Associations Between Adverse Childhood Experiences and Early Adolescent Problematic Screen Use in the United States

doi:10.21203/rs.3.rs-2117790/v1

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Associations Between Adverse Childhood Experiences and Early Adolescent Problematic Screen Use in the United States

https://doi.org/10.21203/rs.3.rs-2117790/v1

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Journal Publication

published 22 Jun, 2023

Read the published version in BMC Public Health →

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Background

Problematic screen use, defined as loss of control over usage resulting in impairments in personal, social, and occupational functioning, has risen dramatically among adolescents. Adverse Childhood Experiences (ACEs) are important risk factors in the development of addictive behaviors and may play an important role in the development of problematic screen use.

Methods

Cross-sectional data from the Adolescent Brain Cognitive Development Study (Year 2; 2018-2020; N = 8,794) was analyzed in 2022. Multiple linear analyses were used to determine associations between ACEs and adolescent-reported problematic use of video games (Video Game Addiction Questionnaire), social media (Social Media Addiction Questionnaire), and mobile phones (Mobile Phone Involvement Questionnaire). Analyses were adjusted for potential confounders including age, sex, race/ethnicity, highest parent education, household income, and site.

Results

The 8,794 adolescent respondents ages 11-12 years old were racially and ethnically diverse (55.1% White, 19.5% Latino/Hispanic, 15.8% Black, 5.1% Asian, 3.2% Native American, 1.3% Other). ACEs were associated with higher problematic video game, social media, and mobile phone use in a dose-dependent fashion in both unadjusted and adjusted models.

Conclusions

Given the dose-dependent relationship in adolescent ACE exposure and rates of problematic screen use, public health programming for trauma-exposed youth should explore video game, social media, and mobile phone use among this population and implement interventions focused on supporting healthy digital habits.

social media

video game

adolescents

adolescent brain cognitive development study

Problematic screen use, defined as a loss of control over usage and impairments in personal, social, and occupational functioning,(1) has risen dramatically among adolescents; 45% of adolescents report being online “almost constantly.”(2) Problematic screen use can span a variety of modalities including video games, social media, and phones.(3) Given that excessive screentime and screen addictions are associated with reduction in physical activity,(4) increased risk of obesity,(5,6) and psychological distress including anxiety and depression,(1,5,7,8) identifying risk factors to inform prevention and intervention efforts is critical.

Recent research has highlighted that adverse childhood experiences (ACEs), defined as potentially traumatic events that occur before the age of 18, are an important risk factor in the development of addictive behaviors.(9,10) Several studies have shown that adolescents who have experienced childhood trauma have a higher risk of developing problematic video game,(11,12) internet,(13–15) and mobile phone use.(16) However, few studies have explored this relationship in a large, nationally representative U.S. sample in the setting of recent screen use increases. Further, few studies have used youth self-report screen-time data or focused on early adolescents, an age range when a spike in computer use, gaming, and social media use occurs.(17) Moreover, the relationship between ACEs and problematic social media use, defined by a perceived need to have a constant connection to technology,(5,7) has yet to be explored. This study aims to fill these gaps by examining the associations between ACEs and problematic video game, social media, and mobile phone use among a large, nationally representative sample of U.S. early adolescents. It is hypothesized that higher adolescent ACE scores will be associated with higher rates of problematic video game, social media, and phone use.

This study used a cross-sectional design to achieve the following aim: determine the association between ACE score and problematic screen use among U.S. early adolescents. This study used survey data from the Adolescent Brain Cognitive Development (ABCD) study, a large, diverse, prospective cohort study of brain development and health among adolescents from 21 recruitment sites across the U.S.(18) Study participants were excluded who were missing data for sociodemographic variables and who were not asked problematic screen use questions due to not reporting video game, social media, or mobile phone use (n = 3,086; Supplemental Table 1). To maximize retention, at a minimum, research staff connects with families every 6 months by telephone and every year in person. In addition, to prevent higher attrition rates from low-income families, during research visits, the study provides a free nutrition and exercise program, a meal, homework assistance, childcare for other family members who attended the participant to the visits, and transportation vouchers as needed. The final sample consisted of 8,794 adolescents ages 11–12 years old during the two-year follow-up. Centralized institutional review board (IRB) approval was received from the University of California, San Diego (UCSD). Written informed consent and assent were obtained from caregivers and the child, respectively.

