Open Access
Open Peer Review

This article has Open Peer Review reports available.

How does Open Peer Review work?

Combined influence of media use on subjective health in elementary school children in Japan: a population-based study

  • Harunobu Nakamura1Email author,
  • Kumiko Ohara1,
  • Katsuyasu Kouda2,
  • Yuki Fujita2,
  • Tomoki Mase1, 3,
  • Chiemi Miyawaki1,
  • Yoshimitsu Okita4 and
  • Tetsuya Ishikawa1
Contributed equally
BMC Public Health201212:432

https://doi.org/10.1186/1471-2458-12-432

Received: 11 January 2012

Accepted: 13 June 2012

Published: 13 June 2012

Abstract

Background

In recent years in Japan, electronic games, home computers, and the internet have assumed an important place in people’s lives, even for elementary school children. Subjective health complaints have also become a problem among children. In the present study, we investigated the relationship between media use and health status in elementary school children in Japan.

Methods

A cross-sectional school-based population survey was conducted in 2009 with a sample of fourth-, fifth-, and sixth-grade children (age range: 10–12 years old) in elementary schools in Japan (n = 3,464). Self-reported health, lifestyle habits, and time spent using media were assessed.

Results

The use of games, television, and personal computers was significantly associated with lifestyle (p < 0.05) and subjective health (p < 0.05). In addition, the use of games, the use of television, and the use of personal computers were mutually associated. The greater the number of media used for more than 1 hour was, the higher the odds ratio of the association of media use with unhealthy lifestyle and subjective health complaints was. The plural use of these media had stronger associations with unhealthy lifestyle and subjective health complaints.

Conclusions

Game, television, and personal-computer use were mutually associated, and the plural use of these media had stronger associations with unhealthy lifestyle and subjective health complaints. Excessive use of media might be a risk for unhealthy lifestyle and subjective health complaints.

Keywords

Children Media Lifestyle Subjective health

Background

In recent years, innovation in electronic media technologies has progressed dramatically, and electronic games, home computers, and the internet have assumed an important place in the lives of both adults and children, even elementary school children. Rideout et al. reported that the time spent using television (TV), personal computers (PC), and video games has increased from 1999 through 2009 in the United States of America [1]. Olds et al. reported that Australian children aged 10–13 years engage in nearly 4 hours of media use per day [2]. In Japan, the use of electronic media is similar to that in other industrial countries. For example, the mean prevalence rates of televisions and PCs per household were 99.6 % and 76.0 %, respectively, in Japan in 2011 [3]. These media provide us with useful information and fulfilment, but the excessive use of them has been identified as a health issue, even for elementary school children. Extensive television viewing tends to be associated with obesity [46], sleep problems [7, 8], and attention disorders [9]. Prolonged video viewing is related with poor attention span, poor creative imagination, and poor visual memory [10].

Subjective health encompasses the physical, emotional, mental, social and behavioral components of well-being and functioning as perceived by the individual [1113], and subjective health complaints have become a problem among children. For example, Gobina et al. reported that health complaints, such as headache, stomach-ache, difficulties in getting to sleep, and nervousness were common among adolescents (11-, 13-, and 15-year-old boys and girls) in 19 countries in Europe and in the USA [14]. Ravens-Sieberer et al. reported that 44 % of school children have multiple recurrent health complaints, such as headache, stomach-ache, nervousness, sleeping difficulties, and dizziness, in 41 European and North-American countries. They also reported that older adolescents and girls had more health problems, and the gender difference increased with age [15].

The relation between media use and some aspects of subjective health, such as sleep problems, has been reported [7, 8]. However, the relation has not been fully elucidated. Since both subjective health complaints and media use are common in adolescents, it is important to determine the relation between media use and the subjective health from a public health perspective. In addition, questions also arise regarding how much media use affects subjective health and what is the effect of the combination of media. However, little evidence has been collected on the influence of media use on children’s subjective health.

Therefore, we conducted a population-based cross-sectional study to investigate the current status of media use and the association of media use with health status and related factors in elementary school children in Japan.

Methods

Participants

We conducted a population-based cross-sectional study in three neighbouring cities (Awaji, Sumoto, and Minami-awaji) located in the urban area of Hyogo prefecture in the central part of Japan. A self-administered questionnaire was conducted in May 2009. The subjects were fourth-, fifth-, and sixth-graders (age range: 10–12 years old; mean ± standard deviation of age: 10.05 ± 0.81 years old) in public elementary schools in these three cities (n = 3,690). The responders included 3,464 children, and the response rate was 93.9 %. The participants included 1,056 fourth-graders (509 boys and 547 girls), 1,195 fifth-graders (597 boys and 598 girls), and 1,213 sixth-graders (615 boys and 598 girls). The study was approved by Human Ethics Committee of Graduate School of Human Development and Environment, Kobe University.

