LOSS OF EXERCISE BENEFITS IN ADOLESCENTS DUE TO EXCESSIVE SCREEN TIME by Robert Shelton A project submitted in partial fulfillment of the requirements for the degree of MASTER OF EDUCATION IN CURRICULUM AND INSTRUCTION WEBER STATE UNIVERSITY Ogden, Utah June 9, 2021 Approved ____________________________________ Peggy J. Saunders, Ph.D. ____________________________________ DeeDee Mower, Ph.D. ____________________________________ Forrest Crawford, Ed.D. EXERCISE BENEFITS AND SCREEN TIME 2 Acknowledgements I would like to express my sincere appreciation to Dr. Peggy Saunders who was my committee chair during this process. Dr. Saunders was always willing to help at any time, and I very much appreciate the many zoom sessions that we held to improve my project. During the completion of my project, COVID-19 was spreading at a rapid rate throughout the United States. This put added pressure upon educators including myself who were teaching in the classroom. It was especially difficult and stressful to find time and focus on my project during the pandemic. I appreciated Dr. Saunders' calming influence, experience, and knowledge that she brought to each of our meetings, which calmed my nerves and gave me direction. I would like to thank my parents for always instilling in me the importance of education and for being an example of high academic achievement. Throughout my education my parents have always gone above and beyond to make sure I had all that I needed to succeed in my education, ranging from a car full of groceries and a tank of gas, to later on, babysitting our little ones to help out with finances. I especially want to thank my wife who has never muttered a word of complaint about my schooling. This master’s degree has been a long and winding road for me, and she has been there for all of it, lending her advice and support when it was needed most. I am sure that she has felt like a single mother during the especially busy times, but was always there after a late night of work or study to greet me with a smile and a “how was your day?” My wife received her masters degree long before I did and was always a good example to me of hard work and dedication to her career and education. My wife and family have been my greatest inspiration through this whole process. EXERCISE BENEFITS AND SCREEN TIME 3 Table of Contents NATURE OF THE PROBLEM…………………………………………………………………...7 Literature Review………………………………………………………………………….8 Adolescents and Screen Time……………………………………………………..8 Current Trends in Screen Time Among Adolescents……………………………..9 Perceptions of Screen Time Use…………………………………………………10 Excessive Screen Time Is Likely Replacing Exercise…………………………...11 Environmental Factors Associated With Increased Screen Time and Decrease Exercise…………………………………………………………………………..12 Academics and Exercise…………………………………………………………15 Cognitive Effects of Exercise and Screen Time on Adolescents………………...17 Ability To Focus………………………………………………………….17 Sleep Patterns…………………………………………………………….18 Anxiety…………………………………………………………………...20 Health Effects of Screen Time and Exercise on Academics……………………..22 Mental Health………………………………………………………….....22 General Health…………………………………………………………...23 Summary………………………………………………………………………………....24 PURPOSE………………………………………………………………………………………..26 METHOD………………………………………………………………………………………..27 EXERCISE BENEFITS AND SCREEN TIME 4 Participants……………………………………………………………………………… 27 Instruments……………………………………………………………………………….28 Procedures………………………………………………………………………………………..29 Data Analysis…………………………………………………………………………….30 RESULTS………………………………………………………………………………………...31 Parental Participants……………………………………………………………………...31 Demographics of Students…………………………………………………………….....32 Screen Time……………………………………………………………………………...32 Exercise and Academics……………………………………………………………...….36 Health Benefits…………………………………………………………………………...38 DISCUSSION…………………………………………………………………………………....44 Adolescents and Daily Screen Time……………………………………………………..45 Exercise, Academics, and Adolescents…………………………………………………..47 Exercise Benefits in Adolescents and Screen Time……………………………………...48 Limitations and Recommendations………………………………………………………50 REFERENCES…………………………………………………………………………………...53 Appendix A Survey…………………………………………………………………………………….61 EXERCISE BENEFITS AND SCREEN TIME 5 Abstract Exercise benefits for adolescents, established by research, may be missing in the lives of adolescents whose lives are dominated by screen time. Research indicates that now more than ever most adolescents spend the majority of their free time on various screen based activities. Adolescents are so preoccupied with screens that little to no time is left during the day for the recommended 60 minutes of exercise. The purpose of this study was to examine a cause and effect relationship between increased leisure screen time and decreased voluntary exercise in adolescents. Additionally, this study explored some of the benefits of exercise such as, improved ability to focus, improved sleep patterns, and decreased anxiety that may be lost as a result of increased screen time and decreased exercise. A quantitative approach was used through distribution of a survey to parents of students at two pre-selected junior high schools. This survey asked parents about their adolescent’s daily voluntary screen time and exercise habits. The survey also asked parents if the adolescent experienced anxiety, problems focusing, or had inconsistent sleep patterns that may be related to increased screen time and little to no exercise. Results of the survey confirmed prior research that adolescents do spend a large portion of their leisure time on screens. The survey also showed that the majority of adolescents do not exercise the recommended daily amount of 60 minutes. Nearly half of all parents reported that their adolescent experiences anxiety, problems focusing, or inconsistent sleep patterns. As indicated by prior research, correlation between increased screen time and decreased exercise is difficult to establish and this study agrees with those findings. However, this study strongly suggests causation between screen time and no exercise in adolescents simply because adolescents are spending so much of their time on screens that no time is left for exercise. Further, because of the EXERCISE BENEFITS AND SCREEN TIME 6 large number of parents that indicated that their adolescent does experience anxiety, sleep issues, or problems focusing, this study could warrant more focused studies pertaining to the loss of exercise benefits due to excessive screen time. EXERCISE BENEFITS AND SCREEN TIME 7 NATURE OF THE PROBLEM Adolescents are becoming increasingly preoccupied with screen-based technology (Twenge et al., 2018). Teens are engaging in more screen time than ever before, frequently turning to social media outlets on their phones during their leisure time (Toh et al., 2019). Twenge & Spitzberg (2018) reported that teens spent approximately four to six hours a day on digital media, texting, and gaming then compared these results to 2010 and found that leisure time spent online increased during that time period. The Center for Disease Control (CDC, 2018) reports that, on average, adolescents are spending seven and a half hours a day on entertainment media. The American Academy of Pediatrics (AAP, 2016) recommends that adolescents participate in at least one hour of daily exercise and limit screen time. In North America, adolescents who exceeded recommendations of limited screen based leisure time, exercise less (Melkevik et al., 2010). Adolescents who spend more leisure time on screen-based activities may be replacing time otherwise spent doing voluntary exercise (Fountaine et al., 2011). While it is difficult to definitively state that voluntary exercise is being replaced by time spent on screens, Fountaine et al. (2011) found that increased screen time is associated with lower levels of activity. If secondary students are spending more time on screens and less time being active, they may be losing the potential benefits of exercise pertaining to academic achievement. Physical exercise has been shown to be beneficial for academic success (Valdez & Yang, 2011). One large study showed that there was a positive correlation between increased levels of physical activity and academic achievement (Bezold et al., 2014). This study also showed a positive correlation EXERCISE BENEFITS AND SCREEN TIME 8 between decreased levels of activity and academic performance. Specific, physiologic reasons why exercise has been shown to consistently have a positive effect on school aged children are still up for debate (Spitzer & Hollmann, 2013). Possible benefits of exercise that could impact academics are increased ability to focus (Spitzer & Hollman, 2013); improved sleep patterns (Schoeni et al., 2015); and reduced anxiety among young adults (Herring et al., 2018). In addition, exercise can possibly combat other mental and general health conditions that could otherwise result in a drop in academic performance (Hrafnkelsdottir et al., 2018). Research indicates that constant usage of screen based activities could not only result in an exclusion of daily exercise but could exacerbate these physiologic effects, thus creating barriers to academic success (Castagna et al., 2019; Ra et al., 2018; Schoeni et al., 2015; Scott et al., 2019). Therefore, this study aims to explore the cause and effect relationship that excessive screen time may have on exercise and subsequent academic achievement. Literature Review Adolescents and Screen Time Recently studies have shown that average American adolescents spend 4-6 hours of their daily leisure time on screen based activities including the internet, social media, and texting (Twenge & Spitzberg, 2018). Although it is difficult to measure than definitively state how much time adolescents are spending on screens, most researchers who have attempted to do so have come up with a figure that represents a large portion of an adolescents’ day (Rideout, 2016). For example, Common Sense Media reported that teens are spending as much as nine hours a day on screen based activities, in addition to other obligations that require technology such as education EXERCISE BENEFITS AND SCREEN TIME 9 (Rideout, 2016). The current body of research clearly indicates that adolescents are spending a significant portion of their day on screens. Current Trends in Screen Time Among Adolescents Smartphone use accounts for a large portion of adolescent screen time, with as many as 95% of adolescents having access to a smartphone, and 85% of adolescents, ages 13-17, owning a smartphone (Throuvala et al., 2019). Smartphone accessibility is one of the main factors why online usage is so high amongst adolescents. Smartphones have made it possible for adolescents to constantly stay connected to the internet and various forms of popular