SAFE USE OF SCREEN TIME AMONG ADOLESCENTS – A RANDOMIZED CONTROL STUDY FOR EFFICACY OF YOGA

Abstract

Background: Excessive screen time among adolescents has emerged as a major concern, contributing to negative outcomes such as depression, anxiety, behavioral issues, poor physical health, and diminished cognitive functioning. These include impaired executive functioning, anxiety, depression, sleep disturbances, and smartphone addiction. The increasing dependency on digital media necessitates effective, holistic interventions. Holistic approaches like yoga may serve as effective interventions by enhancing self-regulation, mental clarity, and physical well-being. Aim: To evaluate the feasibility, efficacy, and validity of yoga-based interventions aimed at managing screen time and associated psychological and physical symptoms in adolescents. Methods: • Study 1: A needs assessment survey was conducted to understand concerns related to excessive screen usage behavior among students, teachers, and parents, with a focus on addressing the health-related impacts on adolescents. • Study 2: A comprehensive yoga module was developed using classical yogic texts and modern scientific literature. The module was reviewed and validated by 26 experienced yoga professors, each with over 10 years of expertise. A feasibility study (pilot study) was conducted to assess the module’s impact on screen time, mental health, and well-being in adolescents, using convenient sampling and non-random group allocation (15 in yoga, 15 in control group). • Study 3: This randomized controlled trial involved 100 schoolchildren aged 13–17 from Endeavour Academy, Bangalore. Participants were randomly assigned to either a yoga group or a control group using an online randomizer, with 50 participants in each. Sample size was calculated using G-Power software based on a prior pilot study, ensuring statistical power. Inclusion criteria focused on adolescents with adequate English skills and willingness to join the yoga program, while exclusions were based on lack of internet access, medical issues, or low screen time. Assessment: For study 1 need assessment survey was conducted based on self-developed google form questionnaire in online mode. For study 2 and study 3 participants were evaluated for Screen Time Use Questionnaire (STQ), WHO-5 Well-being Index, Generalized Anxiety Disorder (GAD-7) for assessing generalized anxiety and Patient Health Questionnaire (PHQ-9) to assess depressive symptoms, and Smartphone Addiction Scale Short Version (SAS-SV). The questionnaires were administered before and after the duration of the study intervention. Additionally in study 2 Content validity of the yoga module developed for optimizing screen time was assessed using Lawshe’s Content Validity Ratio (CVR) Intervention: The study 1 was survey study. The yoga protocol executed in the study 2 and study 3 (main-study) consisted of shitalikarna vyayama (loosing Exercise), Shavasa prashvasa kriya (breathing practice), asanas (physical postures), relaxation technique (supine position) (QRT with affirmation), pranayama (breathing techniques), meditation, concept of four streams of yoga, sitting position, kriya, and yogic games. The yoga intervention was given 3 days a week, 45 minutes a day, for one months in study 2 and three months in study 3. The digital hygiene educational routine issued by UGC (India) was given to the control group for the equivalent duration as the yoga group in both the study. Results: • Study 1: Highlighted the multidimensional benefits of school-based yoga, as it supports students' physical, emotional, and cognitive well-being, fostering resilience and long term healthy development. Reports the evidences that suggests integrating yoga into school curriculums may be an effective, evidence-based strategy to counter the negative effects of excessive screen time. • Study 2: Six practices were removed due to low CVR scores, and 21 out of 27 validated practices were retained in the final module (CVI = 0.72). Feasibility study for authenticating the developed module showed a significant decrease in screen time (p<0.05) and improvements in anxiety (p<0.01), depression (p<0.001), and well-being (p<0.01) after the 12 sessions of intervention. • Study 3: Reported statistically significant reductions in screen time (p<0.001), smartphone addiction, anxiety (p<0.05), and depressive symptoms (p<0.01) in the yoga group. Substantial improvements were also noted in specific subcategories of screen time within the yoga group, with time spent watching television consistently decreasing across all periods [weekdays (p<0.01), weeknights (p<0.001), weekends (p<0.05)]. Conclusion: Yoga interventions significantly reduce excessive screen use and related health complications in adolescents. Incorporating yoga into school curricula offers a preventive and restorative approach to fostering balanced development. Continued research is recommended to further explore its long-term impact and application in broader educational and clinical settings. Keywords: Screen time, adolescents, yoga intervention, mental health, and smartphone addiction, school curriculum, mindfulness.