Measures

Exposure Variables

ACE score was calculated through adolescent and parent responses from the baseline (2016–2018), one-year follow-up (2017–2019), and two-year follow-up (2018–2020) surveys. The ABCD study assesses nine of ten ACEs reflecting the items in the original CDC-Kaiser ACE study (Supplemental Table 2).(19,20) Emotional abuse was not assessed in the ABCD study and therefore not included. ACE score was then categorized as 0 through ≥ 4, as a cumulative ACE score of ≥ 4 has documented greater risk concentration at this threshold.(19,21)

Outcome Variables

Adolescents completed the following questionnaires at the two-year follow-up, the first time these surveys were administered (Supplemental Table 3).

The Video Game Addiction Questionnaire (VGAQ) is a six-question instrument used to assess problematic video game use. The questions were adapted from the Bergen Facebook Addiction Scale.(22) The Bergen Facebook Addiction Scale consists of a single factor structure questionnaire assessing Facebook addiction, but authors have previously extrapolated its application to broader video game and social media addiction among high school and college students.(23,24) Example questions include “I spend a lot of time thinking about playing video games” and “I’ve become stressed or upset if I am not allowed to play video games.” Likert-type scale responses ranged from 1 (never) to 6 (very often). Participants who reported any video game use on weekdays or weekends were asked these items.

The Social Media Addiction Questionnaire (SMAQ) is a six-question survey also adapted from the Bergen Facebook Addiction Scale (25). Example questions include “I feel the need to use social media apps more and more” and “I use social media apps so much that it has had a bad effect on my schoolwork or job.” Likert-type scale responses ranged from 1 (never) to 6 (very often). Participants who reported having at least one social media account were asked these items.

The eight question Mobile Phone Involvement Questionnaire (MPIQ) was developed to assess problematic phone use in adolescents.(26) This instrument has been previously used in a study of U.S. high school students examining smartphone dependence.(27) Examples include “I lose track of how much I am using my phone” and “Arguments have arisen because of my phone use.” Likert-type scale responses ranged from 1 (strongly disagree) to 7 (strongly agree). Participants who reported having mobile phones were asked these items.

Covariates

Parents reported participants’ age, sex (male or female) and race/ethnicity (White, Black, Native American, Latino/Hispanic, Asian, or Other) at baseline. Parents also reported highest parent education (high school or lower versus college or higher) and household income (less than $75,000 and $75,000 or more, reflecting U.S. median household income) at the two-year follow-up.(29)

Statistical Analyses

Linear regression analyses estimated prospective associations between baseline ACE score and problematic screen use scores (video game, social media, and mobile phone). Analyses were adjusted for potential confounders listed above. Analyses were conducted using Stata 17.0 (StataCorp). Propensity weights were applied to match sociodemographic variables in the ABCD Study to the American Community Survey from the U.S. Census.(30) Given potential overlap between outcome variables, a correlation matrix is shown in the appendix (Supplemental Table 4).

The sample of 8,794 adolescents was racially and ethnically diverse (55.1% White, 19.5% Latino/Hispanic, 15.8% Black, 5.1% Asian, 3.2% Native American, 1.3% Other; Table 1).

In both the unadjusted and adjusted models, a higher ACE score was associated with increased self-report of problematic video game use, problematic media use, and problematic phone use (Table 2). Figure 1 highlights how increasing ACE score was associated with increased problematic screen use in a dose-dependent manner.

This large, demographically diverse, national sample of 8,794 early adolescents found that greater ACE score was significantly associated with increased risk of problematic video game, social media, and phone use. Further, the risk of problematic use increased in a dose-dependent manner, with youth exposed to 4 or more ACEs reporting the highest average problematic use of video games, social media, and phones.

Increased rates of problematic screen use among a nationally representative study of U.S. youth with higher ACE scores builds upon prior findings. Previous studies have shown that ACEs are associated with higher video game use among Japanese adolescents(12) and Chinese university students(11) and higher mobile phone addiction in Chinese university students.(16) In addition, a 2019 study of exclusively high-risk U.S. youth found a dose-dependent relationship between ACEs and problematic media use using parent-report data.(14) This study builds upon these prior findings by using youth self-report data and showing that ACEs continue to be an important risk factor for problematic screen use among demographically diverse, U.S. early adolescents.(17,31) Our study further adds to the literature by focusing on early adolescents, who represent a critical age group because this developmental period is vulnerable to the development of health-related risk factors.(2,32) This study also found that problematic social media use, a contemporary, novel measure associated with adverse physical and mental health consequences, was associated with ACEs, which has not previously been explored.(31,33)