online activities such as social media. Social networking sites such as Youtube, Instagram, Snapchat, and Facebook represent a dominant portion of everyday life among average adolescents especially in adolescent females, while online gaming represents the dominant form of screen based activity for adolescent males (Garcia et al., 2017; Throuvala et al., 2019). Offline video games, which are played less than online video games, are typically played alone and have an end goal during the course of game playing. However, online gaming is done with other people and often does not have an end (Smohai et al., 2017). Online games are played with many other players in a giant virtual room with up to 50 players who can all interact and compete or cooperate during the in-game objective. Gaming has consumed so much of some adolescents' time that it sometimes leads to unhealthy addictions or mental health problems (Ferguson et al., 2011; Kuss & Griffiths, 2012). Internet gaming disorder is even included in the DSM-5 and is diagnosed when the person spends significant portions of the day playing video games with no self inhibition to stop playing (Kuss et al., 2019). It is not uncommon for adolescents to be diagnosed with internet gaming disorder. EXERCISE BENEFITS AND SCREEN TIME 10 Perceptions of Screen Time Use Modern technology has made it possible for society to perform multiple tasks, essential or non essential, with the use of a mobile touch screen device. These tasks include, but are not limited to, health interventions (i.e. doctor visits), family video time using connectivity capabilities such as Face-Time, music, video, gaming, social media, and other online endeavors (Toh et al., 2019). Adolescents are performing some of the same functions as adults while using multi-capability handheld devices. One qualitative study conducted interviews with adolescents, ages 11-17, and their parents about adolescents’ use of multi touch screen devices (Toh et al., 2019). This study offered a unique perspective because it gathered subjective information of adolescent time spent on screens from the adolescents themselves and their parents. Smartphones were the device most frequently used, and all except 2 of the 36 students interviewed owned a smartphone. The adolescents who owned a smartphone reported using them at all hours of the day, everyday of the week whenever possible (Toh et al., 2019). Smartphone use started in the morning when it was used as an alarm clock and to check social media, then continued throughout the morning. On school days smartphone use was continued during breaks, in between classes, during lunch, and even during class time when smartphone use was not permitted. After school, adolescents continued heavy usage of a smartphone well into the night. When at home, smartphone use actually increased because there were less distractions. Night usage was especially high as most adolescents reported that there were less interruptions, more privacy, and they had more free time. Additionally, other activities that do not require the use of a smartphone, such as homework and extracurricular activities, adolescents reported practicing multitasking while doing these EXERCISE BENEFITS AND SCREEN TIME 11 activities to do frequent “check-ins” of social media or texting with friends. Adolescents reported ubiquitous usage of smartphones including any leisure or free time as a form of entertainment to relax and something to do when they experienced boredom (Toh et al., 2019). Toh et al. (2019) also interviewed parents; the parents whose children owned a smartphone reported high frequency use at all hours of the day by their adolescents as well. For example one parent was quoted as saying, “Every other minute they will not go anywhere without the phone, even from the room to the hall to the kitchen... anywhere in the house he moves, the phone moves with him” (Toh, 2019, p. 5). Excessive Screen Time Is Likely Replacing Exercise Currently research has indicated that as many as 78% boys and 85% girls on a global scale are not meeting current recommendations for exercise of at least 60 minutes a day set forth by organizations such as the World Health Organization (WHO) (Guthold et al., 2020). It is difficult to definitively state that children and adolescents who are engaging in leisure time screen based behaviors are replacing time otherwise spent on exercise (Fountaine et al., 2008). However, evidence indicates that adolescents who are spending a large majority of their time on screens exercise less (Melkevik et al., 2010). Clearly adolescents are spending more time doing non active things during their leisure time, and it must be assumed that a large part of sedentary behavior in adolescents is spent on screen based behaviors, such as mobile phones (Guthold et al., 2020; Rideout, 2016; Throuvala et al., 2019; Toh et al., 2019). However, it is difficult to show a definitive, positive correlation between sedentary behaviors and screen time in adolescents and then to state that one is the cause of the other (Melkevik et al., 2010). These ideas are evidenced by the lack of research of this kind, showing a relationship between EXERCISE BENEFITS AND SCREEN TIME 12 excessive screen time and lack of physical activity in adolescents (Fountaine et al., 2008; Melkevik et al., 2010). Recent studies linking excessive screen time and lack of daily exercise with deleterious health behaviors in adolescents do provide helpful evidence that exercise is being replaced by screen time. For example, one study collected data from 59,397 adolescents who participated in surveys conducted by the Youth Risk Behavior Surveillance Survey over multiple years (Knell et al., 2019). These surveys focused on adolescents' daily habits pertaining to screen use, sleeping, and exercise. Results indicated that only five percent of adolescents are meeting professional recommendations of limiting screen time, getting at least 60 minutes of physical activity per day, and getting adequate sleep (Knell et al., 2019). Another study aimed to examine associations between excess body fat and socio-familial contributions, physical activity and screen time in adolescents in Brazil (da Silva Oliveira et al., 2019). This study involved 1354 adolescents, with 52% being female. Researchers distributed questionnaires and took anthropometric measurements which included body weight, height, arm circumference, and triceps skin fold. The factors that were associated with having excess adipose tissue were getting less than 300 minutes of physical activity per week, watching or playing video games for four or more hours per day, and having parents who did not set limits on household screen time for their children (da Silva Oliveira et al., 2019). Environmental Factors Associated With Increased Screen Time and Decreased Exercise Parenting style and regulations are major contributing environmental factors regarding excessive adolescent screen time and too little exercise (Bjelland et al., 2015; Bucksch et al., 2019; da Silva Oliveira et al., 2019). These researchers discovered that households with EXERCISE BENEFITS AND SCREEN TIME 13 adolescents who are not meeting recommendations pertaining to screen time limits or daily physical activity also have parents who are not setting and enforcing rules on screen time use. Adolescents who are spending more time outside are not spending as much time on screens like tv and phones, particularly if they have friends and family who encourage these outside behaviors (Bucksh et al., 2019). Encouragement from parents to go outside and be active as well as providing a safe environment in which to do so can help in providing adolescents with other alternatives to do in their leisure time. Parents who have rules and implement a more structured lifestyle in the household and plan daily activities such as play time, meal time, outside time, and family time can also help young people spend less time in front of screens (Bucksh et al., 2019). Increased and consistent parental rule enforcement, monitoring of behaviors in all aspects of adolescents’ lives, and encouragement of physical activity from parents could play a significant role in reducing screen time in adolescents. By nature many adolescents are defiant with parental rules. Non compliance and blatant disregard for parental rules can also push adolescents to spend more time on screens (Toh et al., 2019). These factors can be frustrating for parents and can lead to an unbridled, constant usage of screens and hand held devices. Parents often give up in these situations and do not monitor their children's screen use (Toh et al., 2019). Early adolescence is a time when some habits are formed, which could set a precedence that lead to life habits (Bjelland et al., 2015). Therefore, for the sake of life long benefits of exercise and controlled screen time it is important that parents guide their children in managing their time. In order to help adolescents in managing their time there is research indicating that parenting styles and communication matter. An excellent suggestion when trying to establish rules for screen time is to employ Hoffman's theory of EXERCISE BENEFITS AND SCREEN TIME 14 autonomy-supportive parenting style (Bjelland et al., 2015). When compared with a controlled style of parenting, an autonomy supportive parenting style seeks to understand the child’s point of view while providing specific and personal reasons when establishing rules (Bjelland et al., 2015). In the current age of technology, parents are also guilty of spending too much time on screens in particular computers and mobile devices and not getting adequate physical activity (Toh et al., 2019). High parental screen usage creates a pattern of parent to adolescent modeling behavior in regards to exercise and screen time balance. When adolescents see their parents using their smartphones excessively this creates an invitation in their minds that the time is right to use their phones as well (Toh et al., 2019). Parental modeling of screen use by adolescents could exacerbate the problem of too much screen time. Adolescents, when compared to adults, have exhibited less self control involving knowing when to stop using a mobile device or watching a screen (Toh et al., 2019). Another strong influence for increased sedentary behavior and constant usage of screens and mobile devices of adolescents are peers (Garcia et al., 2017; Toh et al., 2019). According to Garcia et al. (2017) sedentary behavior is defined as anything that requires little to no body movement and involves such activities as video games, phones, and television. For many adolescents screen time alone and screen time with friends is the preferred activity for leisure time enjoyment and relaxation. Time spent on video games and social media