Questionnaire

The questionnaire was anonymous and had three parts and a total of 21 fixed-choice questions. The first part included questions pertaining to the time spent using media (game, TV, and PC). Response options included:" none", " up to 1 hr", "up to 2 hrs", "2 hrs or more". The second part included 9 items pertaining to lifestyle, including the following: "bedtime", "waking time", "good feeling on waking", "breakfast eating", "eating breakfast alone", "dinner time", "eating dinner alone", "learning time at home", and "reading at home". The responses for "bedtime" included "-21:00", "21:00–22:00", "22:00–23:00", "23:00–24:00", "24:00-", and "irregular". The response for "waking time" included "-6:00", "6:00–7:00", "7:00–8:00", "8:00-", and "irregular". The responses for "good feeling on walking", "eating breakfast alone", "eating dinner alone", or "reading at home" included "usually", "often", "occasionally", and "seldom". The responses for "breakfast eating" included "everyday", "often", "occasionally", and "seldom". The responses for "dinner time" included "-18:00", "18:00–19:00", "19:00–20:00", "20:00–21:00", and "21:00-". The responses for "learning time at home" included "none", "up to 30 min", "30-60 min", "1-2 hrs", and "2 hrs-". The third part included 9 items pertaining to subjective health complaints, as follows: "depression", "sleeplessness", "ill at ease", "dizziness", "poor appetite", "headache", "abdominal pain", "short-tempered", and "negative thinking". Each item had 4 responses: "usually", "often", "occasionally", and "seldom". The questionnaire was distributed during class by a teacher at each elementary school, and then collected after it was completed.

Statistical analysis

To assess the differences among factors, Student’s t test and a chi-square test (or Fisher’s exact test when appropriate) were performed. Logistic regression analysis was used to evaluate the association between the combined influence of media use and lifestyle habits or subjective health complaints, adjusting for gender and grade. Odds ratios (ORs) and 95 % confidence intervals (95 % CIs) were calculated. Differences with p-values <0.05 were considered significant. Statistical analysis was performed by SPSS® 18.0 J for Windows (SPSS Inc., Chicago, IL).

Results

The amounts of time spent using games, TV, and PCs are shown in Table 1. The time spent using games was significantly less in girls than boys (p < 0.001). In addition, children in older grades spent more time using TV and PCs than children in younger grades (TV, p < 0.001; PCs, p < 0.001).
Table 1

Descriptive status of media use in elementary school children

 

Boys

Girls

p value gender / grades

4th grade

5th grade

6th grade

4th grade

5th grade

6th grade

Game

None

86

91

98

167

195

186

* / ns

Up to 1 hr

289

311

315

328

346

337

Up to 2 hrs

85

136

134

42

38

53

2 hrs or more

44

51

65

8

14

18

Total

504

589

612

545

593

594

TV

None

33

33

25

36

26

20

ns / *

Up to 1 hr

156

170

164

201

178

148

Up to 2 hrs

147

178

187

151

178

146

2 hrs or more

160

200

226

140

198

275

Total

496

581

602

528

580

589

PC

None

324

331

338

368

332

301

ns / *

Up to 1 hr

150

208

216

150

212

228

Up to 2 hrs

14

26

35

15

26

43

2 hrs or more

12

14

15

2

9

14

Total

500

579

604

535

579

586

Values are head-counts. TV: television, PC: personal computer.

*p < 0.05 for chi-square analysis.

Lifestyle according to time spent using games, TV, or PCs is shown in Table 2. Children who spent more than 1 hr using games had significantly later bedtimes than those who spent less than 1 hr using games (p < 0.001) and had later waking times (p < 0.001), a lower rate of "good feeling on waking" (p < 0.001), a lower frequency of eating breakfast (p < 0.001), a higher frequency of eating breakfast alone (p < 0.001), had less learning time at home (p < 0.001), and spent less time reading at home (p < 0.001). Those who spent more than 1 hr using TV had significantly later bedtimes than those who spent less than 1 hr using TV (p < 0.001) and had later waking times (p = 0.002), a lower rate of "good feeling on waking" (p < 0.001), a lower frequency of eating breakfast (p = 0.002), a higher frequency of eating breakfast alone (p = 0.001), later dinner times (p = 0.005), and spent less time reading at home (p < 0.001). Those who spent more than 1 hr using PCs had significantly later bedtimes than those who spent less than 1 hr using PCs (p < 0.001) and had later waking times (p = 0.025), a lower rate of "good feeling on waking" (p = 0.005), a lower frequency of eating breakfast (p < 0.001), a higher frequency of "eating breakfast alone" (p < 0.001), a higher frequency of "eating dinner alone" (p = 0.005), and had more "learning time at home" (p = 0.001).
Table 2

Comparative analysis of media use and lifestyle

 

