SCHOOL OF ALLIED AND HEALTHCARE SCIENCES

INTRODUCTION:

With an increasing number of electronic media devices available globally, the concept of
screen time has gotten more complex in recent years. 1 Modern technology has become an
essential element of children's everyday lives in the society in which they grow up. They are
thus exposed to electronic devices at a young age, which leads to screen time (ST) viewing.
Because of the COVID-19 epidemic, there has been a recent rise in interest in
investigating screen time. The rise of digital media (DM) is thought to have socioeconomic
effects in addition to health ones. More than 80% of the parents who participated in a recent
survey stated that they think screen time fosters their children's imagination and creativity,
despite evidence that suggests excessive screen time is detrimental to young people.2

Beyond the sedentary behaviour that may arise from extended sitting, the effects of screen
use on health are a complex topic. Heavy commercial advertising has previously been linked
to poor food habits when watching television. Frequent smartphone use has been linked to
sleep issues, possibly as a result of exposure to electromagnetic fields that are radio
frequency and can alter brain function. Furthermore, prolonged screen time has been linked
to mental health issues including depression, which can negatively impact immune system
and metabolism by upsetting the hypothalamic-adrenal axis. 3 WHO defines screen time as
time spent passively watching screen-based entertainment which excluded screen activities
that required physical activity, thus WHO indirectly classify screen-based activity as
sedentary activity. According to certain data that repeatedly demonstrated a negative
relationship between screen time and lifestyle choices, screen time is predicted to increase
social distancing orders and thus decrease opportunities and time for physical exercise. This
is because university students spend more time in front of screens than engaging in activities
that demand physical mobility since they are shifting their primary learning or recreational
activities from physical to virtual.4

It has been proven that one of the multiple reasons for more and more individuals being
affected by depression and feeling further isolated is their addiction to mobile phones and
other digital gadgets, their dependency on the presence of people on the internet, their views
and values, which need to be individual’s own. It increases reliance on online approval from
anonymous users. In addition to affecting the release and maintenance of sufficient amounts
of feel-good hormones like dopamine, serotonin, endorphins, and oxytocin—all of which are

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naturally necessary for everyone—it slows down the pace at which people physically connect
with others in real life. It is believed that excessive usage of digital media significantly
hinders the development of sound psycho-physiological resilience. 5 Reduced tiredness,
trouble falling asleep, and non-restorative sleep can result from blue light, like that from a
smartphone, which suppresses melatonin production. Limiting computer and TV use close to
bedtime is frequently advised as a crucial component of proper sleep hygiene.6

With this advancement has come the prevalence of students using a variety of screens, most
of which are internet-enabled devices, for a variety of purposes, including academic. While
this can make accessing information easier, there are concerns about internet-enabled screens
negatively impacting young students' concentration and learning. 7 The largest percentage of
smartphone owners and users are young adults between the ages of 18 and 24. The amount of
time spent sitting has increased due to the growth of technology and the availability of smart
devices. Given their widespread use and their alleged associations with poorer mental health,
impaired sleep (both negatively associated with quantity and quality of sleep),
musculoskeletal symptoms, female urinary incontinence, and an increased risk of motor
vehicle accidents, it is imperative to comprehend the health effects of social media and
electronic device use. Chronic conditions like obesity, diabetes, heart disease, and mental
health issues are strongly correlated with excessive sedentary behavior. 8 Since their
curriculum requires extended work hours while they are confined to the hospital, medical
students rely heavily on their mobile devices to stay in contact with their families and peers.
The growing availability of e-books, medical podcasts, dosage calculators, and online
lectures has led to their widespread use as a tool for education and note-taking. Prolonged
usage of mobile devices has been linked to symptoms like headache, weariness, and poor
focus. Mobile phone addiction is categorized as a nonsubstance addiction by the World
Health Organization. As a result of excessive mobile phone use, new diseases including
ringxiety and nomophobia, or "no mobile phone," have emerged.9

Long hours spent in front of electronic screens without taking a break leaves the eyes
exceedingly dry. As a result, dry eye syndrome and other vision issues are becoming
increasingly prevalent.10 Excessive screen usage is linked to other unhealthy lifestyle
behaviours such as poor food and lack of sleep. Early screen exposure has been linked to
decreased cognitive capacities and academic achievement in later years. 11

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Social media may be more effective in displacing sleep and pre-bedtime arousal when
compared to watching television or other "passive" screen-based activities. Very interactive
platforms that allow people and communities to share, co-create, discuss, and edit user-
generated content are social media. Some people become addicted to social media, which is
defined as using it excessively to the point where it interferes with other relationships,
activities, and everyday responsibilities. Addiction to social media has been linked to higher
evening and nighttime screen usage as well as lower subjective sleep quality in both adults
and students.12

Problems Students Face Due to Excessive Screen Use:

One of the indicators of screen addiction is a lack of control over one's screen time. Screen
addiction can harm students' physical, emotional, and social health, leading to isolation.
Students with screen addiction have difficulties setting and maintaining screen time limits.
Prolonged screen time reduces one's ability to engage in other elements of life. Excessive
screen use can harm academic performance and lead to feelings of guilt, humiliation, and
worry among adolescents.

Students prefer to use their smartphones instead of reading books or participating in outside
activities. While reading or conversing with others, individuals may find themselves
constantly pulled to their devices. Screen addiction leads to sleep deprivation. It disrupts the
normal sleep pattern. Excessive screen time can negatively impact kids' logical thinking,
creativity, reasoning, problem-solving, judgement, and decision-making skills. Excessive
screen use can severely impact academic and work performance by reducing concentration,
attention, and retention.13

It has also been noted that many students use their phones right before bed, spending more
time messaging, browsing Facebook, and using other websites. As a result, they are unaware
of how much time they spend on their phones, sleep later than they should, which lowers
their mental alertness and makes it difficult for them to perform well in class, which results in
poor grades. These days, students have an addicted relationship with their phones; if they
leave them at home, they grow agitated in class until they return to retrieve them. 14

Excessive cell phone use among adults was linked to depression, anxiety, and loneliness.
Interestingly, people who spent too much time on their cell phones showed higher levels of
stress. The study found that problematic cell phone use is connected with psychological
distress and emotional dysregulation. Excessive mobile phone usage was also discovered to

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be correlated with obsessive-compulsive disorder behaviours and symptoms related to

attention-deficit hyperactivity disorder (ADHD).15

There are greater behavioural issues among students who favour computer games over other
forms of leisure. Anger, aggression, obesity, epilepsy, and social isolation are all exacerbated
by gaming. One type of internet usage is excessive online purchasing. The pathophysiology
of addiction, also known as pathological buying, involves the escape of bad emotions or the
pursuit of pleasure, as well as cognitive processes including impulsivity, poor self-control, or
impaired decision-making. Limiting screen usage to one or two hours per day is advised, and
taking a vacation or weekend break from the "screen" is a smart idea. 16 The time spent at
colleges and universities is crucial for establishing moral, emotional, ideological, social, and
other personality traits from the standpoint of human growth. There is no denying that
smartphone games give college students unreasonably high levels of fun and satisfaction.
However, there are two sides to mobile gaming as well. College students' gaming activity will
have detrimental repercussions, including bodily and psychological impairment, if it is not
guided by appropriate standards.17