are an outlet for adolescents to “zone out” and to take their mind off other responsibilities. Screen times are highly influenced by peers and could take up more leisure time than would be spent alone on screens. Common examples of peer influence and screen time include, adolescent males EXERCISE BENEFITS AND SCREEN TIME 15 gathering to play video games for more hours than would be otherwise done alone, or adolescent females meeting at a coffee shop or mall to sit and look at social media on mobile devices. Primarily, boys are engaging in high levels of video gaming, while girls are spending most of their free time on phones participating in social media with their peers (Garcia et al., 2017). Some adolescents’ and their peers’ use of phones is so ubiquitous that even when in the same room, they often do not speak verbally but text each other on their phones (Toh et al., 2019). Notably adolescents are also being motivated by their friends to participate less in screen time behavior and spend more time doing moderate to vigorous physical activities (Garcia et al., 2017). Certain adolescents report having two groups of friends, their sport friends and their school friends. Adolescents report more time being spent doing sedentary behaviors, like gaming and social media, when with their school friends and more time spent participating in physical activity with their sports friends (Garcia et al., 2017). Academics and Exercise Although studies have shown that exercise has a positive effect on academics (Ardoy et al., 2014; Bezold et al., 2014; Valdez & Yang, 2011), adolescents may be missing out on these academic benefits because increased screen time may be superseding exercise. Exercise has been shown to have a positive cognitive effect on adolescents, which facilitates several benefits for academics (Ardoy et al., 2014). Daily vigorous physical exercise increases overall cognitive performance, specifically abstract reasoning and non-verbal ability. Additionally, increased cardiovascular fitness has corresponding effects on academic achievement (Ardoy et al., 2014). Researchers suggest that exercise can affect synapses in the brain, increase blood flow, and facilitate neuronal growth. This finding is one explanation for cognitive improvements seen in EXERCISE BENEFITS AND SCREEN TIME 16 adolescents who adhere to a fitness regimen (Noakes & Spedding, 2012). In addition, adolescents who choose a more sedentary lifestyle are seemingly not receiving cognitive benefits that come from physical activity. Researchers point out that adolescents who have no change in physical activity have shown no improvement in academics when compared to more active groups (Bezold et al., 2014; Kantomaa et al., 2016). Adolescents who engage in exercise on a regular basis are performing better on standardized test scores, while those who do not exercise, show no improvement or a decline in standardized test scores (Bezold et al., 2014). For example, one study conducted in New York City collected the fitness and academic data of 83,111 middle school students from 2006 to 2012, through the NYC fitness program database (Bezold et al., 2014). This fitness assessment was part of the K-12 public school system. Students whose fitness level improved also showed a significant improvement in standardized test scores. Specifically, girls who declined in fitness levels also showed a corresponding decline in test scores by .33 percentile points when compared to a reference group. Boys with a substantial decrease in fitness showed a larger decline in academic achievement by .55 percentile points when compared to a reference group (Bezold et al., 2014). Furthermore, high levels of sedentary behavior, such as screen based activity, decreased activity, or no associations with school based clubs requiring higher fitness and physical activity, has been shown to be associated with lower levels of academic test scores (Kantomaa et al., 2016). In-school fitness programs, such as recess and physical education periods, have been known to be beneficial for academic performance (Brez & Sheets, 2017). Their study showed that children displayed an improvement in attention span and creativity after recess as compared EXERCISE BENEFITS AND SCREEN TIME 17 to pre-recess scores. Schools that are ridding themselves of these programs because of budget cuts or more emphasis on academics could be hurting cognitive benefits that would be otherwise gained from in school activity (Ramstetter et al., 2010). Spitzer & Hollmann (2013) confirmed that exercise has a range of cognitive benefits from improved long term and short term memory, to enhanced social and emotional responses, and even neuronal growth. They stated that the mechanisms by which these cognitive benefits occur are less clear, but a growing body of research investigating these effects of exercise on these improved mental functions is occurring. In no case did exercise lead to a negative relationship with academic achievement (Spitzer & Hollman, 2013). Cognitive Effects of Exercise and Screen Time on Adolescents The following paragraphs will explore possible cognitive benefits for adolescents that could come from exercise and compare those same cognitive effects with excessive screen time according to research. This information will be framed around three areas: ability to focus, sleep patterns, and anxiety. Ability to Focus Attention capacity is an important part of adolescent cognition and a major contributing factor to success in academics and can be improved with regular exercise (Pontifex et al., 2014; Vanhelst et al., 2016). Adolescents’ attention capacity is positively correlated with longer time spent in moderate to vigorous physical activity (Vanhelst et al., 2016). Even a single, 20-minute bout of exercise creates increases in attentional processes in adolescents, such as attentional orientation (Pontifex et al., 2014). In contrast, prolonged sitting is related to a more delayed recall in different test subjects of the same demographic (Pontifex et al., 2014). EXERCISE BENEFITS AND SCREEN TIME 18 An effective way to examine exercise and the ability to focus is by looking at students diagnosed with ADHD and physical activity. Cerrillo-Urbina et al. (2015) conducted a meta-analysis of various studies that included children and adolescents experiencing symptoms of ADHD and the treatment of aerobic exercise augmented with medication. This meta-analysis included eight different studies comprised of 249 children ranging in age from 6-18. The pooled findings of this analysis suggested that aerobic exercise did improve attention spans as well as executive function in the involved children and adolescents with ADHD (Cerrillo-Urbina et al., 2015). Exercise has been proven beneficial for students and can help cognitive performance by improving their ability to focus. Frequent modern digital media use could be associated with symptoms of attention deficit hyperactivity disorder (ADHD) in adolescents ages 15-16 (Ra et al., 2018). Specifically, new evidence suggests that high frequency use of modern digital media such as social media, texting, and gaming could be associated with inattention and hyperactivity or impulsivity (Ra et al., 2018). A causal relationship between the nature of some of these media platforms and ADHD symptoms is suspected. Modern digital media is processed at higher speeds than traditional platforms such as television and gaming. Social media, gaming, and forms of instant messaging are based on immediate gratification at high processing speeds. This structure could create a causal relationship between symptoms of ADHD and screen time (Ra et al., 2018). Sleep Patterns Improvements in adolescent cognition could be generated from healthy sleep habit such as decreased wake times during the night and earlier sleep and wake times on school days during the school week (Urrila et al., 2017). Over the past century modern day adolescents have EXERCISE BENEFITS AND SCREEN TIME 19 experienced an accelerated slump in sleep duration times when compared to earlier generations of adolescents (Matricciani et al., 2012). Unhealthy sleep habits can contribute to poorer grades and even affect brain structure, including decreased volumes of grey matter, in ways detrimental to academics (Urrila et al., 2017). A more active lifestyle could lead to improved sleep patterns in adolescents. Consistently, exercise has been shown to improve sleep quality in adolescents (Brand et al., 2009; Mendelson et al., 2015). Studies suggest that possible ways for adolescents to improve sleep quality is to restrict night time use of screens and increase daily exercise (Mendelson et al., 2015; Xu et al., 2019). Mendelson et al. (2015) studied the outcomes of supervised exercise on 20 obese adolescents and sleep quality during the night for 12 weeks. Prior to the study, candidates underwent a seven day sleep study by completing an overnight polysomnography, and each wore an accelerometer for those seven days. The exercise program consisted of a mixture of cardiovascular and strength training. After the 12 week program, subjects showed improvements in sleep duration and quality of sleep as well as spontaneous physical activity during the day. The researchers concluded that the spontaneous increase in physical activity and extra energy during the day resulted in more favorable sleep gained by the adolescents at night (Mendelson et al., 2015). A likely barrier for adolescents and a healthy, good night’s sleep is electronic media use. Cain and Gradisar (2010) conducted a meta-analysis which reviewed 36 research papers concerning electronic media use and sleep in school aged children and adolescents. Findings supported the notion that electronic media does have a negative impact on sleep in children and adolescents. Excessive phone use may deprive adolescents of healthy sleep habits (Schoeni et al., EXERCISE BENEFITS AND SCREEN TIME 20 2015). Many adolescents are obsessive about checking their phones at night for text messages and social media, bypassing additional valuable hours of sleep during the night. This obsession leads to additional sleep disturbances during the night which could consequently be coupled with stress and depression while awake during the day (Thomée et al., 2011). The need for inclusion amongst adolescents can be manifest in excessive social media use during the night and can be a primary driver for delayed sleep times and daytime fatigue (Scott et al., 2019). A study conducted in the United Kingdom used data from a large group of adolescents (11,000+) examining the effects of excessive social media use and adolescent sleep patterns using a self report questionnaire. High usage of social media was defined as five or more hours a day. During school days adolescents who reported high social media