Game

TV

PC

less than 1 hr

more than 1 hr

less than 1 hr

more than 1 hr

less than 1 hr

more than 1 hr

Bedtime

−21:00

91

13*

57

43*

99

4*

21:00–22:00

817

118

409

511

892

30

22:00–23:00

964

227

366

808

1090

84

23:00–24:00

210

80

66

217

250

37

24:00-

22

24

10

35

33

11

Irregular

633

226

278

564

782

58

Total

2737

688

1186

2178

3146

224

Waking time

−6:00

191

30*

97

119*

202

15*

6:00–7:00

1327

287

580

1003

1490

98

7:00–8:00

944

265

379

814

1116

74

8:00-

33

15

15

32

38

8

Irregular

234

90

114

202

295

27

Total

2729

687

1185

2170

3141

222

Good feeling on waking

Usually

727

115*

356

468*

784

41*

Often

1450

316

568

1170

1637

108

Occasionally

432

183

207

400

551

52

Seldom

89

56

38

102

127

16

Total

2698

670

1169

2140

3099

217

Breakfast eating

Everyday

2455

554*

1069

1886*

2783

180*

Often

194

64

74

179

229

21

Occasionally

58

42

24

74

87

13

Seldom

21

23

8

34

33

10

Total

2728

683

1175

2173

3132

224

Eating breakfast alone

Usually

353

107*

130

321*

408

41*

Often

440

107

175

361

494

41

Occasionally

471

154

212

408

570

54

Seldom

1457

310

658

1075

1655

85

Total

2721

678

1175

2165

3127

221

Dinner time

−18:00

101

24

60

63*

114

10

18:00–19:00

730

188

342

562

855

46

19:00–20:00

1383

332

564

1119

1577

112

20:00–21:00

440

114

185

358

500

44

21:00-

54

21

26

50

69

7

Total

2708

679

1177

2152

3115

219

Eating dinner alone

Usually

68

23

31

59

78

12*

Often

235

65

93

202

278

21

Occasionally

425

127

180

364

494

49

Seldom

1980

460

867

1528

2261

138

Total

2708

675

1171

2153

3111

220

Learning time at home

none

78

42*

44

72

103

15*

up to 30 min

776

211

358

599

901

63

30–60 min

1264

282

528

1000

1444

83

1–2 hrs

491

120

198

406

554

50

2 hrs-

110

29

50

88

124

11

Total

2719

684

1178

2165

3126

222

Reading at home

Usually

341

55*

172

218*

364

30

Often

1140

212

494

831

1245

80

Occasionally

755

221

328

634

907

55

Seldom

492

195

186

487

618

58

Total

2728

683

1180

2170

3134

223

Values are head-counts. TV: television, PC: personal computer.

*p<0.05for chi-square test.

Subjective health complaints according to time spent using games, TV, and PCs are shown in Table 3. Children who spent more than 1 hr using games had a significantly higher frequency of depression than those who spent less than 1 hr using games (p < 0.001) and had a higher frequency of sleeplessness (p < 0.001), feeling ill at ease (p < 0.001), dizziness (p < 0.001), poor appetite (p < 0.001), headache (p = 0.002), abdominal pain (p = 0.003), being short-tempered (p < 0.001), and negative thinking (p < 0.001). Those who spent more than 1 hr using TV had a significantly higher frequency of sleeplessness than those who spent less than 1 hr using TV (p = 0.032) and had a higher frequency of feeling ill at ease (p = 0.001), poor appetite (p = 0.037), and being short-tempered (p < 0.001). Those who spent more than 1 hr using PCs had a significantly higher frequency of depression than those who spent less than 1 hr using PCs (p = 0.001) and had a higher frequency of sleeplessness (p = 0.022), feeling ill at ease (p = 0.008), dizziness (p < 0.001), poor appetite (p = 0.003), headache (p = 0.001), abdominal pain (p = 0.010), being short-tempered (p < 0.001), and negative thinking (p < 0.001).
Table 3

Comparative analysis of media use and subjective health complaints

 

Game playing

TV viewing

PC operating

less than 1 hr

more than 1 hr

less than 1 hr

more than 1 hr

less than 1 hr

more than 1 hr

Depression

Usually

173

82*

77

173

217

33*

Often

617

189

293

496

739

55

Occasionally

898

195

361

712

1006

61

Seldom

1052

220

458

798

1186

76

Total

2740

686

1189

2179

3148

225

Sleeplessness

Usually

282

118*

131

263*

360

37*

Often

710

209

320

585

847

57

Occasionally

745

181

291

615

835

68

Seldom

986

173

435

705

1087

60

Total

2723

681

1177

2168

3129

222

Ill at ease

Usually

371

153*

173

343*

469

48*

Often

593

179

238

514

702

53

Occasionally

788

187

327

631

900

61

Seldom

965

156

439

664

1051

54

Total

2717

675

1177

2152

3122

216

Dizziness

Usually

125

58*

67

109

160

20*

Often

385

117

161

333

441

51

Occasionally

543

130

211

454

625

43

Seldom

1649

372

728

1259

1880

108

Total

2702

677

1167

2155

3106

222

Poor appetite

Usually

141

50*

59

127*

173

l16*

Often

561

168

231

490

657

62

Occasionally

840

244

364

704

990

78

Seldom

1153

216

506

835

1281

64

Total

2695

678

1160

2156

3101

220

Headache

Usually

253

87*

129

204

297

36*

Often

738

206

315

608

856

71

Occasionally

833

206

342

688

965

61

Seldom

884

179

388

651

993

53

Total

2708

678

1174

2151

3111

221

Abdominal pain

Usually

162

58*

73

145

196

24*

Often

449

139

201

376

532

45

Occasionally

721

176

302

577

823

60

Seldom

1354

298

582

1041

1538

89

Total

2686

671

1158

2139

3089

218

Short-tempered

Usually

406

151*

172

378*

493

61*

Often

641

192

246

569

764

53

Occasionally

848

199

360

670

967

65

Seldom

795

132

377

535

867

42

Total

2690

674

1155

2152

3091

221

Negative thinking

Usually

257

87*

118

222

297

42*

Often

712

208

304

592

840

60

Occasionally

1005

243

418

806

1149

76

Seldom

748

145

339

544

842

46

Total

2722

683

1179

2164

3128

224

Values are head-counts. TV: television, PC: personal computer.