One of the most important factors influencing life pleasure and quality is mental health.
Undergraduate students at universities in both rich and developing nations frequently struggle
with the complicated psychological issue of poor mental health. University students are more
likely than the overall population to suffer from stress, anxiety, and depression (SAD).
Students' quality of life and academic performance can be adversely affected by untreated
mental health issues, which can include, but are not limited to, diminished academic integrity,
substance and alcohol abuse, less empathetic behaviour, unstable relationships, low self-
esteem, and suicidal thoughts.18 Mental health issues can significantly impact many elements
of campus life and may negatively affect academic performance, retention, and graduation
rates.19 According to a 2017 CDC research, college students aged 18-25 make up 12.4% of all
suicides nationally. This age group is also at the highest risk for serious suicide thoughts and
attempts.20 Due to the sudden transition from high school to college, several students find it
difficult. Others experience stress when they are separated from their homes. Students may
face a variety of emotional and psychological concerns, including anxiety over academic
assignments like as tests and presentations. In addition, they may struggle with eating
problems, deal with the impacts of parental separation or grief, and feel lonely or homesick. 21

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Depression and anxiety can lead to lower GPA, more alcohol consumption, smoking, self-
injury, withdrawal from college, suicidal thinking, and even suicide. 22 Depression is a mental
condition that manifests as low energy, loss of interest, anhedonia (the inability to feel
pleasure), guilt, and low self-esteem. It can also be accompanied by sleep disturbances, poor
eating, and difficulty concentrating.23 Numerous research, both retrospective and prospective,
have indicated that university students are more vulnerable to developmental abnormalities.
Depression is a severe medical condition characterized by a lingering sense of melancholy
and unhappiness. Its symptoms might range from mild to severe and last for an extended
length of time without any discernible cause. More than 40% of mental illnesses are caused
by depression alone. Individuals who suffer from depression are 40–60% more likely to die
young than the overall population.24

Depression is a prevalent, crippling, and sometimes fatal illness. According to the World
Health Organization, depression is the leading cause of disability worldwide, affecting an
estimated 300 million people. Additionally, there is proof that the prevalence of depression
has grown throughout the past ten years (WHO, 2012, 2014). The most concerning finding is
that teenagers with serious depressive disorder have a 30 times higher risk of suicide. 25
Depression is a prevalent issue with a reported prevalence rate ranging from 18.0%-68.5%. It
not only impacts the individual but also significant consequences leading to reduced
academic performance, social dysfunction etc. Notably, one of the risk factors for university
students committing suicide is depression. Depression can be significantly reduced by
exercise.26 Approximately 11.9% of college students suffer from an anxiety condition,
making it the most common mental issue among this demographic. Panic disorder,
generalised anxiety disorder (GAD), and post-traumatic stress disorder (PTSD) all have
considerably later onsets than social phobia, which is one of the anxiety disorders with an
early age of commencement.27 According to a World Health Organisation research, anxiety
has become the most common and top-ranked mental health concern among college students
globally. Emotional dysregulation and unpleasant emotions are significant influences on
mental health.28

In addition to being linked to anxiety, hopelessness may also play a role in the emergence of
depression. Exposure to a variety of academic pressures may result in chronic, unmanageable
stress, which harms students' aspirations and goals and makes them think pessimistically,
which further fuels the emergence of depression.29

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In addition, there are issues related to academic success since, in comparison to average
students, high achievers experience higher levels of anxiety, perfectionism, sensitivity, and
social isolation. These students struggle with issues that may be endogenous despite having
strong mental talents, such as a variety of interests, great sensitivity, and an imbalance in their
mental and physical growth as well as their mental and emotional development. In addition to
having a high level of mental health, self-direction, and self-esteem, high-achieving kids also
confront two kinds of emotional and social issues: first, they are viewed negatively by their
professors and counsellors, who believe they are capable of handling their own affairs. The
second is that these students tend to solve their problems rather than ask for help or
communicate their suffering because this goes against the perceptions, they have of
themselves (perfection), which could have an impact on how well they perform when dealing
with academic, personal, and developmental issues.30

Nutritional problems are caused by improper management of food patterns. Approximately

two billion people worldwide suffer from malnutrition in one way or another, according to
the United Nations' (UN) study on urban livelihood and food and nutrition. According to the
American Dietetic Association (2004), in order to maintain excellent health, dietary patterns
should be appropriate for a person's age, sex, and activities. 31 University students are more
likely to acquire poor eating habits due to low nutritional consumption. These habits include
irregular meals, skipping breakfast, eating less fruits and vegetables, and consuming more
fried foods.32
Many students lack the nutrition knowledge and skills necessary to recognise the danger of
chronic diseases associated with harmful eating habits. Another consequence was a shift in
dietary intake such as overeating or eating more frequently. 33 During the first year of college
or university, students' food habits may worsen, leading to weight problems that can persist
throughout their lives.34 A poor diet can cause a number of health issues, including lack of
energy, difficulty focussing, and compromised immune systems. Lack of time or finances
often leads students to skip meals, which can result in nutritional deficiencies and energy
deficits that negatively impact academic performance. Furthermore, students who stay up
late studying frequently consume high-calorie items like pizza, chips, and ice cream. By
snacking after midnight, this can result in weight gain and poor sleep.35

Many college students have a tendency to choose foods based more on price, time, taste, and
convenience than on nutritional content.36 The student may acquire weight as a result of

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eating poorly and drinking too much alcohol, which both greatly increase energy intake.
Pupils have a much greater consumption of total and saturated fats and much lower
consumption of polyunsaturated and monounsaturated fats, folic acid, vitamin E, and cereals
in comparison to the American Heart Association's recommendations.37

Poor diet quality is the primary cause of depression, and overall nutritional status and nutrient
consumption are linked to sadness. Less frequent eating has been linked to increased levels of
depression. Patients with depression were shown to have inadequate intakes of iron, zinc, and
selenium. Furthermore, inadequate blood levels of folic acid and vitamin B12 were found in
patients with severe depression, and these deficiencies were linked to depressive disorders.38

Adults who regularly use food pantries consume less fruit and vegetables than is advised and
have poorer overall diet quality. A lower risk for all causes of death, particularly
cardiovascular reasons, is linked to those who consume more fruits and vegetables. 39 It has
been determined that the Mediterranean diet is one specific diet that improves human health.
A Mediterranean diet can significantly lower the incidence of neurological disorders like
Parkinson's and Alzheimer's as well as mortality from cardiovascular disease, cancer, and
total mortality. Students' eating habits should be closely watched since they can vary over
time and can occasionally have unfavourable effects. One should refrain from consuming
snacks, butter, salt, and sugar.40 Meal skipping has been connected to a number of detrimental
health effects and is frequently caused by unpredictable academic schedules, financial
limitations, and low food knowledge. Unusual eating habits can interfere with metabolic
functions, making people more vulnerable to malnutrition and overnutrition. 41 It has also been
demonstrated that eating breakfast improves academic performance and is crucial for creating
a healthy, happy lifestyle. Breakfast raises blood sugar levels, which can boost memory,
quick recall, and attention span. These improvements can then translate into higher test
scores.42