use were more likely to experience delayed sleep onset, increased disturbances during the night, and have later wake times than adolescents with average social media usage times. (Scott et al., 2019). Anxiety For many young people adolescence is a time of heightened anxiety, and some develop anxiety disorders, which can have subsequent effects on academics (de Lijster et al., 2018). Anxiety has also been strongly linked to school refusal in adolescents, as well as feelings of school impairment in this demographic (de Lijster et al., 2018). Negative social interactions, such as those potentially encountered through social media, are inherently connected to anxiety in adolescents and could have long term effects on academics (Woodward & Fergusson, 2001). Exercise has been shown to reduce anxiety amongst adolescents with generalized anxiety disorder (GAD). Herring et al. (2018) examined the effects of exercise on feelings of anxiety by comparing quiet rest responses of 35 young adults diagnosed with GAD. The steps in the study EXERCISE BENEFITS AND SCREEN TIME 21 consisted of a 30 minute treadmill run, followed by 30 minutes of quiet time reflection, and a questionnaire. After exercise, feelings of anxiety and worry dissipated in test subjects. In addition, men and women felt feelings of energy and a generalized absence of worry engagement. This study confirmed other positive findings of the support of aerobic exercise on adolescents with worry and anxiety disorders (Herring et al., 2018). Research has shown that increased anxiety could be a potential barrier to academic achievement (Castagna et al., 2019). Researchers in China randomly sampled 1258 high school students with an average age of 16 and showed a causative link between mobile phone addiction and anxiety (Yang et al., 2019 ). A survey was conducted that specifically measured mobile phone use addiction and anxiety. Resulting statistical measures showed that mobile phone use, addiction, and anxiety were positively correlated (Yang et al., 2019). In another study, a negative correlation was found between physiological anxiety and academic achievement in math, reading, and arithmetic in adolescents (Castagna et al., 2019). Excessive screen-based behaviors, such as mobile phone use, may be considered addictions that researchers have suggested leads to increased anxiety in adolescents (Yang et al., 2019). Mobile phone addiction can be defined as craving a cell phone at all times of the day, no longer enjoying things that used to be enjoyable, and experiencing anxiety when separated from a mobile phone (Kim et al., 2015). Adolescents may be at an increased risk for mobile phone addiction because of an accelerated physiological growth rate compared to a slower psychological growth rate (Yang et al., 2019). Thus mobile phone addictions and excessive screen time could cause anxiety that could hinder the mental fortitude required to excel academically among adolescents. EXERCISE BENEFITS AND SCREEN TIME 22 Health Effects of Screen Time and Exercise on Academics Additionally, adolescent students who are not engaging in physical activity and increasing their screen-based behaviors could be putting themselves at risk for mental health and general health conditions. General and mental health conditions are not conducive to success in school. This literature review seeks to further explore correlations between declined mental and general health conditions with exercise and screen time in adolescents. Mental Health Increasing evidence suggests that more adolescents are being diagnosed with mental health disorders (i.e. depression) by licensed clinical practitioners that could impede academics. Adolescents are less likely to suffer from mental health disorders, such as depression, and succeed in school if on a daily regimen of exercise (Xiang et al., 2017). Excessive screen time could be a detriment to mental health, while increased physical activity could improve mental health (Hrafnkelsdottir et al., 2018). These researchers measured adolescents' physical activity with general mental health disorders associated with screen time. This study, conducted in Iceland, consisted of 411 tenth grade students. A questionnaire was administered to participants, which analyzed background, including health and lifestyle, such as screen-time and physical activity. A strength of this study was that researchers used objective measures to analyze activity in subjects. Voluntary, leisure time physical activity was measured by distributing accelerometers to students. Prior studies have focused on subjective measures of a fit lifestyle such as a survey. These monitors were worn on the wrist and monitored activity for seven consecutive days. Screen-time was self-reported; participants were asked to report how many hours per day they used the internet for other use, social media, television, and played EXERCISE BENEFITS AND SCREEN TIME 23 video games. Mental health was assessed using a 22 item version of subscales Symptoms Checklist 90 (SCL-90). Global self esteem and life satisfaction were also measured. Researchers observed that less screen time and more frequent physical activity, at least four times a week, was associated with a lower risk of reporting with symptoms of mental health deficiencies including anxiety, depression, and low self-esteem in adolescents in their mid-teens (Hrafnkelsdottir et al., 2018). Wu et al. (2015) also studied the effects of low activity and high screen time with mental health in Chinese adolescents. This study was large; 4747 students with a mean age of 19 were selected. Physical activity was measured using an at youth risk behavior survey. Screen time was reported using a questionnaire which asked specific questions concerning hours spent per day in front of the computer, TV, and video games. Psychological problems were assessed using the self-rating anxiety scale (SAS). Researchers concluded that low levels of physical activity and high screen-time is significantly correlated with increased reported mental health problems, such as depression and anxiety, as well as poor sleep quality (Wu et al., 2015). General Health In order to excel in academics, adolescents should be in good general health. The definition of a subjective health complaint is, general somatic issues pertaining to the body such as headaches and backaches and also includes psychological symptoms such as feeling nervous or feeling down (Keane et al., 2016). These symptoms can not be explained by any other underlying issues. Further, these subjective health complaints could compound into issues that lead to excessive absenteeism from school, which are not conducive to academic achievement (Saps et al., 2009). EXERCISE BENEFITS AND SCREEN TIME 24 Exercise could help mitigate the effects of subjective health complaints (Keane et al., 2017). Adolescents who exclude daily exercise could be putting their academic success as well as their general health at risk. Keane et al. (2016) studied screen-time and subjective health complaints in adolescents. Subjects were sampled from a study done by the World Health Organization (WHO), which consisted of 10,474 children ranging in ages 10-17. The WHO recommends 60 minutes of exercise per day, and the American Academy of Pediatrics (AAP) recommends a significant amount of time be designated as media free, as well as media free zones in the home (Swanson, 2016). The adolescent subjects were asked on a questionnaire to report how often they experienced health complaints, both somatic and psychological. They were also asked how many times they had exercised at least 60 minutes in the last seven days. Screen time was measured by asking how much time was spent on electronic devices. Possible answers ranged from none at all, to seven hours or more a day. Findings suggested that adolescents who did not meet the physical activity recommendation of 60 minutes a day nor the screen-time recommendation of less than two hours a day did have an increase in health complaints (Keane et al., 2016). Summary One of the ways increased screen time has been hypothesized to adversely affect the health in adolescents is by displacing time otherwise used for exercise (Melkevik et al., 2011). Exercise has a well documented beneficial effect on academic success. Furthermore, exercise assists in deterring mental health symptoms, such as depression and anxiety, that likely inhibit academic success. If adolescents are using all their leisure time for screen-based activities, resulting in the exclusion of exercise from their daily regimen, and thus benefits of exercise, they EXERCISE BENEFITS AND SCREEN TIME 25 could be hurting their potential to succeed in academics for reasons explained in this literature review. EXERCISE BENEFITS AND SCREEN TIME 26 PURPOSE Adolescents are spending much of their leisure time on screen based activities according to a plethora of evidence (Guthold et al., 2020; Rideout, 2016; Throuvala et al., 2019; Toh et al., 2019). Recent technological advances, such as mobile devices, have allowed adolescents to be constantly connected to the internet while engaging in such activities as social media and video games. Many adolescents are spending anywhere from six to nine hours a day on a screen, outside of other requirements, which require internet use such as education (Rideout, 2016). It is highly likely that if adolescents are using all of their free time for screens, that they are not leaving sufficient time in the day for daily exercise and physical activity. According to research, it is hard to suggest that exercise is definitively being replaced by time on screens (Melkevik et al., 2010). A few researchers have noted that these two behaviors in adolescents, being exercise and screen time, are difficult to establish any correlations because they are behaviors independent of each other. However, it could be assumed that if adolescents are in fact spending numerous hours during the day on screens that they are not leaving any time to exercise and be physically active. Given the many benefits of exercise for academics this is concerning. The purpose of this study was to examine correlations between excessive screen time and the subsequent lack of exercise and physical activity in adolescents. This study answered the following questions: 1. Is there a cause and effect relationship between excessive screen time and the lack of leisure time exercise and/or physical activity in adolescents? 