Background Over the past decade, smartphones have become an integral part of family life, shaping both daily routines and parent-child interactions. Although parental smartphone use in the presence of children is frequently framed as harmful through concepts such as phubbing and technoference, these constructs emphasize disruptive smartphone use and may bias interpretations toward negative effects. Moreover, most previous research has relied on cross-sectional self-report data, limiting insight into how parental smartphone use relates to children’s well-being in everyday life. Objective This study examined the associations between parental smartphone use in the presence of the child and children’s affective well-being, as well as perceived threats to children’s fundamental needs, using both self-reported and device-logged measures of smartphone use. Methods Individual parents (N=131) participated in a 10-day daily diary study. Each evening, parents reported their smartphone use in the presence of a selected target child, their child’s positive and negative affect, and perceived threats to their child’s fundamental psychological needs. In addition, Android users who provided consent installed a mobile sensing app that continuously recorded objective smartphone use throughout the study period. Multilevel models were used to examine both within-person (day-to-day fluctuations) and between-person associations separately for mothers and fathers while controlling for day of study, weekday vs weekend, and daily working hours. Results Higher parental smartphone use was largely unrelated to children’s affective well-being. However, mothers who, on average, reported greater overall smartphone use perceived greater threat to their child’s fundamental needs. Similarly, on days when fathers reported using their smartphones more than usual, they also perceived greater threats to their child’s fundamental needs. In regard to positive affect, no significant associations were found for children’s positive affect perceived by their parents, indicating that parents who, on average, used their smartphones more frequently around their child did not report lower child positive affect. Regarding negative affect, fathers who reported higher overall smartphone use also reported higher child negative affect. Additionally, on days when mothers used their smartphone more than usual, they perceived their child as displaying more negative affect. None of these associations emerged when parental smartphone use was assessed using device-logged data. Conclusions Taken together, these findings suggest that perceived child need threat may be linked to parents’ subjective perceptions and interpretations of their smartphone use rather than to their digitally traced smartphone behavior. This discrepancy underscores the importance of distinguishing between subjective and objective assessments of parental smartphone use and highlights the need for future research that integrates children’s perspectives and interactional context to clarify when and how parental smartphone use may impact children’s well-being.
Abstract Background Adolescents’ high engagement with smartphones creates opportunities for mobile health (mHealth) apps targeting dietary behaviors. However, despite the availability of diverse dietary mHealth apps, user engagement remains low. Existing quantitative literature has identified barriers and facilitators to app effectiveness in youth (aged 10-19 years) but has not fully captured the nuanced perceptions of adolescents (aged 12-19 years), who represent a unique life stage. Synthesizing similarities and differences in adolescents’ perceptions of what they value in dietary mHealth apps from qualitative studies may provide a more comprehensive understanding of app engagement and future app design. Objective We aimed to synthesize adolescents’ perceptions of using diverse dietary mHealth apps. Methods A scoping review was conducted according to the 5-stage framework by Arksey and O’Malley. Eligible studies were published in English and reported on adolescents (aged 12-19 years) with perceptions of dietary mHealth apps using qualitative methods. Apps that were not specific to diet, relied only on SMS text messaging, were delivered as part of a school-based intervention or telemedicine service, or were housed on a website or social media platform were excluded. Five evidence sources (PsycINFO, Embase, Medline, Web of Science, and CINAHL) were searched. Extracted data were charted by 1 researcher following a pilot test. Similarities and differences in adolescents’ perceptions were synthesized across studies using thematic analysis. Results Of the 1195 search results, 1.2% (n=14) met the eligibility criteria. We identified six themes that represented adolescents’ perceptions of using dietary mHealth apps: (1) functionality and design, (2) content and depth, (3) social connection and support, (4) entertainment and gamification, (5) goal setting and motivation, and (6) perceived effectiveness. Overall, adolescents favorably perceived apps that were easy to navigate, fostered social connections, were personalizable, and were gamified. Apps that were felt to increase awareness of personal eating habits, often through tracking calories and foods consumed, and foster awareness of personal well-being were especially discussed in relation to perceived app effectiveness. Conclusions The findings of this review provide an innovative synthesis of adolescents’ perceptions of diverse dietary mHealth apps, using qualitative data. Notably, dietary mHealth apps that were perceived as easy to navigate, tailored (eg, in terms of content), and gamified and those that included social engagement were perceived favorably, regardless of their dietary target and features. Apps that were perceived to improve adolescents’ current dietary awareness were particularly valued. Inclusion of these elements in dietary mHealth apps may promote greater engagement. App developers should work with adolescents to establish how specific apps can incorporate these elements into their design, including how best to track dietary habits and integrate AI into app features.