College students' elevated levels of anxiety and despair are substantially correlated with bad
eating habits. Poor mental health outcomes are a result of people choosing unhealthy foods
like fruits and vegetables over refined sugars and saturated fats. These results highlight the
necessity of nutritional interventions as a component of academic mental health programs.
Educational institutions can significantly contribute to students' mental health by encouraging
good eating habits, which may enhance their academic performance and general quality of
life. This emphasises how crucial it is to incorporate mental health support and nutritional

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education into the young adult healthcare system in order to promote a comprehensive
approach to students' health and wellbeing.43

People tend to binge eat and not exercise when they eat in front of a screen, which can result
in weight gain and other health care problems. Their eating schedule and speed are also
impacted. Decreased consumption of fiber, fish, vegetables, fruits, and whole grains;
increased consumption of low-nutrient-quality foods like french fries, refined grain products,
snacks, and desserts; and increased consumption of sugar, especially from soft drinks, have
all been associated with prolonged screen time. Electronic media advertisements affect the
nutritional value of the meals that teenagers eat.44

A physiological state that alternates with wakefulness is sleep. An individual's quality of life
is influenced by both the quantity and quality of their sleep. A one-third of a person's life is
spent sleeping, which is essential for mental, emotional, and physical health, according to the
WHO.45 Sleep is essential for several processes, including learning, memory processing, brain
development, and cellular repair. Sleep is crucial for regulating the operations of numerous
bodily systems in addition to preserving optimal brain function. Lack of sleep is linked to
exhaustion, decreased neurocognitive function, and increased daily drowsiness. 46 Inadequate
sleep is a major public health concern and a prevalent medical condition that can have serious
implications. Teenagers should aim for 8.5-9.5hours of sleep per night, where adults over the
age of 18 should aim for 7-9hours. Yet many college students do not reach these
recommendations and many sleep less than 6 hours per night. 47 Sleep issues and stress are
closely related and have an impact on one's health and wellbeing. Sleep disturbance is
characterised by either interrupted sleep during the night or sleep deprivation due to
insufficient total sleep time, which can have a negative impact on one's health. Sleep
deprivation raises the risk of cardiovascular diseases, diabetes mellitus, and death, according
to epidemiologic research. Fatigue and depressed feelings are frequent signs of sleep
problems.48

Students are more vulnerable to sleep disruptions and deprivation due to their erratic
schedules, increased academic and social obligations, and other factors. College students'
social lives include a range of entertainment options and goods that degrade sleep quality.
Significant independence, little oversight, bad habits like drinking and smoking, and easily
accessible recreational opportunities are all features of university life. Common signs of poor
sleep quality, such as insomnia and sleep disruptions, are linked to coffee usage. In addition

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to causing sleep issues, excessive smartphone use also leads to physical inactivity, which
exacerbates sleep issues.49 College students with low sleep quality exhibit daytime
drowsiness and weariness linked to poor cognition, emotional dysfunction, and concentration,
all of which impair academic and learning abilities as well as physio-psychological health. A
significant contributing factor to sleep disruptions is screen time and the usage of light-
emitting devices after hours.50

One of the most frequent reasons college-aged students become drowsy during the day is
sleep loss, which occurs when students go to bed late and wake up early. There are several
causes for this, some of which are behavioural and others of which are physiological. A
regular sleep-wake pattern, a peaceful sleeping environment, and avoiding stimulating
activities right before bed and coffee after lunch are all components of good sleep hygiene.
It's likely that students with sleep issues don't perform at their best academically.51

Adults' and children's health is directly impacted by diet and exercise. Physical inactivity is
regarded as a public health issue rather than an individual one as the majority of people on
the planet are not physically active. In addition to smoking, obesity, and high blood pressure,
the World Health Organization report states that physical inactivity is a risk factor. In
addition to chronic non-communicable diseases that neither children nor young people are
resistant to, the leading causes of premature death are stress, obesity, and movement disorders
including hypokinesia. About 60–70% of economically stable nations do not even meet the
World Health Organization's minimal physical activity guidelines for preserving energy
balance and health.52According to recent estimates, physical inactivity-related health
problems account for over 3.2 million deaths annually, ranking it as the fourth most important
risk factor for mortality worldwide. Engaging in regular physical activity (PA) can enhance
one's quality of life (QOL) in addition to preventing the onset of chronic diseases. The term
quality of life (QOL) describes how people subjectively perceive the good and bad parts of
their lives. It includes psychological and physical elements that work together to affect how
satisfied a person feels with their life overall.53

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Screen time has become an important aspect of daily living in the current digital era,
particularly for college students. Concerns have been expressed over the possible effects of
the growing use of electronic devices for social, educational, and recreational purposes on
health and wellbeing. Excessive screen time, whether for social connections, education, or
entertainment, has caused worries about its possible effects on health and wellbeing. Long-
term screen time is frequently linked to changes in eating patterns, a decrease in physical
activity, and mental health issues like anxiety, stress, and insomnia. Dietary habits have a
significant impact on physical fitness, emotional stability, and cognitive performance, all of
which are essential for preserving general health. Excessive screen time has been connected
to poor eating habits such frequent snacking, processed food consumption, and irregular meal
schedules, all of which can lead to metabolic diseases and nutritional imbalances. The risk of
anxiety, depression, and other psychological disorders may rise as a result of these lifestyle
modifications, which may also have an impact on mental health. This cross-sectional study
focuses on connection between screen usage, eating habits, and mental health among Malla
Reddy University students. The study aims to provide awareness on how students' health and
well-being are affected by digital involvement in everyday life.

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1. REVIEW OF LITERATURE:

1.1 Information Related to Study:

A cross-sectional study on screen time, food patterns, and mental health effects among
college students aims to investigate the relationship between lifestyle behaviours and
psychological well-being. The study often collects data via surveys or questionnaires to
examine characteristics such as average screen time, dietary habits (e.g., consumption of
processed or nutrient-dense foods), and mental health indicators such as stress, anxiety, and
depression. Excessive screen time is frequently associated with harmful eating habits,
according to research. Because of their course work, social media accounts, entertainment,
college students spend more time on screens. Overuse of screens is linked to lower levels of
physical activity, worse sleep and higher levels of anxiety. Anxiety and body image issues are
associated with increased social media use. Unhealthy eating habits are linked to mental
health problems, and weight increase.