*p<0.05for chi-square test.

The relationships among games, TV, and PCs are shown in Table 4. Games were positively related with TV (Spearman’s ρ = 0.191, p < 0.001) or PCs (Spearman’s ρ = 0.242, p < 0.001). TV was positively related with PCs (Spearman’s ρ = 0.110, p < 0.001).
Table 4

Correlation coefficients among game, TV, and PC use

 

Game

TV

PC

Game

-

0.191*

0.242*

TV

 

-

0.110*

PC

  

-

The number is Spearman’s ρ. TV: television, PC: personal computer.

*p < 0.05 for Spearman’s correlation coefficients.

The results of the logistic regression model exploring the association between the plural use of media and lifestyle are shown in Table 5. Children who spent more than 1 hr on each of one, two, or all media devices were almost twice as likely (odds of one device: 1.224, p = 0.034; odds of two devices: 1.908, p < 0.001; odds of all devices: 2.258, p < 0.001) to go to bed at later hours, after the model was adjusted for sex and grade. Those who spent more than 1 hr on each of all media devices were almost two and one-half times more likely (odds: 2.502, p = 0.001) to wake at later hours, after the model was adjusted for sex and grade. Those who spent more than 1 hr on each of two or all media devices were twice as likely (odds of two devices: 2.071, p < 0.001) or two and one-half times as likely (odds of all devices: 2.621, p < 0.001) to have a bad feeling on waking, after the model was adjusted for sex and grade. Those who spent more than 1 hr on each of two or all media devices were about 4 times (odds of two devices: 3.843, p < 0.001) or 8 times (odds of all devices: 7.816, p < 0.001) more likely to eat breakfast with low frequency, after the model was adjusted for sex and grade. Those who spent more than 1 hr on each of one, two, or all media devices were about one and one-half times more likely (odds of one device: 1.301, p = 0.004; odds of two devices: 1.436, p = 0.003; odds of all devices: 1.572, p = 0.046) to eat breakfast alone, after the model was adjusted for sex and grade. Those who spent more than 1 hr on each of two or all media devices were about one and one-half times more likely (odds of two devices: 1.436, p = 0.003; odds of all devices: 1.572, p = 0.046) to eat breakfast alone, after the model was adjusted for sex and grade. Those who spent more than 1 hr on each of two media devices were almost one and one-half times more likely (odds: 1.306, p = 0.049) to eat dinner at later hours, after the model was adjusted for sex and grade. Those who spent more than 1 hr on each of one, two, or all media devices were about one and one-half times (odds of one device: 1.360, p < 0.001; odds of all devices: 1.633, p = 0.025) or two times (odds of two devices: 1.835, p < 0.001) more likely to read books with low frequency, after the model was adjusted for sex and grade.
Table 5

Associations between plural use of media and lifestyles

 

not adjusted

adjusted*

Odds

95 % CI

p value

Odds

95 % CI

p value

Bedtime

all less than 1 hr (ref)

1

  

1

  

one - more than 1 hr

1.158

(0.963-1.393)

0.119

1.224

(1.015-1.476)

0.034

two- more than 1 hr

1.871

(1.484-2.360)

<0.001

1.908

(1.502-2.424)

<0.001

all more than 1 hr

2.014

(1.302-3.117)

0.002

2.258

(1.446-3.525)

<0.001

Waking time

all less than 1 hr (ref)

1

  

1

  

one - more than 1 hr

1.038

(0.800-1.346)

0.779

1.088

(0.837-1.415)

0.527

two– more than 1 hr

1.325

(0.954-1.842)

0.093

1.286

(0.918-1.801)

0.144

all more than 1 hr

2.328

(1.366-3.967)

0.002

2.502

(1.452-4.312)

0.001

Good awakened feeling

all less than 1 hr (ref)

1

  

1

  

one - more than 1 hr

1.123

(0.920-1.370)

0.256

1.107

(0.906-1.352)

0.319

two– more than 1 hr

2.155

(1.690-2.747)

<0.001

2.071

(1.617-2.652)

<0.000

all more than 1 hr

2.754

(1.762-4.304)

<0.001

2.621

(1.671-4.111)

<0.000

Breakfast eating

all less than 1 hr (ref)

1

  

1

  

one - more than 1 hr

1.401

(0.853-2.301)

0.182

1.406

(0.855-2.311)

0.179

two– more than 1 hr

4.168

(2.501-6.945)

<0.001

3.843

(2.286-6.462)

<0.001

all more than 1 hr

8.305

(4.222-16.339)

<0.001

7.816

(3.935-15.525)

<0.000

Eating breakfast alone

all less than 1 hr (ref)

1

  

1

  

one - more than 1 hr

1.315

(1.101-1.570)