Background Home monitoring has the potential to enable early detection of disease progression in pediatric lung diseases such as asthma and cystic fibrosis (CF). There is minimal evidence regarding the opinions of caregivers and children on home monitoring. Objective This study aimed to explore children’s and caregivers’ perspectives on home monitoring. Methods This multicenter, mixed methods study included children aged 6 to 18 years with asthma or CF and their caregivers. Participants were recruited from Juliana Children’s Hospital and Erasmus MC Sophia Children’s Hospital between September 2023 and June 2025. Participants completed a structured questionnaire assessing experiences, attitudes, and potential barriers and facilitators to home monitoring. Fourteen children and their caregivers took part in in-depth interviews. Conventional content analysis was applied to both open-text and interview data. Results A total of 113 caregiver-child dyads (62 [54.9%] asthma and 51 [45.1%] CF) participated in this study. Willingness to use home monitoring was high among both children (asthma: n=47, 83.9%; CF: n=30, 62.5%) and caregivers (asthma: n=54, 87.1%; CF: n=44, 86.3%). Children with asthma and their caregivers showed significantly greater willingness to use the proposed types of home monitoring than children with CF and their caregivers. Caregivers who expressed difficulty with symptom interpretation were significantly more motivated to use home monitoring. Key barriers included time demands, usability, device size, and concerns about maintaining personal contact with health care providers. Facilitators included compact, user-friendly devices, clear instructions, and improved disease understanding. Conclusions High willingness to adopt home monitoring was observed among children with asthma and children with CF, but preferences and perceived barriers differ. Tailoring device choice and implementation strategies to patient needs, minimizing burden, and integrating medical oversight are important for successful uptake.
BackgroundAdolescent nicotine use initiation remains a significant public health concern. While screen-based behaviors have been linked to substance use, few prospective studies have examined specific forms of interactive screen engagement or tested potential psychological mechanisms underlying this association. ObjectiveThis study aimed to examine whether weekend texting screen time was prospectively associated with subsequent nicotine use initiation among early adolescents and evaluate whether negative urgency statistically accounted for part of this association. MethodsWe analyzed longitudinal data from a large cohort of adolescents who were nicotine naive at baseline. Weekend texting screen time (hours) was assessed via self-report. Negative urgency, reflecting impulsive action during negative affect, was measured using the UPPS (Urgency, Premeditation, Perseverance, and Sensation Seeking) impulsivity scale. Incident nicotine use initiation was modeled using Cox proportional hazards regression, adjusting for sex, age, race, ethnicity, and household income. We evaluated whether adjustment for negative urgency attenuated the texting-initiation association and conducted a sensitivity analysis restricted to participants for whom texting assessment, negative urgency assessment, and nicotine use initiation were temporally ordered. ResultsAmong 5,965 nicotine-naïve adolescents followed prospectively, 239 (4%) initiated nicotine use. Greater weekend texting was associated with increased hazard of nicotine use initiation (per hour: hazard ratio [HR]=1.07, 95% CI 1.04‐1.11). A 5-hour increase corresponded to an approximately 30% to 40% higher hazard of initiation. Weekend texting was positively associated with negative urgency (β=0.079; P<.001), and negative urgency independently predicted nicotine use initiation (per point: HR=1.19, 95% CI 1.13‐1.25). Inclusion of negative urgency slightly attenuated the texting association (per hour: HR=1.06, 95% CI 1.02‐1.09), although attenuation was modest. In standardized models, a 1-SD increase in weekend texting was associated with a 21% higher hazard of initiation (HR=1.21, 95% CI 1.10‐1.31). In a sensitivity analysis restricted to participants with temporally ordered assessments and nicotine use initiation, weekend texting remained associated with nicotine use initiation (HR=1.11, 95% CI 1.06‐1.16), and negative urgency remained independently associated with use initiation (HR=1.11, 95% CI 1.02‐1.21). Adjustment for negative urgency attenuated the texting log-hazard coefficient by 6.8%. ConclusionsGreater weekend texting screen time was prospectively associated with subsequent nicotine use initiation among early adolescents. Negative urgency was independently associated with nicotine use initiation and modestly attenuated the texting-initiation association. These findings are consistent with overlapping contributions of digital engagement and affect-driven impulsivity to early nicotine risk but do not establish a causal mediating pathway.