2. What are some academic benefits that result from exercise that are missing in the lives of more sedentary adolescents who are engaging in excessive screen time? EXERCISE BENEFITS AND SCREEN TIME 27 METHOD A survey approach was used to address the purpose of this study. This study gathered quantitative data from parents of adolescents concerning their children’s screen time and exercise habits as well as the adolescents academic standing (grade average). Participants for this study were gathered from two different junior high schools in a northern Utah school district. The two schools were chosen because they have different demographics. Participants All participants were parents of a student attending one of the two participating junior high schools. Ages of the students were eleven to fifteen years, grades seven to nine. The ages of the parents varied more significantly. Instances where the biological or adopted parent was absent, participation of the primary guardian was also accepted. Parents and students were not discriminated against socioeconomic status, education level for parents, grade point average for students, gender, or race. All parents of both schools will be invited to participate in the study regardless of background. During the 2019-2020 school year, junior high one (JH1) had an enrollment of 1013 students (495 males and 518 females), and junior high two (JH2) had 943 students (494 males and 449 females) for the 2019-2020 school year. According to The National Center for Education Statistics (NCES, 2019), JH1 students were predominantly white with 854 white students, 83 Hispanic students, 17 Asian students, 6 African American students, and the remaining 53 students constituting other ethnicities including Native American. JH2 has 601 white students, 233 Hispanic students, 28 African American students, 21 Asian students with the EXERCISE BENEFITS AND SCREEN TIME 28 remaining 60 students constituting other ethnicities including Native American. The student to teacher ratio at JH1 is 26.5 to 1, and the student teacher ratio at JH2 is 19.48 to 1. Instruments In order to examine correlations between excessive screen time and the lack of exercise in adolescents as well as the effects of the lack of exercise on academic performance, a researcher-developed survey was successfully distributed to the parents of each junior high school. Upon IRB approval and school district clearance, the survey was distributed among the parents of students currently attending each junior high (see Appendix A) using Google forms. All participants were given a link to the survey where they were able to complete the survey anywhere with an internet connection at their convenience. Parents were assured that their identity, nor the identity of their children, was not requested or disclosed. The questionnaire consisted of a three part survey. The first section of the survey requested basic demographic information from parents. This information included the school which their child attends, the gender of the student, as well as the grade level of the student. Section two investigated how many hours of total screen time that the parent’s child participates on a daily basis. The first question asked how many total hours of screen time that the parent’s child participates in on a daily basis. Answers for this question are: 1-2 hours, 3-4 hours, 5-6 hours, 7-8 hours, 9-10 hours, or 12+ hours of screen time per day. Question three in section two inquired about the types of activities that are spent while the adolescents are on screens. Answers to question two included: social media (Facebook, Instagram, Snapchat, Tiktok), online or offline video gaming, watching television or movies including Netflix, Amazon, and other online EXERCISE BENEFITS AND SCREEN TIME 29 vendors, or non essential communication: talking on the phone, texting, facetime. The fourth and final question asks if the child owns or has continuous access to a cell phone. Section 3 asked the parents about their children’s exercise habits. The question read: About how much voluntary exercise does your son or daughter participate in on a daily basis? (These hours include anything in which your child is being physically active i.e. playing outside, sports practices and competitions, riding bikes or skateboards, etc.). Parents had the option of choosing anytime between 0, 0-15, 16-30, 31-45, 46-60, or over 60 minutes. The next question inquired about the child’s academics by asking the grade average (A-F) of the student. The final section determined possible causes and effects of the lack of exercise because of excessive screen time on academic performance. In order to obtain data the Likert scale was used for this portion of the survey. The rating scale ranged on a one through five scale and included strongly disagree (one) to strongly agree (five). The first question asked about if the child voluntarily leaves the screen time to exercise daily. Next, questions will ask about possible ailments that the child may be currently experiencing such as, anxiety, problems focusing, or sleep disturbances. The final question will determine any household regulations that may be placed on the child’s screen time throughout the course of the day. Procedures Prior to sending the survey to parents, a pilot was conducted with five to ten colleagues who are parents for feedback on question structure and to examine if the questions were eliciting responses that would answer the research questions. Once the pilot was conducted and analyzed, approval was obtained from WSU and Davis School District for participation in the survey from the parents of the two junior high schools. The principals of both junior high schools were asked EXERCISE BENEFITS AND SCREEN TIME 30 for permission to distribute the survey and conduct the study in their respective schools. Distribution of the survey was conducted using google forms. Links were sent out through teachers and administration of the two junior high schools. The survey was taken at any location participants chose in approximately two weeks. A confidentiality notice was included in the survey ensuring that the identity of the parent or their child attending the school would not be requested or divulged. Data Analysis The data were collected using Google Forms, and individual questions were analyzed using frequency distribution and descriptive statistics. Questions were analyzed using Google Forms response sheets that are automatically generated upon submission. Specifically responses were manipulated using the spreadsheet and screen usage was compared against daily exercise times in adolescents. The general academic achievement responses as well as the questions pertaining to exercise benefits using the Likert scale were also analyzed and compared to exercise and screen times. EXERCISE BENEFITS AND SCREEN TIME 31 RESULTS This study sought to establish a correlation between decreased voluntary exercise and increased leisure screen time in adolescents. A survey was distributed to parents of students at two different junior high schools (grades 7–9) to examine correlations between increased screen time and decreased voluntary exercise in adolescents. School A is predominantly Caucasian students consisting of mostly middle class families. School B has more diversity than School A, having more students representing different ethnicities. School B, a Title 1 school, has families mostly in lower class income levels. Using Google Forms for the survey, data were collected and analyzed in order to investigate a possible cause and effect relationship between excessive leisure screen time and decreased voluntary exercise in adolescents and consequential exercise benefits that may be missing from these adolescents. Exercise benefits that may be superseded by excessive screen time that were questioned in the survey were (a) ability to focus, (b) improved sleep patterns, and (c) decreased anxiety. Results also included data from all questions in the survey divided into School A and School B in order to examine responses between different student populations and demographics. Parental Participants All participating parents were given the link to the full informed consent in an email that was distributed by the administrators from each of the two participating schools. A total of 307 parents responded to the survey. The first section of the survey included an informed consent question that asked the parents if they wished to participate. A total of 303, 99% of the parents, gave their consent and clicked yes and completed the survey. Four surveys were excluded EXERCISE BENEFITS AND SCREEN TIME 32 because of incompletion of all questions included in the survey. Of the remaining 303 participants, 246 were from one junior high school (A), and the remaining 57 were from the other participating junior high school (B). Demographics of Students Parents were asked to identify the gender and grade-level of their child. The parents identified the following genders of their students: 147 male (48.5%), 152 female (50.2%), 3 preferred not to say (1%), and 1 (0.3%) non-binary. The parents indicated the following grade levels: 68 seventh grade students (22.4%), 137 eighth grade students (45.1%), and 100 ninth grade students (32.9%). If the parent had more than one child who was currently enrolled in one of the two schools they were instructed on the survey to answer for only the older child. Table 1 Grades of Adolescents with Participating Parents Grade Number of Students Total School A School B 7 68/22.4% 51/16.7% 17/5.6% 8 137/45.1% 119/39% 18/5.9% 9 100/32.9% 76/24.9% 24/7.8% Screen Time This section of the survey asked parents about their child’s voluntary screen time. The first question asked, “About how many hours does your child spend engaging in non essential EXERCISE BENEFITS AND SCREEN TIME 33 screen time on a daily basis? This information includes television, internet on the computer or phone, social media, non essential communication, iPads/tablets, gaming, etc. Please exclude time spent on essential screen time i.e. education, essential communication, work purposes.” Options for this question were in increments of one or two hours ranging from one to two hours and reaching to 12 or more hours of screen time per day (see Figure 1). The option that 144 parents and the most common answer for daily leisure screen time was three to four hours. This amounted to 47.5% of the parents who responded to this survey. There was also an option of 5-6 hours which 18.2% or 55 parents selected. There were eleven parents who indicated that their child participates in seven to eight hours of non essential screen time per day (3.6%). There were a total of six parents who reported that their children spent 8-12 hours of leisure screen time a day. Results were divided into the two participating schools and analyzed. The results were then converted into percentages which were based on the total number of respondents to each question. School A and School B reported similar percentages when asked about their adolescents’ daily screen time. Fifty percent of parents of School B, and forty one percent of parents