0.002

1.301

(1.089-1.555)

0.004

two– more than 1 hr

1.489

(1.181-1.877)

0.001

1.436

(1.135-1.818)

0.003

all more than 1 hr

1.647

(1.059-2.563)

0.027

1.572

(1.007-2.452)

0.046

Dinner eating

all less than 1 hr (ref)

1

  

1

  

one - more than 1 hr

0.982

(0.800-1.206)

0.865

0.979

(0.797-1.202)

0.839

two– more than 1 hr

1.329

(1.024-1.725)

0.033

1.306

(1.001-1.703)

0.049

all more than 1 hr

1.069

(0.624-1.830)

0.808

1.048

(0.610-1.801)

0.865

Eating dinner alone

all less than 1 hr (ref)

1

  

1

  

one - more than 1 hr

1.227

(0.952-1.582)

0.115

1.220

(0.946-1.575)

0.126

two– more than 1 hr

1.222

(0.873-1.711)

0.242

1.154

(0.820-1.624)

0.412

all more than 1 hr

1.657

(0.920-2.985)

0.092

1.563

(0.864-2.828)

0.140

Learning time at home

all less than 1 hr (ref)

1

  

1

  

one - more than 1 hr

0.923

(0.763-1.116)

0.408

0.949

(0.784-1.149)

0.591

two– more than 1 hr

0.957

(0.740-1.236)

0.735

0.908

(0.755-1.273)

0.883

all more than 1 hr

0.629

(0.397-0.997)

0.049

0.672

(0.423-1.069)

0.094

Reading at home

all less than 1 hr (ref)

1

  

1

  

one - more than 1 hr

1.356

(1.157-1.588)

<0.001

1.360

(1.159-1.596)

<0.001

two– more than 1 hr

2.081

(1.679-2.580)

<0.001

1.835

(1.474-2.285)

<0.001

all more than 1 hr

1.807

(1.184-2.756)

0.006

1.633

(1.065-2.504)

0.025

ref: reference.

*adjusted by gender and grade.

The results of the logistic regression model exploring the association between the plural use of media and subjective complaints are shown in Table 6. Children who spent more than 1 hr on each of two or all media devices were almost one and one-half times more likely (odds of two devices: 1.456, p = 0.001; odds of all devices: 1.644, p = 0.024) to feel "depression", after the model was adjusted for sex and grade. Those who spent more than 1 hr on each of two or all media devices were almost one and one-half times (odds of two devices: 1.477, p = 0.001) or two times (odds of all devices: 1.783, p = 0.007) more likely to feel "sleeplessness", after the model was adjusted for sex and grade. Those who spent more than 1 hr on each of one, two, or all media devices were between 1.2 and 2.5 times more likely (odds of one device: 1.286, p = 0.003; odds of two devices: 1.704, p < 0.001; odds of all devices: 2.476, p < 0.001) to feel "ill at ease", after the model was adjusted for sex and grade. Those who spent more than 1 hr on each of two or all media devices were almost two times more likely (odds of two devices: 1.728, p < 0.001; odds of all devices: 1.791, p = 0.016) to feel "dizziness", after the model was adjusted for sex and grade. Those who spent more than 1 hr on each of one or two media devices were almost one and one-half times more likely (odds of one device:1.248, p = 0.018; odds of two devices: 1.555, p < 0.001) to have a "poor appetite", after the model was adjusted for sex and grade. Those who spent more than 1 hr on each of two or all media devices were almost one and one-half times (odds of two devices: 1.327, p = 0.012) or two times (odds of all devices: 1.854, p = 0.004) more likely to suffer from "headache", after the model was adjusted for sex and grade. Those who spent more than 1 hr on each of two media devices were almost one and one-half times more likely (odds: 1.420, p = 0.005) to feel "abdominal pain", after the model was adjusted for sex and grade. Those who spent more than 1 hr on each of one, two, or all media devices were almost one and one-half times (odds of one device:1.446, p < 0.001) or two times (odds of two devices: 2.271, p < 0.001; odds of all devices: 1.864, p = 0.004) more likely to feel "short-tempered", after the model was adjusted for sex and grade. Those who spent more than 1 hr on each of two or all media devices were almost one and one-half times (odds of two devices: 1.463, p = 0.001) or two times (odds of all devices: 2.128, p < 0.001) more likely to experience "negative thinking", after the model was adjusted for sex and grade.
Table 6

Associations between plural use of media and subjective health complaints

 

not adjusted

adjusted*

Odds

95 % CI

p value

Odds

95 % CI

p value

Depression

all less than 1 hr (ref)

1

  

1

  

one - more than 1 hr

1.132

(0.952-1.345)

0.160

1.139

(0.958-1.355)

0.139

two- more than 1 hr

1.472

(1.176-1.842)

0.001

1.456

(1.158-1.830)

0.001

all more than 1 hr

1.639

(1.068-2.518)

0.024

1.644

(1.067-2.532)

0.024

Sleeplessness

all less than 1 hr (ref)

1

  

1

  

one - more than 1 hr

1.037

(0.881-1.220)

0.664

1.074

(0.911-1.265)

0.395

two - more than 1 hr

1.422

(1.147-1.762)