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1.2 Literature Review

Association between screen time and other factors:

Kumban W et al., (2025), according to this survey, college students who are addicted to
smartphones spend a lot of time in front of screens and use their phones more regularly. Both
university students with and without smartphone addiction spent more than eight hours a day
in front of screens. According to GPAQ, there was no difference in physical activity between
the groups with and without addiction. Students majoring in the humanities and social
sciences were less likely to be physically active than students majoring in science,
technology, and health sciences. There were no changes in smartphone use between junior
and senior students, despite the former being more physically active. These groups should
encourage real-world activities and give priority to leisure and physical education in order to
decrease screen usage. Programs or instructional activities that promote physical activity and
reduce screen time should also be developed.8

Kader NA et al., (2024), the study's findings suggest that multiple screen addiction has a
substantial impact on senior secondary students. Additionally, it shows that there is a
statistically significant difference in senior secondary students' cases of multiple screen
addiction based on their gender and a substantial difference between the multiple screen
addiction of both private and public seniors in high school.13

Ong JXT., (2023), the purpose of this study was to investigate the association between
screen time, physical activity level, and sleep quality among male and female UTAR students
during the transition to COVID-19 endemic. These are most affected, as they have increased
their use of electronic devices, participated in less physical activity, and experienced more
sleeping problems. This cross-sectional study comprised 482 university students (47.3%
male, 52.7% female) who were recruited using the convenience sampling method. The results
revealed that the majority of individuals had moderate screen use, physical activity, and poor
sleep quality. There was no significant relationship seen between screen time, physical
activity level and sleep quality.4

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Muppalla SK et al., (2023), the study findings suggest that children's development can be
impacted by excessive screen time in both positive and negative. Screens have the ability to
improve education and learning in terms of cognitive development. However, research has
indicated that media multitasking and excessive screen usage might have a detrimental
impact on academic performance, sensorimotor development, and executive functioning.
Early screen time has been linked to worse cognitive function and later academic
achievement. Screen time also has an impact on language development since it reduces the
amount and calibre of interactions between kids and their caretakers. The influence on
language development depends on contextual elements like co-viewing and topic
appropriateness. Overuse of screens can also result in issues with social-emotional
development, such as anxiety, sadness, obesity, and sleep disruptions. It can impede social
and emotional competency, encourage aggressive conduct, and limit emotional
comprehension.11

Nakshine et al., (2022), researched the growing dependence on digital gadgets which
contributes to continuous increase in screen time, has also been linked to a number of
negative consequences on mental and physical health. Continuous use of gadgets can have a
negative impact on mental health. Among the physical health consequences, we observe risk
factors for obesity and cardiovascular diseases, such as insulin resistance, low HDL
cholesterol etc. A condition of hyper-arousal is frequently induced, stress hormones are
elevated, the body clock or circadian cycle is disrupted, brain chemistry is changed, and
mental energy and development are impeded. This study examines the different facets of
screen addiction and excessive screen exposure, with an emphasis on how children's brains
grow and the negative impacts on both adults and children.5

Daniyal et al., (2022), observed that numerous detrimental impacts on people's physical and
mental health have been linked to mobile gadgets. This, however, depends on the type of use
and could be counterbalanced by the advantages that these gadgets provide. Stakeholders
should work to support students' health and wellness by implementing suitable policies and
communicating with them. The connection between mental and physical health is a major
worldwide issue. Future studies must therefore investigate the relationships between cell
phone use and people's physical and mental health using larger and more comprehensive
samples from a range of age groups.15

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Wang P., (2022), the study findings suggest that the development of contemporary
technology, college students can no longer resist playing mobile games. Although kids are
entitled to enjoy the internet, it is imperative that internet addiction be avoided by appropriate
control and instruction. It is necessary to address the negative effects of mobile gaming while
utilizing their beneficial aspects. In order to do this, students should refrain from utilizing
games as a form of escape and instead concentrate on goal-setting and constructive
communication in order to gain self-control. To draw attention away from excessive gaming,
universities should encourage interesting programs and activities. To promote the wellbeing
of pupils, authorities should also improve youth programs and control the content of mobile
games. A well-rounded strategy will provide a safe online environment where students can
flourish and make significant contributions to society.17

Jahagirdar V et al., (2021), the study findings suggest that mobile addiction is now
considered a public health concern. It has becoming more well-known in emerging nations
with youthful populations, such as India. The current study simply demonstrates the startling
rise in smartphone addiction among young medical students. Research on the use of mobile
phones by physicians and medical students, as well as the negative consequences of such use,
is desperately needed. Students can be made aware of this problem and encouraged to use
online tools to evaluate their risk of developing a mobile addiction. The Diagnostic and
Statistical Manual of Mental Disorders (DSM-V) may include mobile addiction, just like it
would any other behavioral addiction. Additional research can be conducted on standardized
instruments for early detection and suitable treatments for treating mobile addiction. 9

Barros VF et al., (2021), according to this study Keratoconus was one of the eye conditions
that the majority of the young people in our sample reported having. The emphasis was on
smartphone addiction and dependence. The results of this observational study provide
credence to the identification of variables linked to ocular pathology and could guide future
research as well as preventive public health initiatives and control measures. 10

Hjetland GJ et al., (2021), according to the current research, students' screen time has a
significant impact on both the quantity and quality of their sleep, with nighttime screen time
having a higher correlation with sleep than daily screen time. Students frequently struggle
with sleep, and cutting less on evening screen use may help them sleep better, though more
research is required to verify a link. Additionally, the findings point to the involvement of
social media addiction and addictive society.12

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Aust LA et al., (2019), reported on how pharmacy students try to mitigate the perceived
harmful effects of screen use on their academic performance, both directly and indirectly.
According to the participants, screen time is used for communication, entertainment,
education, and creative outlets. Having helpful internet resources and electronically
organising instructional materials were two positive academic outcomes. Distraction,
including the routine nature of screen time and difficulties with time management, and poor
sleep hygiene were the main detrimental effects. Being more self-aware, rewarding screen
time, and reducing the amount of time spent on internet-enabled devices for academic
purposes by performing tasks "by hand" are some ways that students reported meeting their
demands for self-control.7

Domingues‐Montanari S., (2017), this study findings suggests that the idea of screen time
has grown increasingly complex in recent years due to the global availability of an ever-
increasing range of electronic media devices. The most common screen-based activity for
kids is still watching television. Nonetheless, the usage of computers, video games, and
gadgets like smartphones and tablets are becoming more common at younger ages. Screen
usage, especially watching television, has been positively linked to obesity and adversely
linked to the development of cognitive and physical capacities, anxiety, sadness, and sleep
issues. It's unknown what physiological processes underlie the negative health effects of
screen time and how much each type of screen and media material contributes to particular
health consequences.1

Christensen MA et al., (2016), according to this research, screen time varies by age, race,
and ethnicity and may be influenced by environmental factors or cultural norms. The amount
of time spent on screens varies throughout the day; most exposure takes place during the day,
however some people use screens most frequently at night. A poorer quality of sleep is linked
to smartphone screen usage, especially right before bed.6

Impact of screen time on mental health:

Zheng H et al., (2024), this study emphasizes how crucial a healthy lifestyle—which
includes regular exercise, limiting screen time, and eating a balanced diet—is in avoiding and
lessening depression among college students. Additionally, this study indicates that the lowest
levels of anxiety and depression are linked to exercising three to four times each week.