of School A indicated that their adolescent child spends about three to four hours of leisure screen time a day which was the most common response. One to two hours was the next most selected response on the survey which amounted to 31% of the parental respondents of School A, and 21% of School B. EXERCISE BENEFITS AND SCREEN TIME 34 . Figure 1. Frequency distribution comparison of daily adolescent non essential screen time as estimated by parents with a child enrolled at one of the two participating schools. Non essential screen time includes television, internet on the computer or phone, social media, non essential communication, ipads, gaming, etc.. Time spent on essential screen time i.e. education, essential communication or work purposes was excluded. Parents indicated that the primary nonessential screen time activity that their children participated in the most was television watching, including online streaming platforms such as Netflix (59.1%, 179, n = 303). Video gaming, online or offline, was the next most common answer for the most popular online activity for adolescents (45.9%, 139, n=303). Parents of 117 (38.6%) adolescents responded that non essential communication such as texting and instant messaging was the primary activity that adolescents participated in while on a screen. Finally 84 (27.7%) parents had adolescents who spent the majority of their non essential time on screens engaging with social media (Facebook, Instagram, Snapchat). Figure 2 represents the most popular activities of non essential screen time for adolescents. EXERCISE BENEFITS AND SCREEN TIME 35 Figure 2. Frequency distribution of primary non essential screen time activities that adolescents engage during their leisure time. Social media includes Facebook, Instagram, Snapchat, or Tiktok). Video Gaming included online or offline gaming. Television included Netflix, Amazon, and other streaming vendors. Nonessential communication included talking on the phone, texting, and facetime. Among the parents who responded to the survey, the majority have adolescent children who own cell phones. There were 267 adolescents, whose parents responded to the survey, that own a cell phone while 35 did not own a cell phone. Table 2 Adolescents Owning A Cell Phone Adolescents owning a cell phone Number of Adolescents Yes 267 88.4 % No 35 11.6% EXERCISE BENEFITS AND SCREEN TIME 36 Comparison of School A and School B of adolescent ownership of a cell phone indicated that School B has a slightly higher ownership at 91%. Parents from School A indicated that 87% of adolescents own a cell phone. Figure 3. Shown above is a frequency distribution showing a comparison of cell phone ownership among the two participating schools for the survey. Exercise and Academics Parents were asked to input their child’s voluntary exercise time. The first question in this section stated, “About how much voluntary exercise does your son or daughter participate in on a daily basis? (This time includes anything in which your child is being physically active i.e. playing outside, sports practices and competitions, riding bikes or skateboards, etc.).” The options for this question were zero minutes, one to fifteen minutes, sixteen to thirty minutes, thirty-one to forty-five minutes, or sixty minutes. The three most common responses were over EXERCISE BENEFITS AND SCREEN TIME 37 sixty minutes (91, 30%, n=303), sixteen to thirty minutes (68, 22.4%, n=303), and thirty-one to forty-five minutes. (57, 18.8%, n=303). Thirty-nine (12.9%, n=303) respondents indicated that their adolescent child participated in one to fifteen minutes of daily voluntary exercise, and forty-two (13.9%, n=303) indicated that their adolescent child participated in forty-six to sixty minutes of voluntary exercise per day. The least common answer for this question was that their adolescent child did not participate in voluntary exercise (15%, n=303). Participation in voluntary exercise by adolescents with parents who responded to this survey question is shown in Figure 4. Figure 4. Results were analyzed and then divided into percentages of parents responding to the amount of minutes that their adolescent participated in on a daily basis and their respective schools. These results were similar among School A and School B. Both schools showed that between 26 and 30 percent of adolescents are voluntarily exercising over 60 minutes a day. Both schools also reported that 21% of adolescents exercise 16 - 30 minutes a day. School A and School B indicated that 4.2% and 9% reported zero minutes of exercise a day respectively. EXERCISE BENEFITS AND SCREEN TIME 38 When asked about the academics of their adolescent child, 51.5% (156) of the respondents indicated that their child receives excellent grades (A average); 34.3% (104) of the respondents had adolescent children who received good grades (B average); and 9.9% (30) had adolescent children who received average grades. The respondents who marked adolescent children with below average or failing grades were 3.6% (11) and 0.7% (2) respectively. Table 3 illustrates the academics of adolescent children with parental participation in this survey. Table 3 Academics of Adolescents with Participating Parents Academics Number of Students Excellent Grades (A average) 156 51.5% Good Grades (B average) 104 34.3% Average Grades (C average) 30 9.9% Below Average Grades (D average) 11 3.6% Failing Grades (F average) 2 0.7% Health Benefits The survey asked questions relating to physiological benefits that may pertain to exercise. These benefits include ability to focus, improved sleep patterns, and decreased anxiety. Questions in this section used a Likert scale, with 1 being strongly disagree, 2 is disagree, 3 is neutral, 4 is agree, and 5 is strongly agree for questions in this section. The first question of this section asked the parents if their children will voluntarily put down a screen and participate in voluntary exercise (i.e. playing outside). The most common response to this question was neutral (3) with 83 respondents (27.5%) selecting this answer. EXERCISE BENEFITS AND SCREEN TIME 39 There were 75 parents (24.8%) who strongly agreed with this statement, and 70 (22.8%) who agreed with this statement. Among those who did not agree with this statement, 46 disagreed (15.2%) and 28 (9.3%) strongly disagreed with this statement. Figure 5 is a frequency distribution to this question of the health benefits section. Figure 5. Frequency distribution of responses to the question relating to adolescents and voluntarily putting down a screen then exercise. Responses for this question were divided into the two participating schools, School A and School B and analyzed. When compared to each other, more parents from School B strongly agreed with the statement that their child will voluntarily put down a screen to exercise (38%) than School A (22%). The next question which related to screen time and health benefits from exercise inquired about the ability for adolescents to focus. This question requested the parent to rate their child’s ability to focus on school work and other cognitive activities that require attention. The most commonly answered question was 1 (strongly disagree), which had 86 responses (28.4%) to the EXERCISE BENEFITS AND SCREEN TIME 40 statement that their adolescent does have difficulty focusing. There were 78 parents (25.7%) who answered that they disagree (2) with this statement, and 62 (20.5%) parents responded that they were neutral. There were 42 parents (13.9%) who agreed that their adolescent child has difficulty focusing on school work and other cognitive activities that require attention, while 35 parents (11.6%) strongly agreed with this same statement. The frequency distribution for this question relating to ability to focus is displayed in Figure 6. Figure 6. Parental participants were divided into two groups based on the junior high school, which their adolescent student attends with the question relating to the ability of the adolescent to focus on their school work. Nearly 30% of the respondents from School B strongly agreed with the statement that their child has difficulty focusing on school work while just over 10% of parental respondents from School A strongly agreed with this same statement. Roughly the same percentage of parents strongly disagreed that their adolescent student has difficulty focusing on their school work (28%). More parents from School A selected neutral for this question (22%) than School B (12%). EXERCISE BENEFITS AND SCREEN TIME 41 The following question on the survey inquired about any unhealthy sleep habits that may be related to excessive screen time in adolescents. This statement on the survey read, “My child has unhealthy sleep patterns which may be related to excessive screen time.” In total, 100 parents (n=303) strongly disagreed with this statement (33%), and 78 parents disagreed with this statement (25.75%). There were 53 parents (17.5%) who had chosen neutral to this question, and 51 parents (16.8%) agreed with the statement that their child has unhealthy sleep habits that may be related to excessive screen time and 21 (6.9%) strongly agreed. Figure 7 is a representation of total responses relating to sleep habits and excessive screen time in adolescents. Figure 7. An analysis was also conducted in order to determine frequencies of the responses relating to the question about unhealthy sleep patterns that may be related to excessive screen time for School A and School B. Among parents who responded to this question from School A, 32% strongly disagreed that their adolescent has unhealthy sleep habits related to screen time and 25% of parents from School B also strongly disagreed with this statement. In addition, 19% of parents said that they were neutral when answering this question and 8% of parents from School B gave the same response. Those who strongly agreed with this statement were 7% from School A and 22% from School B. EXERCISE BENEFITS AND SCREEN TIME 42 The subject of the next question on the survey was anxiety. This question inquired of parents if their adolescent child experiences anxiety. In total 49 parents strongly agreed, and 49 parents agreed with this statement (n=303). Among those who selected neutral to statement were 60 parents. There were 74 parents who strongly disagreed that their adolescent child experienced anxiety, and 70 parents disagreed with this statement. Figure 8 is a frequency distribution of parents who responded to the statement that their adolescent experiences anxiety. Figure 8. Frequency distribution of anxiety that may be present among adolescents whose parents responded to this survey. More people (21%) from School B agreed with the statement that their adolescent experiences anxiety than School A (14%). However, more parents from School