0.001

1.477

(1.185-1.840)

0.001

all more than 1 hr

1.631

(1.073-2.478)

0.022

1.783

(1.168-2.721)

0.007

Ill at ease

all less than 1 hr (ref)

1

  

1

  

one - more than 1 hr

1.233

(1.045-1.454)

0.013

1.286

(1.087-1.521)

0.003

two - more than 1 hr

1.848

(1.488-2.297)

<0.001

1.704

(1.362-2.131)

<0.001

all more than 1 hr

2.452

(1.600-3.757)

<0.001

2.476

(1.601-3.829)

<0.001

Dizziness

all less than 1 hr (ref)

1

  

1

  

one - more than 1 hr

0.929

(0.758-1.138)

0.475

0.912

(0.744-1.119)

0.378

two - more than 1 hr

1.622

(1.264-2.081)

<0.001

1.728

(1.338-2.232)

<0.001

all more than 1 hr

1.740

(1.091-2.775)

0.020

1.791

(1.117-2.872)

0.016

Poor appetite

all less than 1 hr (ref)

1

  

1

  

one - more than 1 hr

1.235

(1.030-1.482)

0.023

1.248

(1.040-1.498)

0.018

two - more than 1 hr

1.576

(1.246-1.994)

<0.001

1.555

(1.224-1.975)

<0.001

all more than 1 hr

1.497

(0.954-2.349)

0.079

1.505

(0.956-2.369)

0.077

Headache

all less than 1 hr (ref)

1

  

1

  

one - more than 1 hr

0.950

(0.807-1.119)

0.539

0.973

(0.826-1.146)

0.742

two - more than 1 hr

1.258

(1.013-1.561)

0.038

1.327

(1.064-1.654)

0.012

all more than 1 hr

1.713

(1.125-2.607)

0.012

1.854

(1.214-2.833)

0.004

Abdominal pain

all less than 1 hr (ref)

1

  

1

  

one - more than 1 hr

1.016

(0.842-1.226)

0.871

1.033

(0.855-1.248)

0.735

two - more than 1 hr

1.394

(1.095-1.775)

0.007

1.420

(1.110-1.817)

0.005

all more than 1 hr

1.443

(0.905-2.301)

0.123

1.506

(0.941-2.411)

0.088

Short-tempered

all less than 1 hr (ref)

1

  

1

  

one - more than 1 hr

1.409

(1.195-1.661)

<0.001

1.446

(1.225-1.706)

<0.001

two - more than 1 hr

2.186

(1.759-2.716)

<0.001

2.271

(1.819-2.836)

<0.001

all more than 1 hr

1.738

(1.140-2.651)

0.010

1.864

(1.218-2.853)

0.004

Negative thinking

all less than 1 hr (ref)

1

  

1

  

one - more than 1 hr

1.049

(0.890-1.236)

0.566

1.069

(0.906-1.261)

0.432

two - more than 1 hr

1.339

(1.078-1.662)

0.008

1.463

(1.172-1.826)

0.001

all more than 1 hr

1.922

(1.264-2.921)

0.002

2.128

(1.394-3.250)

<0.001

ref: reference.

*adjusted by gender and grade.

Discussion

We investigated the relationship between media use and lifestyle or subjective health complaints in elementary school children in Japan. The main finding of the present study was that those who spent more time using media had less healthy lifestyles and more subjective health complaints. In addition, game use, TV use, and PC use were mutually associated, and the plural use of these media had a stronger association with unhealthy lifestyles and subjective health complaints.

In the present study, those who spent more than 1 hr using a media device went to bed at a later time, woke at a later time, had a low frequency of feeling good on waking, ate breakfast with low frequency, and ate breakfast alone with high frequency. These indicators related to sleep or breakfast are associated with lifestyle regularity. According to the previous study, there was some evidence indicating that media use consumed time or displaced other activities after school. Van den Bulck reported that secondary school students who watched more television, played computer games, or used the internet went to bed later [16], and skipped meals [17, 18]. These results suggest that media use may be responsible for lifestyle irregularity through the displacement of daily activities or through surplus time spent.

Regarding subjective health complaints, those who spent more than 1 hr using a media device were more likely to have subjective health complaints, regardless of the kind of media. Bener et al. and Mathers et al. showed similar results in 6- to 18-year-old children and adolescents (mean age, 16 years old) [19, 20]. Namely, they found that spending prolonged hours using a computer or TV was associated with poor life habits, such as sleeplessness [19, 20]. Nagane et al. reported that lifestyle irregularity is associated with health complaints in university students [21]. In the present study, excessive media use was related with unhealthy lifestyles, which may be causally related to the frequency of subjective health complaints. In addition, the present results showed that game and PC use had stronger associations with multiple subjective health complaints than TV viewing, although the prevalence of the excessive use of TV was greater than that for games or PCs. The reason for this discrepancy among these media is not clear. There have been few previous reports in which differences among media are discussed. The present study also cannot address the reason for this discrepancy. It has been reported in children and adolescents that TV viewing is related with sedentary behavior and obesity because it involves long periods of sitting [19, 22, 23]. On the other hand, most of the studies regarding addiction referred to the influence of game or computer use [2427]. It is not clear why specific health issues are connected to specific media. The results of the present and previous studies may reflect the mechanism underlying the related health issues. Indeed, games, TV, and PCs involve very different communication methods. For example, TV watching is a one-way communication experience, while game-playing and PC operation involve two-way communication. In future studies, we should focus on the differences among these media.