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Regular exercise, such as playing sports like basketball, tennis, dancing, and running, can
help reduce these mental health problems.26

Wen X et al., (2023), this study showed that there is a positive link between screen time and
anxiety, negative emotions mediate this relationship, the mediating effect is larger than the
direct effect, and emotion control moderates this relationship. It offers a clear way to
effectively reduce college students' anxiety levels, such as limiting screen time, monitoring
their emotional states, intervening and reducing negative emotions as soon as possible, and
strengthening their capacity for emotional regulation. This will support academic college
students' mental health and have a positive impact on their future planning, study, and life.28

Almousa NA et al., (2022), the study concentrated on a number of issues that high achievers
deal with, including social issues, family issues, professional choice issues, emotional issues,
and study issues. where family issues were least prevalent and academic issues were most
prevalent. In light of the findings, the researchers advise further study of additional factors
associated with high achievers and the provision of specialized instruction to improve their
capacity to manage issues more effectively and, eventually, improve their quality of life. 30

Khidri FF et al., (2022), this study findings suggests that COVID-19 pandemic adversely
affected physical activity and sleeping habits in association with depression among medical
students. Promoting healthy eating habits, adequate physical activity, and a healthy lifestyle,
particularly among students during lockdowns, are critical components of coping with mental
stress and depression. The findings of this study will aid in future research and campaign
design in preparation for future pandemics and lockdowns. Additional research is required to
confirm our findings in diverse populations in order to determine the effects of the COVID-
19 pandemic.23

Oswalt SB et al., (2020), this study examines how diagnoses and treatments for 12 mental
health (MH) issues have changed, as well as past campus MH service utilization and future
MH service seeking intentions. According to a nationwide sample, college students are
increasingly self-reporting diagnoses and treatments for a number of mental health issues.
Engaging institutional stakeholders on the resources required to support college students'
mental health can be facilitated by this examination of several mental health challenges. 22

Shaffique S et al., (2020), this study findings suggest that all people are affected by mental
illnesses, and both sexes are equally affected. The current study was carried out as part of a
meta-analysis to show how common stress, anxiety, and depression are among college

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students. The meta-analysis study concludes that the prevalence of anxiety and depression is
startlingly high. To address this issue, initiatives for health education and mental health
prevention must be developed and designed immediately.24

Pedrelli P et al., (2015), this study findings suggest that students in college frequently have
mental health issues. Stressors associated with beginning and completing college, along with
academic pressure, may cause mental health and substance use disorders to first manifest or
worsen. Due to poor rates of treatment seeking and persistence, psychopathology is
frequently chronic in nature. Therefore, it is essential to use outreach initiatives and have
plans in place to guarantee treatment retention.27

Kumaraswamy N., (2013), this study finding suggests that colleges ought to support
students in a welcoming and impactful learning environment. More than just facilitating the
acquisition of knowledge and skills is required to prepare medical students for careers as
doctors and ensure that they adhere to professional conduct standards. For stress to be
recognized early and managed effectively, support and mentoring are necessary. Important
tactics to help undergraduates better handle the demands of postsecondary education include
health education initiatives, mentorship, and a reduction in the amount of knowledge covered
in the curriculum. College teaching methods need to be given greater consideration, and
students' psychological health has to be better attended to. It is determined that three key
concerns require attention: teachers and their instruction must be appreciated; college
students and trainees should have access to suitable support systems; and educational
processes must receive more attention.21

Kitzrow MA., (2003), this study observed that the evolving mental health demands of
today's college students provide significant problems for universities and institutions.
Administrators, instructors, and staff should approach mental health concerns as an
institutional priority and obligation because they can have a significant impact on every facet
of campus life. With the administration's backing and dedication, counseling centers can
effectively address today's issues. They can also balance the demand for services with
available resources by reevaluating priorities, setting reasonable boundaries, using creative
approaches, and taking good care of themselves to reduce stress and burnout. Counseling
centers are more needed than ever.19

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 SCHOOL OF ALLIED AND HEALTHCARE SCIENCES

Dietary patterns among college students:

Olagunju M et al., (2024), the study emphasizes how important it is to take preventative
actions like promoting good eating habits and providing nutritional knowledge. These
interventions need to be customized to target the unique food habits and nutritional hazards
seen in college students. Additionally, our study supports the use of a complete approach that
include dietary changes and the encouragement of consistent exercise. Using this strategy is
crucial for preserving ideal weight ranges and averting future health problems. In addition to
addressing the immediate issue of malnutrition, this holistic approach will promote
undergraduate students' long-term health and wellbeing.41

Shafiq I et al., (2024), the purpose of the study was to assess how anxiety and depression
affected the dietary preferences of University of Management and Technology, Lahore
college students. College students who engage in unhealthy eating habits are more likely to
experience anxiety and sadness. These mental health problems may be lessened by
encouraging wholesome eating practices.43

Saha S et al., (2023), this comprehensive research highlights the significant correlations
between mental health throughout this crucial stage of life and a good diet. Due to the
methodological constraints of the 14 cross-sectional studies that were utilized in this
investigation, we are unable to draw the conclusion that eating a healthy diet such as fruits
and vegetables or an unhealthy diet such as fast food and sugary food is positively associated
with anxiety and depression. Nonetheless, the four interventional studies found that, at least
temporarily, eating a healthy diet reduces depressed symptoms. Therefore, in order to
comprehend the directionality and generalize the proposed relationships, more longitudinal,
prospective, and/or randomized controlled trial studies should be carried out. The
biochemical processes by which nutrition affect anxiety and depression should also be
investigated in research. Additionally, it is important to consider nutrition and health
education as a foundation for fostering mental wellness. 68 To learn more about how diet
affects anxiety, depression, and college students' general mental health, nutrition
interventions, including digital platforms/, should be tried on college campuses.33

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Ahmed H et al., (2022), it was found that students' eating habits and food preferences were
adversely impacted by the high incidence of increasing screen usage. The majority of them
used screens for more than seven hours a day, which is higher than the suggested amount of
time. Due to excessive screen time, the majority of them were missing breakfast, putting off
meals, or consuming significantly more than they had intended. The most popular snack
foods when using screens were mostly junk food, fast food, and sweets, which had a negative
impact on their general health.44

Pop LM et al., (2021), it was found that when it comes to their future careers as advocates
for good physical and mental health, medical students apply their understanding on how to
live a healthy lifestyle. A few nutritional, lifestyle, and physical activity adjustments are
linked to the hectic timetable and lengthy practical stages. Therefore, the university campus
should have more facilities to help medical students stay healthy and meet the demand for a
healthcare setting at higher education institutions.37

