BLOG: If sitting is the new smoking, should apps have warnings like cigarette packages?
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For most of us doctors, it’s the last thing we look at before bed and the first thing when we wake up: the screen of our smartphone or tablet.
At the office, we no longer look at paper charts but navigate records and test reports on a monitor. During breaks, we catch up on the news or our social media feed, yet again on a screen. We pay close attention, blinking as few as four times per minute, down from 15 to 20 blinks per minute for normal activity. And if we adult professionals are addicted to our screens, how much more are our young patients, who spend on average almost 7.5 hours each day on screens, according to a 2019 Common Sense Media report? Knowing the immense health impact of so much screen time, is it time for organized medicine to take more definitive action to encourage regulation of the software that drives our screen time?
Dry eye might be the most evident harm done by screen time. The rates of both symptoms and objective signs of this progressive disease among young people are difficult to estimate, but a 2020 study in JAMA Ophthalmology showed an increased rate among adolescents who spent more than 3 hours per day on screens, and a 2020 study in Acta Ophthalmologica showed similar results in university students when blink rate was reduced. The truth is we don’t know the long-term impact of dry eye that begins in childhood because it was a very uncommon entity prior to the past decade. If the disease course parallels the progressive nature of adult-onset dry eye, these kids could be severely functionally impaired by mid to late adulthood. Isn’t that worthy of action now?
What about harm to the general health of the screen user? Screen time equals sedentary time. Many studies have showed that “sitting is the new smoking,” linking inactivity to the early onset of obesity, insulin resistance and diabetes, with the incidence of diabetes in people younger than age 20 expected to increase sevenfold by 2060, according to a 2023 study published in Diabetes Care. Heart disease, too, comes from a sedentary lifestyle; a 2016 study showed each additional hour of screen time led to a 6% to 10% increase in the incidence of potentially life-threatening coronary events. Guess I won’t binge watch The Bear this evening after all!
Prior to 1950, tobacco producers had few restrictions on advertising claims, and many states had no minimum age to purchase tobacco products because the health risks were unrecognized. Today, the goal of every social and gaming app, video service and website is to keep viewers on the screen as long as possible. But the growing evidence of screen risks almost mandates some type of regulation. If so, what action can we physicians advocate? It’s clear that just advising patients to follow the 20-20-20 rule is insufficient. Should all apps be required to display a warning message every few minutes? Should schools have limits on the use of up-close screens in the classroom and in homework? How do we even begin to regulate the software industry that benefits so richly from addictive behavior? Probably self-regulation would be more innovative than oversimplified and easily circumvented government mandates. We need to change either the way our eyes work during intense concentration or the amount of time we spend doing it.
Finally, we doctors need to examine the example we are setting for patients. Currently, our excessive use of screens makes us about as credible as our predecessors who appeared in magazine ads of the 1950s declaring “more doctors smoke Camels.” Instead of sitting in a corner staring at a screen, we need to find ways to spend our time face to face relating to patients. It’s not just good for them. It’s also good for us.
Follow @DrHovanesian on X, formerly known as Twitter, and Instagram.
References:
- Inomata T, et al. JAMA Ophthalmol. 2020;doi:10.1001/jamaophthalmol.2019.4815.
- The common sense census: Media use by tweens and teens. https://www.commonsensemedia.org/sites/default/files/research/report/2019_8-18-infographic_final-release.pdf. Published 2019. Accessed Jan. 29, 2024.
- Tönnies T, et al. Diabetes Care. 2023;doi:10.2337/dc22-0945.
- Xu Y, et al. Acta Ophthalmol. 2019;doi:10.1111/aos.13885.
- Young DR, et al. Circulation. 2016;doi:10.1161/CIR.0000000000000440.
- Young K. Study provides ‘little or no support’ that 20-second breaks alleviate digital eye strain. https://www.healio.com/news/optometry/20230120/study-provides-little-or-no-support-that-20second-breaks-alleviate-digital-eye-strain. Published Jan. 20, 2023. Accessed Jan. 29, 2024.
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