Game use, TV use, and PC use for more than 1 hr per day were positively mutually correlated. We then verified the cumulative effects when these media were used for more than 1 hr combined. It was found that the greater the number of media used for more than 1 hr was, the higher the odds ratio of the association between media use and subjective health complaints was. Up to now, there has been little evidence with which to assess the combined effect of media on subjective health complaints in elementary school children. In adolescents, Punamaki et al. found that intensive usage of information and communication technology was associated with poor subjective health in adolescents [8]. In the present study, the plural use of media was also strongly associated with unhealthy lifestyles. This unhealthy lifestyle that accompanies the plural use of media may have an influence on subjective health complaints. As a consequence, the present results suggest that the plural use of media has a cumulative influence on subjective health.

The limitations of this study should be noted. First, the present study has a cross-sectional design which cannot draw conclusion about any cause-effect relationship. Second, the samples were collected from a limited area in Japan. Future studies will need to collect samples from a wider area and to employ a longitudinal design for the estimation of any cause-effect relationship. Third, the questionnaire in the present study has not been sufficiently validated, and the link between subjective health and objectively assessed health indices has not been established. In addition, we did not separate sedentary gaming from active gaming. Active gaming could be health enhancing, such as through energy expenditure [28]. Therefore, interpretation of our results may be limited.

Conclusions

We investigated the relationship between media use and lifestyle or subjective health complaints in elementary school children in Japan. Media use was positively associated with unhealthy lifestyles and subjective health complaints. In addition, game, TV, and PC use were mutually associated, and the plural use of these media had stronger associations with unhealthy lifestyles and subjective health complaints.

Notes

Declarations

Acknowledgements

We thank the children who participated in the present study. We also thank the many schools and education boards that allowed us to survey the children. We acknowledge the work of all of the teachers who conducted the data collection.

Authors’ Affiliations

(1)
Graduate School of Human Development and Environment, Kobe University
(2)
Department of Public Health, Kinki University Faculty of Medicine
(3)
Department of Childhood Education, Nagoya Women's University
(4)
Graduate School of Science and Technology, Shizuoka University