Reuter PR et al., (2021), according to the results of their study it was found that, students'
self-reported GPA is positively impacted by how often they eat breakfast each week. A
significantly higher GPA was recorded by students who ate breakfast at least five days a week
as opposed to those who only ate breakfast three days a week. But there are additional
elements, such academic performance may be more impacted by sleep patterns and work
hours than by breakfast consumption. However, the consumption of fast food has a
detrimental impact on student performance. Pupils who consumed fast food at least seven
times in the previous week reported substantially lower current GPAs than those who
consumed it less frequently four times or not at all.42

Clerkin KD et al., (2021), this study findings suggest that poor eating habits are linked to
food insecurity among college students. This project's goal was to use a campus food bank to
encourage college students to eat more fruits and vegetables. In this study, a modifiable
behavior was the increased eating of fruits and vegetables among female college students
who used the food pantry.39

Yun TC et al., (2018), according to this study, males and females were equally affected by
the prevalence of overweight/obesity, which was 28.8% among this group of university
students. Dieting was more common among females since a larger percentage of them were
worried about their physical appearance and body size. Despite claiming to be well-informed
on balanced nutrition and the food pyramid, the majority of college students did not follow or

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apply these healthful eating practices. The majority of them ate little in the way of fruits and
vegetables each day, missed breakfast, snacked regularly, and ate fried food frequently.
Students' levels of physical exercise were low and below WHO recommendations.32

Abraham S et al., (2018), this study findings suggest that approximately one-third of college
students who took part said they were overweight, weighing between 6 and 50 pounds or
more. Students mixed processed and fast food according to taste preference and convenience
with fruits and salads, despite their understanding of food additives, the dangers of fast food,
and the unhealthy nature of soda and processed food. Even though a large number of
participants demonstrated healthy eating practices and sufficient understanding of nutritional
needs, it was found that more research was necessary to fully understand the various aspects
influencing their eating patterns and level of knowledge.36

Ilow R et al., (2017), the purpose of this study was to assess the dietary practices of students
at Wroclaw Medical University in order to identify the nutritional risk factors for heart
disease. A significant portion of the students under study, particularly the males, were found
to have poor eating habits. Therefore, it is strongly advised that this group be encouraged to
follow the guidelines of appropriate nutrition.40

Manwa L., (2013), this study's primary goal was to determine how nutritionally aware
university students were of their food preferences and eating habits and how these affected
their health. Nearly 75% of the pupils lacked nutritional awareness, as evidenced by their
diets that were primarily composed of carbohydrates rather than vitamins and proteins. Thus,
it may be concluded that students' poor food choices are caused by their ignorance of their
dietary needs. Based on these findings, dietary habits may be impacted by leaving the family
home and taking on food preparation and shopping duties for the first time. Physical
indicators of malnutrition are common among university students, which suggests that they
were not well and could have a detrimental effect on their academic performance. 31

Park JY et al., (2010), this study looked into the relationship between life stress, dietary
behaviors, dietary taurine intake, nutrition, and depression. The typical consumption of b-
carotene, vitamin A, depression patients had considerably lower levels of vitamin C, folic
acid, and fiber than the control group. Compared to the control group, depression patients'
average total life stress score was significantly greater and their average total dietary habit
score was much lower. The dietary taurine intake of the control group and depression patients
did not, however, differ significantly. These findings demonstrate that people with depression

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 SCHOOL OF ALLIED AND HEALTHCARE SCIENCES

have uneven nutritional status and bad eating habits. Thus, to prevent depression in Korean
college students, ongoing nutrition education and counselling for healthy eating habits and
balanced nutrition status are required.38

Deshpande S et al., (2009), in this study, the impact of food characteristics, gender, dietary
status, the value of a healthy diet, and cues to action on the intention to eat healthily.
Numerous social change initiatives could be used to encourage healthy
dining with college students.34:

Factors influencing sleep patterns on college going students:

Wang F et al., (2021), using a scoping review methodology, this study determined the major
factors influencing college students' sleep quality. Sleep quality was significantly impacted
by physical, social, mental, and lifestyle aspects. Notably, exercise showed both beneficial
and detrimental effects, underscoring the need for more study. The results highlight how
crucial it is to take lifestyle factors into account when doing sleep intervention research.
Improving sleep quality can aid students' general health and academic performance by
addressing social jetlag and other contributing factors.49

Saxena R et al., (2021), according to the study's findings, students in the 18–24 age range
spent more time on screens on average at night when the area was under lockdown. Due to
prolonged nighttime watching, the circadian cycle of sleep has been moved to the morning,
resulting in poor sleep quality and daytime drowsiness. Although there was no link found
between screen usage and sleep quality, pupils' increased calorie intake was also noted during
lockdown.50

Dietrich SK et al., (2013), this systematic review aims to determine how sleep education
programs affected college students' knowledge, behavior, and/or quality of sleep regarding
sleep hygiene. Nevertheless, there is not enough data to form any firm judgments about the
intervention's overall efficacy. Additional research is necessary because the review's findings
revealed little evidence of variable importance.45

Hershner SD et al., (2014), this study findings suggest that due to academic expectations,
poor sleep hygiene, and circadian misalignment, college students frequently suffer from
insufficient sleep and afternoon drowsiness. Chronic sleep deprivation can have detrimental
effects on mood, safety, and academic performance. Effective implementation of sleep
education is still a difficulty, despite its critical importance. For this technologically adept

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group, digital interventions might provide a workable option. Academic institutions must
acknowledge how regulations and class scheduling influence students' sleep habits. Research
on methods to encourage sound sleeping practices should be given top priority because it can
significantly improve public health.51

Vélez JC et al., (2013), according to this study, sleep issues are prevalent among college
students and are substantial predictors of serious negative behavioral and health
consequences, such as impaired cognitive performance and productivity, increased
interpersonal issues, driving while sleepy, and poorer academic achievement.47

Lee SY et al., (2013), in this study many of the female college students faced emotional and
physical difficulties, and many of them reported severe discomfort. Low participation rates
could be a sign that individuals who declined were under significantly more stress. Although
stress will always be a part of college life, organizations can take steps to lessen its effects.
Self-administered cognitive behavioural treatments have been shown to enhance sleep quality
and lessen symptoms of depression. Developing successful therapies, such as mind-body
exercises and stress-coping education, can be facilitated by an understanding of the
connections between stress, sleep, and health. Investigating ethnic variations in sleep habits
may also aid in developing customized strategies to improve the wellbeing of students.48

Altun İ et al., (2012), This study provides recommendations for encouraging good sleep as
part of routine healthcare and methodically examines the causes of university students' poor
sleep. The findings of the survey can assist teachers in putting sleep-improvement strategies
into practice. Universities may greatly improve sleep patterns and lessen challenges by
incorporating stress management and sleep education programs.46

Impact of physical activity on +students’ health:

Kljajević V et al., (2021), this study findings suggest that university students exhibit a
satisfactory degree of physical activity and fitness, according to the results obtained. The
various elements involved, which are mostly connected to cultural and educational disparities
across nations, cause the results to differ. Physical exercise has a positive impact on the
development and maintenance of physical activity and fitness, according to the results for the
students in the college of sport. Regarding students from various faculties, this study
recommends that more research be done to encourage regular exercise since it might improve
students' physical fitness and health-related activities.52

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Joseph RP et al., (2014), this study findings suggest that the relationship between PA and
QOL was found to be significantly influenced by physical self-esteem and, to a lesser extent,
positive affect. Results point to the potential effectiveness of health education initiatives
aimed at encouraging regular physical activity and boosting physical self-esteem in
enhancing young adults' quality of life.53

3. AIM & OBJECTIVES OF THE STUDY:

3.1 Aim of the Study:

To study the association between screen time, dietary patterns and mental health effects
among college going students at Malla Reddy University.

