Increased Screen Time Associated With Higher BMI, Less Sleep in Adolescent Girls

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Screen usage among adolescent girls was associated with shorter weekday sleep and time in bed, as well as higher body mass index compared with girls reporting no screen time. Nearly two-thirds of girls also reported use of more than 1 screen at a time after school, in the evenings, and on weekends.

Nearly two-thirds of adolescent girls were found to use more than 1 screen at the same time after school, in the evenings, and on weekends, with increased screen time associated with less sleep and higher body mass index (BMI) compared with girls reporting no screen usage, according to a study published in Acta Paediatrica.

Among adolescents, a prior study found that insufficient sleep was associated with physical and mental health consequences, including increased risk of depression and obesity. Contributing to adverse sleep outcomes in children, technology usage has become a common issue that has further intensified amid the COVID-19 pandemic as children spend less time outdoors and more time at home.

Although conducted prior to the pandemic, the present cross-sectional study sought to assess this rise in screen time, particularly concurrent screen usage, and whether this was associated with any lifestyle behaviors and psychosocial health.

“Given the proliferation of screens beyond the TV and mobile phone, data on the prevalence and extent of concurrent viewing that includes a wider range of devices and from multi-ethnic groups would add to the extant literature,” explained the study authors.


Recruiting 816 adolescent females (mean age (SD), 12.8 (0.8) years; 20.4% non-White European) of East Midlands, United Kingdom, from April to June 2016. The participants wore an accelerometer for 7 days to calculate physical activity sleep and sedentary time, with screen ownership/use and psychosocial variables self-reported.

Relationships were determined via mixed models accounting for school clustering and confounders, in which adolescent girls' reporting use of no screens, 1 screen, 2 screens, 3 screens, and 4 or more screens was compared. Moreover, timing on use was also compared, indicated as straight after school, evening in your free time, in bed at night, and on weekends. BMI was also measured.

Among the participants, 59%, 65%, 36%, and 68% used > 2 screens concurrently after school, in the evening, before bed, and on weekends, respectively. The combination of TV/phone/tablet was the main combination after school (16.5%), in evenings (24.1%), while in bed (7.4%), and on the weekends (36.5%) among adolescent girls.

Compared with those reporting no screen usage, several significant associations were found in adolescent girls reporting use of 1 screen:

  • Lower physical activity following use of 1 screen on weekends
  • Lower weekend moderate to vigorous physical activity following use of 1 screen at bedtime
  • Higher BMI and lower time in bed with use of 1 screen use after school
  • Lower moderate to vigorous physical activity in the after‐school and evening period with the use of 1 screen in the evening

Additionally, use of 2 or more screens on the weekend and at bed time was associated with lower weekend moderate to vigorous physical activity, and use of 3 or more screens on the weekend was linked with higher weekend sedentary time. Compared with no screens, those reporting use of 1 to 3 screens after school exhibited shorter weekday sleep.

No differences in psychosocial or health-related quality of life measures were found in nonscreen users compared with 1-, 2-, or 3-screen users.

“In our analysis, the use of multiple screens did not appear to be more detrimental than screen use itself,” concluded the study authors. “Concurrent screen use may pose an opportunity to target young people with interventions or health-related content through multiple devices. This study adds to the evidence base to inform future screen use guidelines.”


Harrington DM, Ioannidou E, Davies MJ, et al. Concurrent screen use and cross-sectional association with lifestyle behaviours and psychosocial health in adolescent females. Acta Paediatr. Published online February 11, 2021. doi:10.1111/apa.15806