References

  1. Rideout V, Foehr U, Roberts D: Media in the lives of 8–18 year-olds. Generation M. 2010, Henry J. Kaiser Family Foundation, Menlo Park, CAGoogle Scholar
  2. Olds T, Ridley K, Dollman J: Screenieboppers and extreme screenies: the place of screen time in the time budgets of 10–13 year-old Australian children. Aust N Z J Public Health. 2006, 30 (2): 137-142. 10.1111/j.1467-842X.2006.tb00106.x.View ArticlePubMedGoogle Scholar
  3. Cabinet Office Government of Japan: Explanation of Monthly Consumer Confidence Survey Covering All of Japan. 2011, National Printing Bureau, TokyoGoogle Scholar
  4. Perez A, Hoelscher DM, Springer AE, Brown HS, Barroso CS, Kelder SH, Castrucci BC: Physical activity, watching television, and the risk of obesity in students, Texas, 2004–2005. Prev Chronic Dis. 2011, 8 (3): A61-PubMedPubMed CentralGoogle Scholar
  5. Anderson SE, Whitaker RC: Household routines and obesity in US preschool-aged children. Pediatrics. 2010, 125 (3): 420-428. 10.1542/peds.2009-0417.View ArticlePubMedGoogle Scholar
  6. Vandewater EA, Shim MS, Caplovitz AG: Linking obesity and activity level with children's television and video game use. J Adolesc. 2004, 27 (1): 71-85. 10.1016/j.adolescence.2003.10.003.View ArticlePubMedGoogle Scholar
  7. Gaina A, Sekine M, Hamanishi S, Chen X, Wang H, Yamagami T, Kagamimori S: Daytime Sleepiness and Associated Factors in Japanese School Children. J Pediatr. 2007, 151 (5): 518-522. 10.1016/j.jpeds.2007.04.036. e514View ArticlePubMedGoogle Scholar
  8. Punamaki RL, Wallenius M, Nygard CH, Saarni L, Rimpela A: Use of information and communication technology (ICT) and perceived health in adolescence: the role of sleeping habits and waking-time tiredness. J Adolesc. 2007, 30 (4): 569-585. 10.1016/j.adolescence.2006.07.004.View ArticlePubMedGoogle Scholar
  9. Swing EL, Gentile DA, Anderson CA, Walsh DA: Television and video game exposure and the development of attention problems. Pediatrics. 2010, 126 (2): 214-221. 10.1542/peds.2009-1508.View ArticlePubMedGoogle Scholar
  10. Kumari S, Ahuja S: Video Viewing and Cognitive Development in Preadolescents. Soc Sci Comput Rev. 2010, 28 (2): 170-176. 10.1177/0894439309334815.View ArticleGoogle Scholar
  11. Bullinger M: Assessing health related quality of life in medicine. An overview over concepts, methods and applications in international research. Restor Neurol Neurosci. 2002, 20 (3–4): 93-101.PubMedGoogle Scholar
  12. Taillefer M-C, Dupuis G, Roberge M-A, LeMay S: Health-Related Quality of Life Models: Systematic Review of the Literature. Sol Indic Res. 2003, 64 (2): 293-323. 10.1023/A:1024740307643.View ArticleGoogle Scholar
  13. The World Health Organization Quality of Life assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med. 1995, 41 (10): 1403-1409.View ArticleGoogle Scholar
  14. Gobina I, Valimaa R, Tynjala J, Villberg J, Villerusa A, Iannotti RJ, Godeau E, Gabhainn SN, Andersen A, Holstein BE, et al: The medicine use and corresponding subjective health complaints among adolescents, a cross-national survey. Pharmacoepidemiol Drug Saf. 2011, 20 (4): 424-431. 10.1002/pds.2102.View ArticlePubMedGoogle Scholar
  15. Ravens-Sieberer U, Torsheim T, Hetland J, Vollebergh W, Cavallo F, Jericek H, Alikasifoglu M, Valimaa R, Ottova V, Erhart M: Subjective health, symptom load and quality of life of children and adolescents in Europe. Int J Public Health. 2009, 54 (Suppl 2): 151-159.View ArticlePubMedGoogle Scholar
  16. Van den Bulck J: Television viewing, computer game playing, and Internet use and self-reported time to bed and time out of bed in secondary-school children. Sleep. 2004, 27 (1): 101-104.PubMedGoogle Scholar
  17. Van den Bulck J, Eggermont S: Media use as a reason for meal skipping and fast eating in secondary school children. J Hum Nutr Diet. 2006, 19 (2): 91-100. 10.1111/j.1365-277X.2006.00683.x.View ArticlePubMedGoogle Scholar
  18. Custers K, Van den Bulck J: Television viewing, computer game play and book reading during meals are predictors of meal skipping in a cross-sectional sample of 12-, 14- and 16-year-olds. Public Health Nutr. 2010, 13 (4): 537-543. 10.1017/S1368980009991467.View ArticlePubMedGoogle Scholar
  19. Bener A, Al-Mahdi HS, Vachhani PJ, Al-Nufal M, Ali AI: Do excessive internet use, television viewing and poor lifestyle habits affect low vision in school children?. Journal of child health care : for professionals working with children in the hospital and community. 2010, 14 (4): 375-385.View ArticleGoogle Scholar
  20. Mathers M, Canterford L, Olds T, Hesketh K, Ridley K, Wake M: Electronic media use and adolescent health and well-being: cross-sectional community study. Acad Pediatr. 2009, 9 (5): 307-314. 10.1016/j.acap.2009.04.003.View ArticlePubMedGoogle Scholar
  21. Nagane M, Suge R, Watanabe SI: Relationship between psychosomatic complaints and circadian rhythm irregularity assessed by salivary levels of melatonin and growth hormone. Journal of circadian rhythms. 2011, 9 (1): 9-10.1186/1740-3391-9-9.View ArticlePubMedPubMed CentralGoogle Scholar
  22. Bener A, Al-Mahdi HS, Ali AI, Al-Nufal M, Vachhani PJ, Tewfik I: Obesity and low vision as a result of excessive Internet use and television viewing. Int J Food Sci Nutr. 2011, 62 (1): 60-62. 10.3109/09637486.2010.495711.View ArticlePubMedGoogle Scholar
  23. Fulton JE, Wang X, Yore MM, Carlson SA, Galuska DA, Caspersen CJ: Television viewing, computer use, and BMI among U.S. children and adolescents. J Phys Act Health. 2009, 6 (Suppl 1): S28-35.PubMedGoogle Scholar
  24. Gentile DA, Choo H, Liau A, Sim T, Li D, Fung D, Khoo A: Pathological video game use among youths: a two-year longitudinal study. Pediatrics. 2011, 127 (2): e319-329. 10.1542/peds.2010-1353.View ArticlePubMedGoogle Scholar
  25. Chiu SI, Lee JZ, Huang DH: Video game addiction in children and teenagers in Taiwan. Cyberpsychol Behav. 2004, 7 (5): 571-581.View ArticlePubMedGoogle Scholar
  26. Skoric MM, Teo LL, Neo RL: Children and video games: addiction, engagement, and scholastic achievement. Cyberpsychol Behav. 2009, 12 (5): 567-572. 10.1089/cpb.2009.0079.View ArticlePubMedGoogle Scholar
  27. Gentile D: Pathological video-game use among youth ages 8 to 18: a national study. Psychological science. 2009, 20 (5): 594-602. 10.1111/j.1467-9280.2009.02340.x.View ArticlePubMedGoogle Scholar
  28. White K, Schofield G, Kilding AE: Energy expended by boys playing active video games. J Sci Med Sport. 2011, 14 (2): 130-134. 10.1016/j.jsams.2010.07.005.View ArticlePubMedGoogle Scholar
  29. Pre-publication history

    1. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/12/432/prepub

Copyright

© Nakamura et al.; licensee BioMed Central Ltd. 2012

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Advertisement