3.2 Objectives of the Study:

 To assess the average screen time among college going students and identify most
common screen-based activity.
 To evaluate mental health status (stress, depression, and anxiety) among university
students.
 To analyse the dietary habits of students, focusing on consumption of healthy and
unhealthy foods, meal frequency.
 To study the relationship between screen time and dietary pattern, mental health and
sleep quality among university students.

DEPARTMENT OF CLINICAL NUTRITION AND DIETETICS

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4. MATERIALS AND METHODS:

4.1 MATERIALS

 Study area
 Eligibility criteria
 Selection of the respondents
 Sample size calculation
 Selection of tool
 Collection of data

4.2 METHODOLOGY

The methodology followed in the study “A cross-sectional study on association between

screentime, dietary patterns and mental health effects among college going students” is
explained below:

Study area:

The researcher conducted the study at Malla Reddy University which serves as the study's
representative academic institution located at maisammaguda, Hyderabad. Malla Reddy
University has diverse student population comprising both technical and non-technical
disciplines, based on that the primary target population chosen for this study was School of
Engineering and School of Allied and Health care Sciences students. Among the branches of
Engineering the chosen groups are CSE and AIML.

Eligibility Criteria:

Inclusion criteria:

1. Currently enrolled B. Tech (AIML, CSE) and Allied Health Sciences students.
2. Age between 18-23 years.
3. Those students who voluntarily take part in the research by answering
questionnaires.

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4. Both male and Female students.

Exclusion Criteria:

1. Students whose nutrition or level of physical activity is impacted by long-term

medical issues.
2. People receiving treatment for mental health conditions at the moment.
3. Participants aged below 18 and above 23.
4. Participants who are not willing to participate.

Selection of the respondents:

The study comprised college students between the ages of 18 and 23. Respondents were
chosen in accordance with the inclusion and exclusion criteria. The population for this study
included B. Tech (AIML, CSE) and School of Allied and Health care Sciences students from
the university were chosen based on their willingness to provide informed consent. The study
includes both male and female students who meet the inclusion criteria. Exclusion criteria
include college students aged below 18 and above 23. A total of 384 respondents were chosen
for the study after their signed consent form was used to get informed consent. The
permission form guarantees the study's goals, risks, and rewards as well as the participants'
rights. A representative and willing sample was guaranteed by this stringent selection
procedure, which made it possible to gather high-quality data.

Sample size calculation:

Sample size: The sample size is calculated using formula: N=Z2×PQ/d2

Where Z-1.96 at 95% confidence interval. So, N=Z2×PQ/d2

N-sample size

Z-statistic corresponding to level of confidence

P-Expected Prevalence

Q-Proportion Without the Characteristics (1-P)

d-Absolute error

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 SCHOOL OF ALLIED AND HEALTHCARE SCIENCES

The sample size is calculated by taking a confidence level of 95%and a confidence interval of
5. The sample size is 384 the population size is 600.

Selection of tool:

Tools used for data collection techniques allow researcher to systematically collect
information about respondents. In this study a standardised questionnaire was prepared to
capture a comprehensive range of information comprising various sections. The first section
collected demographic information related to participant. The second section focused on daily
screen exposure and time distribution. The third section focused on validated self-reported
measures designed to evaluate the psychological well-being. The fourth section focused on
dietary patterns of college students based on their daily consumption. The fifth section
focused on physical activity of students. The sixth section focused on sleep quality of
students and its relationship with screen time.

Collection of data:

Participants were provided with a survey-based questionnaire, and each person was given the
chance to answer the questions in a systematic manner. It provides a more comprehensive
dataset for the study. This strategy also fostered an environment where people felt more
comfortable discussing their thoughts as well as their experiences. A stratified random
sampling approach was used to ensure equal representation from both B. Tech (AIML, CSE)
and School of Allied and Health care Sciences students. Within each stratum, participants
were randomly selected from class lists obtained from the respective departments.

The survey employed range of tools to collect accurate and reliable data. Participants aged 18
to 23 were recruited for this study. Anthropometric measurements such as age, weight, height
was taken. Along with these measurements, a systematic questionnaire was administered to
the university students for further information.

Data collection: This cross-sectional study focused on the association between screen time,
dietary patterns and mental health effects among college students.

1. Dietary pattern of selected respondents: Dietary patterns among university students

were assessed using a combination of modified Food Frequency Questionnaire (FFQ) and
24-hour dietary recall to obtain comprehensive dietary intake.

DEPARTMENT OF CLINICAL NUTRITION AND DIETETICS

 SCHOOL OF ALLIED AND HEALTHCARE SCIENCES

This Food frequency questionnaire is a validated tool used to evaluate the habitual dietary
intake of students over a certain period of time. The frequency of consumption was
categorized as daily, weekly, occasionally, never.
The 24-hour dietary recall was conducted to capture a detailed information of food and
nutrients intake in a particular day.

These tools helped assess:

i. Frequency of consumption of major food groups (eg: fruits, vegetables, dairy

products, grains, protein sources, processed foods and sugar beverages)
ii. Meal frequency and regularity (eg: breakfast skipping, snacking habits)

2. Nutritional status and anthropometric measurements of selected respondents: The

nutritional status of participants will be assessed using Body Mass Index (BMI) as a
proxy indicator which determines underweight, normal, overweight, obesity, calculated
based on self-reported height and weight. Height and weight measured usually vary
according to the person’s age and sex.
The Body Mass Index (BMI) of the selected respondents was calculated using the
formula:
BMI= Weight (in kg)/ Height (in m2)

3. Mental health assessment: Data on stress, anxiety, and depression were gathered
through validated questionnaires- DASS-21 to assess the impact of mental well-being. It
is particularly useful in evaluating mental health status among college students, a
population vulnerable to psychological distress due to academic pressure, life style
changes. Scores from this scale will help categorize participants into normal, mild,
moderate or high levels of depression, anxiety, stress.