A (17%) indicated that their adolescent child experiences anxiety than School B (11%). Percentages of parents from both schools who strongly disagreed that their children experienced anxiety were similar, being 23% for both schools. The final question on the parental survey included the following statement, “My child is free to be on screens as they please and there are no regulations concerning screen time in the EXERCISE BENEFITS AND SCREEN TIME 43 household.” The majority of parents, 121, strongly disagreed with this statement. There were 76 parents who disagreed with this statement. A small minority did agree or strongly agree with this statement concerning regulations of screen time. The number of parents who agreed with this statement was 35, and 20 parents strongly agreed with this statement. Figure 9. Figure 9 is the frequency distribution from School A and School B of the statement, “My child is free to be on screens as they please and there are no regulations concerning screen time in the household.”The comparison for this question, showed that among the two participating schools, 20% more parents from School A strongly disagreed with this statement than School B. Additionally 5% more parents again from School A disagreed with this statement than School B. A combined total of 16% of the parents who responded to this survey from School A either agreed or strongly agreed with this statement. School B had a combined total of 26% that either agreed or strongly agreed with this statement. EXERCISE BENEFITS AND SCREEN TIME 44 DISCUSSION The purpose of this study was to provide further evidence that adolescents may be losing the benefits of daily exercise by a regimen that is dominated by non essential screen time, as suggested in previous studies (Fountaine et al., 2011; Melkevik et al., 2010; Twenge et al., 2018; Toh et al., 2019). The results of the parental study that was distributed to two local junior high schools were analyzed for this purpose. Parental questions and answers were examined to determine (a) a cause and effect relationship between excessive leisure screen time and decreased daily exercise in adolescents and (b) physiologic benefits that are known to be associated with regular exercise that may be lost due to increased leisure screen time. This study supports prior research studies which have suggested that adolescents spend less of their leisure time exercising and more of their leisure time participating in various screen based activities. In addition, this study confirmed specifically that social media, television watching, and video gaming represent a large portion of many adolescents’ day. Researchers have suggested that presently an adolescent may spend as much as 4-7 hours per day on a screen doing non-essential activities and that time spent on screens has increased over the last 10 years. The majority of parental responses from this research supported other research indicating that their adolescent participated in 4-7 hours of nonessential screen time. This study affirmed that it is difficult to establish a correlation between decreased voluntary exercise and increased leisure screen time and evidenced by the lack of research solely focusing on these two factors. In addition, benefits in adolescents that could be gained from a regular exercise routine may be lost as a result of increased leisure screen time. Some of these benefits included in this study are increased ability to focus, improved sleep patterns, and EXERCISE BENEFITS AND SCREEN TIME 45 decreased anxiety. Medical professional organizations such as the American Academy of Pediatrics recommend that adolescents spend at least 60 minutes a day participating in physical activity and limit screen time wherever possible and reasons for these recommendations most certainly include improved cognitive abilities. However, the parental study included in this study showed that many adolescents are not meeting the recommendation of 60 minutes per day. Exercising daily for sixty minutes may be an issue if adolescents are more likely to choose screens as their preferred activity during their leisure time and exclude exercise. It would seem that some adolescents are spending so much of their time on screens that they are choosing to omit things that may be beneficial to their health like exercise from their daily habits. Exercise has been shown extensively by peer reviewed research to improve mental and physical health. Mental functions such as the ability to focus, sleep patterns, and anxiety can be greatly abated through the practice of daily exercise. This study may provide some evidence that many adolescents could be negating this improvement in physiologic and cognitive functions by omitting exercise and engaging solely in non essential screen time. This is evidenced by not only the high amount of parental responses indicating that their adolescent child has high leisure screen time habits, but also high numbers of parents who responded that their adolescent child suffers from these same mental setbacks. Adolescents and Daily Screen Time Results of the parental survey that was conducted for this study confirm much of the prior research concerning adolescents and an increase in daily screen time use. Recent studies have suggested that adolescents spend anywhere from 4-9 hours per day on screens participating in non essential activities like social media, television, or video gaming (Garcia et al., 2017; Kuss et EXERCISE BENEFITS AND SCREEN TIME 46 al., 2019; Throuvala et al., 2019). This study confirmed those findings that adolescents do spend a significant portion of their day on screens doing activities that are non essential. Among parents of the two participating schools that responded to this survey, 31% indicated that their adolescent child spends one to two hours on non essential screen based activities. The remaining 69% of parental respondents indicated that their child spends between 3-12 hours per day on leisure screen time. The majority of these parents indicated that their child spends 4-6 hours per day on these screen time activities (see Figure 1). These findings confirm research studies that were conducted by Twenge & Spitzberg in 2018. However, few parents in this study (2%) indicated that their adolescent child spends in excess of eight hours per day as claimed by Common Sense Media (2016). Assumptions can be made that one of the primary reasons why adolescents are spending an inordinate amount of time on screens is cell phone ownership. Throuvala et al. (2019) implied through their research that as many as 91% of adolescents ages 13-19 own a smartphone. The survey conducted in this study confirms those findings within three percent. A total of 88% of parental respondents in this survey responded yes to the question inquiring about the cell phone ownership of their child (see Figure 3). This survey however differed from Throuvala et al. regarding the ages of the involved adolescents. The age range for adolescents in this study was seventh to ninth grade, ages 12-15. Adolescent ages in the Throuvala et al. study maximized at age 19. This age difference could account for the slight differences in percentiles of cell phone ownership in adolescents between these two studies. These results were not surprising to the researcher who is an educator to adolescents of this age group and observes the majority of adolescents in the classroom attempting to use their cell phones constantly and with no restraint. EXERCISE BENEFITS AND SCREEN TIME 47 Surprisingly, the primary activity which the parents reported that the adolescents are participating in while on screens is television watching which accounted for 59% of the responses in the survey. This number is contrary to Throuvala et al. (2019) and Garcia et al. (2017) who reported that females spend the majority of their screen time on social media and males on video games. This result could be attributed to the increasingly popular variety of online viewing subscriptions such as Netflix, Disney Plus, and YouTube. One of the contributing factors to excessive screen time is parental involvement, rules, and regulations. Indeed in many cases it is possible that parents themselves are strong users of ubiquitous screen time usage, and this may contribute to overuse in their adolescent children. This point was made in studies such as Toh et al. (2019) and Bjelland et al. (2015) and some inferences could be made with regard to the survey in this study. One question in the survey for this study inquired of parents if there were rules in the household that pertained to screen usage and if the adolescent is allowed to be on their screens as they please with no restrictions in place. This question perhaps felt invasive to some parents as is evidenced by the 35% who answered either neutral, agree, or strongly agree with the statement in the survey, “my child is free to be on screens as they please and there are no regulations concerning screen time in the household.” It could be argued that the same children who have no rules and regulations in the household pertaining to screen time usage and whose parents are also heavy screen time users may not voluntarily choose to put down a screen then participate in exercise. Exercise, Academics, and Adolescents It is significant that this study showed that only 30% of parents reported that their adolescent children participated in at least 60 minutes of voluntary daily exercise (see Figure 4) EXERCISE BENEFITS AND SCREEN TIME 48 as recommended by The American Academy of Pediatrics. These numbers are similarly correlated with Guthold et al. (2020) who reported that 78% of boys and 85% of girls on a global scale are not meeting this exercise recommendation of 60 minutes per day as established by The World Health Organization. It is also of significance that this study showed that among parents who responded to this survey that nearly 60% (see Figure 4) spent 45 minutes or less participating in voluntary exercise. Many studies have suggested that exercise should be a part of adolescents' regular behaviors and could pose numerous benefits such as improved academics. Slightly over half of the parents who took part in this survey reported that their child receives excellent grades (see Table 3). When combining the 25-30% of parents that responded that their child exercises 60 minutes or more and the 9-13% of parents who reported that their children exercised for 45-60 minutes per day (see Figure 4), this study could support Ardoy et al. (2014) who concluded that exercise facilitates academic achievement. Exercise Benefits in Adolescents and Screen Time There have been some studies such as the research conducted by Ra et al. in 2018 that suggest that increased screen time could lead to exacerbation of cognitive symptoms