BackgroundPositional cranial deformities are common in infancy. Smartphone-based apps are increasingly used to assess infant head shape, but evidence comparing these tools with 3D scanners across age groups in community-based settings remains limited. ObjectiveThis study evaluated age-stratified agreement and screening performance of a mobile app for estimating Cranial Vault Asymmetry Index (CVAI) and Cephalic Index, compared with a 3D scanner, when used by a trained examiner during routine municipal health checkups in Japan. MethodsWe conducted a cross-sectional study in Goto City, Japan, between May 2023 and March 2025. Independent, age-specific cohorts of children attending municipal health checkups at 4, 18, and 42 months were included. Paired cranial measurements were obtained by a trained examiner using a VECTRA H2 3D scanner (Canfield Scientific Inc) and the mobile app. Agreement was assessed using mean differences, 95% limits of agreement (LoA), and intraclass correlation coefficients (ICCs), with device-stratified sensitivity analyses. Screening performance was evaluated using sensitivity and specificity based on prespecified clinical thresholds. Receiver operating characteristic (ROC) analyses were secondary exploratory analyses. The primary outcome was app-based CVAI for detecting scanner-defined moderate-or-worse plagiocephaly (CVAI≥7%). Secondary outcomes were app-based Cephalic Index for detecting brachycephaly (Cephalic Index>94%) and dolichocephaly (Cephalic Index<79%). ResultsThe final analytic samples comprised 262 children at 4 months, 171 at 18 months, and 216 at 42 months. Agreement for continuous CVAI was highest at 4 months (mean difference 0.14, 95% LoA −4.18 to 4.46; ICC 0.76, 95% CI 0.71‐0.81) and lower at 18 months (ICC 0.42, 95% CI 0.29‐0.54) and 42 months (ICC 0.49, 95% CI 0.38‐0.59). For Cephalic Index, the app consistently overestimated values relative to the scanner, with mean differences of 3.83 SD 3.42, 3.24 SD 3.07, and 2.61 SD 3.33 points at 4, 18, and 42 months, respectively. For detecting scanner-defined moderate-or-worse plagiocephaly, app sensitivity and specificity were 84.8% and 88.0% at 4 months, 50.0% and 88.4% at 18 months, and 53.3% and 89.6% at 42 months, respectively. Device-stratified analyses showed some variation in measurement agreement and screening performance across devices. ConclusionsUnder municipal health checkup conditions with a trained examiner, app-based CVAI showed the strongest performance at 4 months and may be useful for early screening. However, performance was weaker at 18 and 42 months. App-based Cephalic Index was systematically higher than scanner-based Cephalic Index, potentially increasing false-positive classifications for brachycephaly when identical thresholds are applied. Performance varied somewhat between devices, although device effects could not be separated from study period and accumulated examiner experience. Positive findings, particularly at later ages or for Cephalic Index–based measures, should be interpreted in the context of the child’s age and broader clinical findings, with further evaluation or referral considered only when clinically indicated. Trial RegistrationUMIN Clinical Trials Registry UMIN000052342; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_his_list.cgi?recptno=R000059748