Limitations to this study include vulnerability to confounding variables. Although several potential sociodemographic variables were controlled for, residual confounders may have been present. This study includes data from prior and during the pandemic (2018–2020), so we are unable to detect solely pandemic-related changes in screen time behaviors. Participants were excluded due to missing data, which creates the possibility of selection bias and may limit generalizability. Finally, mobile phone and social media behavior may have areas of overlap.(34)

This study demonstrates that adolescent problematic screen use is associated with ACE score, which has important clinical and public policy implications for screen time recommendations. For example, clinicians should be aware of the increased risk of problematic screen use among youth with high ACE scores, explore video game, social media, and mobile phone use among this population, and collaborate with families to implement a family media use plan informed by the American Academy of Pediatrics.(35) In addition, schools may consider implementing curricula focused on promoting healthy digital habits.(36) Future studies should explore protective factors to problematic video game, social media, and mobile phone use among ACE-exposed adolescents and the effectiveness of clinic-based interventions for this population.

Adverse Childhood Experiences (ACEs)

Adolescent Brain Cognitive Development (ABCD) study

Video Game Addiction Questionnaire (VGAQ)

Social Media Addiction Questionnaire (SMAQ)

Mobile Phone Involvement Questionnaire (MPIQ)

Ethics approval and consent to participate

Written informed consent and assent were obtained from the parent/guardian and adolescent, respectively, to participate in the ABCD Study. The University of California, San Diego provided centralized institutional review board (IRB) approval and each participating site received local IRB approval:

• Children’s Hospital Los Angeles, Los Angeles, California

• Florida International University, Miami, Florida

• Laureate Institute for Brain Research, Tulsa, Oklahoma

• Medical University of South Carolina, Charleston, South Carolina

• Oregon Health and Science University, Portland, Oregon

• SRI International, Menlo Park, California

• University of California San Diego, San Diego, California

• University of California Los Angeles, Los Angeles, California

• University of Colorado Boulder, Boulder, Colorado

• University of Florida, Gainesville, Florida

• University of Maryland at Baltimore, Baltimore, Maryland

• University of Michigan, Ann Arbor, Michigan

• University of Minnesota, Minneapolis, Minnesota

• University of Pittsburgh, Pittsburgh, Pennsylvania

• University of Rochester, Rochester, New York

• University of Utah, Salt Lake City, Utah

• University of Vermont, Burlington, Vermont

• University of Wisconsin—Milwaukee, Milwaukee, Wisconsin

• Virginia Commonwealth University, Richmond, Virginia

• Washington University in St. Louis, St. Louis, Missouri

• Yale University, New Haven, Connecticut

All methods were carried out in accordance with relevant guidelines and regulations.

Consent for publication

Not applicable

Availability of data and materials

Data used in the preparation of this article were obtained from the ABCD Study (https://abcdstudy.org), held in the NIMH Data Archive (NDA). Investigators can apply for data access through the NDA (https://nda.nih.gov/).

Competing interests

The authors declare that they have no competing interests.

Funding

J.M.N. was funded by the National Institutes of Health (K08HL159350), the American Heart Association Career Development Award (CDA34760281), and the Doris Duke Charitable Foundation (2022056). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author’s contributions

J.H.R. was responsible for the co-development of the research study design, methods, and data analysis; she also drafted the initial manuscript. K.T.G, A.T., and D.B.J. co-developed the study design, methods, and formal analysis; they also provided oversight and participated in the revision of the manuscript. G.S and O.M.S. completed the data cleaning and critically reviewed the manuscript. J.M.N provided supervision; he also co-developed the conceptualization of the study, methods, and supported the analysis and manuscript revision. All authors approved the final submitted version.

Acknowledgements

The ABCD Study was supported by the Nacional Institutes of Health and additional federal partners under award numbers U01DA041022, U01DA041025, U01DA041028, U01DA041048, U01DA041089, U01DA041093, U01DA041106, U01DA041117, U01DA041120, U01DA041134, U01DA041148, U01DA041156, U01DA041174, U24DA041123, and U24DA041147. A full list of supporters is available at https://abcdstudy.org/federal-partners/. A listing of participating sites and a complete listing of the study investigators can be found at https://abcdstudy.org/principal-investigators.html. ABCD consortium investigators designed and implemented the study and/or provided data but did not necessarily participate in the analysis or writing of this report.