that hinder academic achievement such as the inability to focus. Of some significance in this study, nearly half of parents responded neutral, agree, or strongly agree that their child has some difficulty focusing on school work or other cognitive activities that require attention (see Figure 6). Schoeni et al. (2015) and Scott et al. (2019) focused on the effects of excessive phone use and showed there exists a negative relationship between increased screen time and sleep patterns in adolescents. When examining the question that inquired about screen time possibly interfering EXERCISE BENEFITS AND SCREEN TIME 49 with healthy sleep patterns a total of 41% responded neutral, agreed, or strongly agree to this statement (see Figure 7). Lastly, over half of the total parents (52%) indicated that their child has anxiety (see Figure 8). Yang et al. (2019) suggest that mobile phone addictions could lead to increased anxiety in some adolescents. The survey showed that 59% of parents indicated that their adolescent child spends 45 minutes or less participating in exercise (see Figure 4). According to research, if adolescents are not exercising at least 60 minutes then they would not be receiving health benefits that come from exercise that would aid in alleviating these ailments. It could be argued that it is a possibility that some of the 59% of the adolescents who were the subjects of this survey that do not exercise the recommended amount would fall into this category. It should be noted that this study may provide some evidence that adolescents are choosing to spend the majority of their leisure time on screens. Additionally, the researcher of this study agrees with Fountaine et al. (2011) and other researchers (Melkevik et al., 2010; Xu et al., 2019) who have pointed out that it is difficult to definitely state that adolescents are replacing exercise with excessive screen time and establish a positive correlation. However, other studies have strongly suggested that increased screen time is associated with lower levels of physical activity (da Silva Oliveria et al., 2019; Keane et al., 2017; Wu et al., 2015). It is certain that this study provides further evidence that adolescents are spending most of their leisure time on screens than exercise and subsequent possible causation that exercise is being replaced with increased leisure screen time. Further, this study is valuable because it may provide additional evidence that adolescents who are spending all their time on screens and little to no time EXERCISE BENEFITS AND SCREEN TIME 50 exercising may be more vulnerable to conditions which are not conducive to academic achievement which include the inability to focus, unhealthy sleep patterns, and anxiety. Limitations and Recommendations This study confirmed prior research stating that it is difficult to establish a correlation between increased screen time and decreased exercise in adolescents. However, as seen by the results of the survey conducted in this study, it is a strong possibility that screen time is replacing leisure time that would otherwise be spent participating in exercise. Recommendations for ongoing research concerning this subject would include a more focused study strictly on the displacement of exercise with screen time as causation and not definitive correlation in adolescents. This study also included some cognitive benefits that result from a regular exercise regimen that may be lost in more sedentary adolescents who spend their leisure time on screens. These include the increased ability to focus, improved sleep patterns, and reduction of anxiety. Currently there are many studies that focus on the ability of exercise to improve or reduce these mental deficits. However, in order to explore the question if adolescents who may have these mental dysfunctions and who spend the majority of their leisure time on screens may otherwise show improvements by regular exercise screen time, a more focused study would be advised. This would include a focus group of adolescent individuals who may be prone to one or more of the mentioned cognitive and physical impairments who do not exercise and who spend the majority of their free time on nonessential screen time versus another focus group consisting of the same subjects who do participate in the daily recommended amount of 60 minutes of exercise. Additionally, it is also recommended that research is conducted on each of these mental EXERCISE BENEFITS AND SCREEN TIME 51 abilities individually. An example study of this nature would be, exercise and its effects on adolescents prone to and possessing excessive anxiety who also engage in all day screen time and no exercise, versus the same individuals in an exercise group. A study of this nature could prove to be beneficial because the researcher could compare anxiety levels of the two groups as well as provide evidence that excessive screen time and no exercise plays a major role in anxiety among adolescents. The researcher also recommends that there be more incentive for parents to participate in a research study of this type. It is very possible that many parents who did not wish to participate declined because they are heavy screen users themselves, and are aware that their adolescent child does not exercise and is on a screen at all times of the day. These people would obviously greatly influence the outcome of a study such as this and are in fact the target audience. Increased incentives such as more promotion and advertisement and or giveaways (i.e. gift cards) could perhaps lure more of these parents to complete the survey. This study was performed by an educator who currently teaches at one of the schools of which the survey was distributed. This school, School A, received over four times the parental responses than School B. Additionally, the grade in which the researcher teaches had by far the most parental participation. There were efforts by other teachers of School A to encourage the parents to participate in the survey, such as reminders to the students during class time. School B had no prior associations with the researcher and had no prior knowledge, incentive, or reason to participate in the study. In this case it was not possible to reach out to the students of School B as was done by School A; therefore, this became the biggest limitation to the study. EXERCISE BENEFITS AND SCREEN TIME 52 Ultimately, this research is intended to bring awareness to the fact that adolescents are now spending more time than ever before on screens and less time on exercise, which is not conducive to good mental and physical health. This is important because although people of all ages may spend excessive amounts of time on screens, it may be especially difficult for adolescents to inhibit these behaviors. This could possibly be setting life long habits that are counterintuitive to success in education and subsequent career placement. This study encourages all including parents, educators, and adolescents themselves to live a more balanced life that includes less time on nonessential screen based activities and more healthy activities such as exercise which could greatly assist efforts towards a more successful education and better quality of life. EXERCISE BENEFITS AND SCREEN TIME 53 References American Academy of Pediatrics. (2016, November 1). Where we stand:Screen time. https://www.healthychildren.org/English/family-life/Media/Pages/Where-We-Stand-TV-Viewing- Time.aspx Ardoy, D. N., Fernández-Rodríguez, J. M., Jiménez-Pavón, D., Castillo, R., Ruiz, J. R., & Ortega, F. B. (2013). A physical education trial improves adolescents’ cognitive performance and academic achievement: The EDUFIT study. 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Mobile phone addiction and adolescents’ anxiety and depression: The moderating role of mindfulness. Journal of Child and Family Studies,28(3), 822–830. doi:10.1007/s10826-018-01323-2 EXERCISE BENEFITS AND SCREEN TIME 61 Appendix A Survey Instrument EXERCISE BENEFITS AND SCREEN TIME 62 Parent Questionnaire In order to investigate non essential screen time that may replace leisure time exercise as well as a loss of educational benefits that may result from an exclusion of exercise in adolescents, please answer the following questions. Your responses are very much appreciated and will be confidential. Neither you or your child’s identity will be asked nor revealed. Section 1 1. Which school does your child attend? __ Centerville Junior High School __ North Davis Junior High School 2. Please indicate your child’s gender __ Male __ Female 3. What grade is your child currently attending? (Note: If you have more than one child at the school, please answer for only the older child.) __ 7 __ 8 __ 9 Section 2 1. About how many hours does your child spend engaging in non essential screen time? This includes: television, internet on the computer or phone, social media, non essential communication, ipads, gaming, etc. Please exclude time spent on essential screen time i.e. education, essential communication, work purposes. __ 1-2 hours __ 3-4 hours __ 5-6 hours __7-8 hours __8-10 hours __12+ hours 2. What is the primary activity that your child participates in while on a screen? __ Social media (Facebook, Instagram, Snapchat, Tiktok) __ Video Gaming, online or offline __ Television watching, including Netflix, Amazon, and other online vendors __ Non essential communication: talking on the phone, texting, facetime. 3. Does your child currently own or have constant access to a cell phone? EXERCISE BENEFITS AND SCREEN TIME 63 __Yes __No Section 3 1. About how much voluntary exercise does your son or daughter participate in on a daily basis? (This time includes anything in which your child is being physically active i.e. playing outside, sports practices and competitions, riding bikes or skateboards, etc..) __0 min. __ 1-15 min. __ 16-30 min. __ 31-45 min. __46-60 min. __over 60 min. 2. How does your child do academically in school? __ Excellent grades (A average) __ Good grades (B average) __ Average grades (C average) __ Below average grades (D average) __ Failing grades (F average) Section 4 For this section please indicate the degree to which you agree with the statements below. 1 = Strongly Disagree 3 = Neutral 5 = Strongly Agree 2 = Disagree 4 = Agree 1. My child will voluntarily put down a screen and engage in physical activity. 1 2 3 4 5 2. My child has difficulty focusing on school work or other cognitive activities that require attention. 1 2 3 4 5 EXERCISE BENEFITS AND SCREEN TIME 64 3. My child has unhealthy sleep habits that may be related to excessive screen time. 1 2 3 4 5 4. My child experiences anxiety. 1 2 3 4 5 5. My child is free to be on screens as he/she pleases and there are no regulations concerning screen time in the household. 1 2 3 4 5