taveras
mesh_terms: D040421:Cell Phone; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008404:Massachusetts; D009043:Motor Activity; D063766:Pediatric Obesity / Q000453:epidemiology / Q000209:etiology; D012146:Rest; D012307:Risk Factors; D012890:Sleep; D012892:Sleep Deprivation / Q000453:epidemiology / Q000209:etiology*; D012931:Social Environment; D013690:Television; D018910:Video Games; D014742:Videodisc Recording
keywords: adolescent; child; screen time; sleep; television