Prospective Associations Between Early Adolescent Problematic Screen Use, Mental Health, Sleep, and Substance Use
Among U.S. children aged 11–12, more addiction-like screen use was linked to worse mood, sleep, and early substance trying one year later.
*Prospective cohort study; Level 2b (OCEBM).
*Prospective cohort study; Level 2b (OCEBM).
Citation
Nagata JM, Shim JE, Balasubramanian P, et al. Prospective Associations Between Early Adolescent Problematic Screen Use, Mental Health, Sleep, and Substance Use. American Journal of Preventive Medicine. 2026;70(4):108248. doi:10.1016/j.amepre.2025.108248.
Background
Most prior research on addiction-like screen use and youth health has been cross-sectional, making timing unclear. This study tested whether addiction-like screen use predicts later mental health, sleep, and substance initiation in early adolescence.
Patients
8,119 U.S. participants (mostly age 11–12) from a national longitudinal cohort study (Adolescent Brain Cognitive Development Study). Excluded: missing key sociodemographic data, no reported screen use, or missing all outcomes.
Intervention
Higher addiction-like use scores for mobile phones, social media, and video games (self-report at baseline).
Control
Lower addiction-like use scores for the same screen types.
Outcome
Parent-reported behavior and mood symptom scores; self-reported suicidal behaviors; sleep duration and sleep disturbance; initiation of alcohol, tobacco, or marijuana use.
Follow-up Period
1 year.
Results
| Screen type (addiction-like use) | Outcomes linked to worse health at 1 year |
|---|---|
| Mobile phone | Higher depressive, physical-complaint, attention, oppositional, conduct problem scores; higher suicidal behaviors; shorter sleep; more sleep disturbance; higher alcohol, tobacco, and marijuana initiation |
| Social media | Higher depressive, physical-complaint, attention, oppositional, conduct problem scores; higher suicidal behaviors; shorter sleep; more sleep disturbance; higher alcohol, tobacco, and marijuana initiation |
| Video games | Higher depressive, attention, oppositional problem scores; higher suicidal behaviors; shorter sleep; more sleep disturbance |
Models adjusted for demographics, study region, and each matching baseline outcome; effects were reported by authors as small.
Limitations
Observational design cannot prove cause-and-effect, and unmeasured factors may explain some links. Screen use and several outcomes relied on self/parent report. Follow-up was only 1 year, and effect sizes were small.
Funding
National Institutes of Health grants (K08HL159350; R01DA057567).
Clinical Application
In early adolescents, assess addiction-like screen behaviors (not just hours) and counsel families on a structured media plan, sleep protection, and mental health/substance risk screening.
Discussion
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In this prospective cohort of 8,119 early adolescents, problematic mobile phone/social media use was associated with later suicidal behaviors and substance initiation; Year 3 rates were 2.9% and 12.8%, respectively. Given the observational design, how valid and applicable are these findings for changing counseling about screen use? In this study, problematic screen use was measured at Year 2 and mental health, sleep, and substance use outcomes were assessed at Year 3. Which feature most strengthens this study compared with a cross-sectional study?