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Table 1: Descriptive characteristics of participants in the Adolescent Brain Cognitive Development Study (ABCD) Study, 2018-2020 (n=8,794)

	Mean (SD) or %
Demographic characteristics
Age		12.0 (0.7)
Sex
Female		47.7%
Male		52.3%
Race/ethnicity
White		55.1%
Latino / Hispanic		19.5%
Black		15.8%
Asian		5.1%
Native American		3.2%
Other		1.3%
Highest parent education
High school education or less		15.1%
College education or more		84.9%
Household income
Less than $75,000		48.2%
$75,000 and greater		51.8%
Self-reported adverse childhood experiences
No ACEs		16.8%
1 ACE		30.8%
2 ACEs		27.0%
3 ACEs		15.7%
4 or more ACEs		9.8%
Problematic screen use measures
Video game use (Videogame Addiction Questionnaire, range 1-6)		2.1 (1.1)^a
Social media use (Social Media Addiction Questionnaire, range 1-6)		1.8 (0.9)^b
Mobile phone use (Mobile Phone Involvement Questionnaire, range 1-8)		3.1 (1.1)^c

Propensity weights from the Adolescent Brain Cognitive Development Study were applied based on the American Community Survey from the US Census. ACEs = Adverse Childhood Experiences.

^aAsked among a subset who reported video game use (n=6,911)

^bAsked among a subset who reported social media use (n=5,080)

^cAsked among a subset who reported mobile use (n=6,703)

Table 2. Associations among ACE score and problematic video game use, social media use, and phone use

Panel A: Bivariate Model
Problematic screen use measures	Problematic Video Game Use^a	Problematic Social Media Use^b	Problematic Phone Use^c
	B	B	B
	(95% CI)	(95% CI)	(95% CI)
ACEs - 0	reference	reference	reference
ACEs – 1	0.19***	0.11**	0.17***
ACEs – 1	(0.10 - 0.27)	(0.04 - 0.19)	(0.08 - 0.26)
ACEs – 2	0.27***	0.13**	0.24***
ACEs – 2	(0.19 - 0.35)	(0.05 - 0.21)	(0.15 - 0.33)
ACEs – 3	0.38***	0.23**	0.34***
ACEs – 3	(0.28 - 0.47)	(0.13 - 0.33)	(0.23 - 0.44)
ACEs – 4+	0.52***	0.29***	0.32***
ACEs – 4+	(0.39 -0.65)	(0.17-0.41)	(0.19 - 0.45)
Panel B: With Confounding Variables
	Problematic Video Game Use vs. ACE score	Problematic Social Media Use vs. ACE score	Problematic Phone Use vs. ACE score
	B	B	B
	(95% CI)	(95% CI)	(95% CI)
ACEs - 0	reference	reference	reference
ACEs – 1	0.13***	0.11**	0.18***
ACEs – 1	(0.06 - 0.20)	(0.04 - 0.19)	(0.10 - 0.26)
ACEs – 2	0.21***	0.14**	0.24***
ACEs – 2	(0.14 - 0.28)	(0.06-0.22)	(0.16 - 0.33)
ACEs – 3	0.25***	0.16**	0.25***
ACEs – 3	(0.15 - 0.34)	(0.06 - 0.26)	(0.23 - 0.35)
ACEs – 4+	0.42***	0.33***	0.33***
ACEs – 4+	(0.26 - 0.59)	(0.17 - 0.48)	(0.15 - 0.51)
indicates statistical significance at p<0.01, * indicates statistical significance at p<0.001. ABCD propensity weights were applied based on the American Community Survey from the U.S. Census. Panel B models include sex, race/ethnicity, household income, parent education, and site. ACEs = Adverse childhood experiences; CI = Confidence Interval;

^aAsked among a subset who reported video game use (n=6,911)

^bAsked among a subset who reported social media use (n=5,080)

^cAsked among a subset who reported mobile use (n=6,703)

No competing interests reported.

SupplementalAppendix.docx
· File name: Additional file 1 · File format: .docx · Title of data: Supplemental Appendix
- Supplemental Table 1. Comparison of participants included vs excluded
- Supplemental Table 2: Childhood Adverse Childhood Experiences (ACEs) Scale from the ABCD study
- Supplemental Table 3. Dependent Variables
- Supplemental Table 4: Correlations among problematic video game, social media, and mobile phone use

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Associations Between Adverse Childhood Experiences and Early Adolescent Problematic Screen Use in the United States

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Abstract

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Introduction

Methods

Measures

Exposure Variables

Outcome Variables

Covariates

Statistical Analyses

Results

Discussion

Conclusions

Abbreviations

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