4. Screen time assessment: A self-reported measure derived from validated screen-time

questionnaire will be used to measure screen time. Participants will report the average
daily hours spent on different types of screen activities. Assessing screentime helps in
understanding its impact on their physical health, mental health and academic outcomes.

5. Physical health status assessment: Assessing the physical health status of college
students is crucial for understanding their overall well-being and risk factors. This
assessment typically involves self-reported exercise frequency and duration.

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6. Sleep patterns of selected respondents:

4.3 STATISTICAL ANALYSIS

After entering the gathered data into Microsoft Excel, data will be analysed using
Statistical Package for the Social Sciences (SPSS) software. Chi-square test, multivariate
regression will assess relationship between categorical eating practices and BMI categories in
order to investigate dietary patterns and nutritional status. Pearson’s correlation will be used
to examine the relationship between dietary patterns and physical health.

8. REFERENCES:

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1. Domingues‐Montanari S. Clinical and psychological effects of excessive screen time

on children. Journal of paediatrics and child health. 2017 Apr;53(4):333-338.
2. Priftis N, Panagiotakos D. Screen time and its health consequences in children and
adolescents. Children. 2023 Oct 8;10(10):1665.
3. Vizcaino M, Buman M, DesRoches CT, Wharton C. Reliability of a new measure to
assess modern screen time in adults. BMC public health. 2019 Dec; 19:1-8.
4. Ong JXT. Relationship between screen time, physical activity level and sleep quality
among male and female students from University Tunku Abdul Rahman (UTAR)
during transition to covid-19 endemic (Doctoral dissertation, UTAR). 2023 May.1-91.
5. Nakshine VS, Thute P, Khatib MN, Sarkar B. Increased screen time as a cause of
declining physical, psychological health, and sleep patterns: a literary review. Cureus.
2022 Oct;14(10).e30051.
6. Christensen MA, Bettencourt L, Kaye L, Moturu ST, Nguyen KT, Olgin JE, Pletcher
MJ, Marcus GM. Direct measurements of smartphone screen-time: relationships with
demographics and sleep. PloS one. 2016 Nov 9;11(11):e0165331.
7. Aust LA, Bockman SA, Hermansen-Kobulnicky CJ. One click away: pilot study of
the perceived academic impact of screen time among pharmacy students. Currents in
Pharmacy Teaching and Learning. 2019 Jun 1;11(6):565-570.
8. Kumban W, Cetthakrikul S, Santiworakul A. Smartphone Addiction, Screen Time, and
Physical Activity of Different Academic Majors and Study Levels in University
Students. International Journal of Environmental Research and Public Health. 2025
Feb 7;22(2):237.
9. Jahagirdar V, Rama K, Soppari P, Kumar MV. Mobile phones: Vital addiction or lethal
addiction? Mobile phone usage patterns and assessment of mobile addiction among
undergraduate medical students in Telangana, India. Journal of Addiction.
2021;2021(1):8750650.
10. Barros VF, Oliveira RA, Maia RB, Fernandes N, Almodin EM. Effects of the
excessive use of electronic screens on vision and emotional state. Revista Brasileira
de Oftalmologia. 2021 Nov 8;80(5):e0046.
11. Muppalla SK, Vuppalapati S, Pulliahgaru AR, Sreenivasulu H, kumar Muppalla S.
Effects of excessive screen time on child development: an updated review and
strategies for management. Cureus. 2023 Jun 18;15(6).

DEPARTMENT OF CLINICAL NUTRITION AND DIETETICS

 SCHOOL OF ALLIED AND HEALTHCARE SCIENCES

12. Hjetland GJ, Skogen JC, Hysing M, Sivertsen B. The association between self-
reported screen time, social media addiction, and sleep among Norwegian University
students. Frontiers in public health. 2021 Dec 16; 9:794307.
13. Kader NA, Fatima A. Multiple Screen Addiction Explained: Effects and Coping
Strategies. International Journal of All Research Education & Scientific Methods.
2024 June; 12(6): 2455-6211.
14. Soomro LA, Memon P, Malik M. Excessive use of mobile phone on Study habits of
Young Students: A case study of Sindh university students. Journal of Media &
Communication (JMC) Volume. 2022;3(2):140-150.
15. Daniyal M, Javaid SF, Hassan A, Khan MA. The relationship between cell phone
usage on the physical and mental wellbeing of university students: A cross-sectional
study. International journal of environmental research and public health. 2022 Jul
30;19(15):9352.
16. Sarla GS. Managing your screen time. Journal of Diagnosis & Case Reports.
SRC/JDCRS-123. 2021;2(3):2-4.
17. Wang P. Analysis on Advantages and Disadvantages of Playing Mobile Games among
Colleges Students. Journal of Higher Education Research. 2022;3(1); 29-33.
18. Mofatteh M. Risk factors associated with stress, anxiety, and depression among
university undergraduate students. AIMS public health. 2020 Dec 25;8(1):36.
19. Kitzrow MA. The mental health needs of today's college students: Challenges and
recommendations. Journal of Student Affairs Research and Practice. 2003 Dec
2;41(1):167-81.
20. Keck MM, Vivier H, Cassisi JE, Dvorak RD, Dunn ME, Neer SM, Ross EJ.
Examining the role of anxiety and depression in dietary choices among college
students. Nutrients. 2020 Jul 11;12(7):2061.
21. Kumaraswamy N. Academic stress, anxiety and depression among college students: A
brief review. International review of social sciences and humanities. 2013
Oct;5(1):135-143.
22. Oswalt SB, Lederer AM, Chestnut-Steich K, Day C, Halbritter A, Ortiz D. Trends in
college students’ mental health diagnoses and utilization of services, 2009–2015.
Journal of American college health. 2020 Jan 2;68(1):41-51.
23. Khidri FF, Riaz H, Bhatti U, Shahani KA, Kamran Ali F, Effendi S, Rani K, Chohan
MN. Physical activity, dietary habits and factors associated with depression among

DEPARTMENT OF CLINICAL NUTRITION AND DIETETICS

 SCHOOL OF ALLIED AND HEALTHCARE SCIENCES

medical students of Sindh, Pakistan, during the COVID-19 pandemic. Psychology

Research and Behavior Management. 2022 May 25:1311-23.
24. Shaffique S, Farooq SS, Anwar H, Asif HM, Akram M, Jung SK. Meta-analysis of
prevalence of depression, anxiety and stress among university students. RADS
Journal of Biological Research & Applied Sciences. 2020 Sep 21;11(1):27-32.
25. Stringaris A. What is depression? Journal of Child Psychology and Psychiatry. 2017
Dec;58(12):1287-9.
26. Zheng H, Li C, Zhang L, Wang T, Cai Z, Lei M. Evaluation of depression and its
correlates in terms of demographics, eating habits, and exercises among university
students: a multicenter cross-sectional analysis. Neuropsychiatric disease and
treatment. 2024 Dec 31:1079-95.
27. Pedrelli P, Nyer M, Yeung A, Zulauf C, Wilens T. College students: mental health
problems and treatment considerations. Academic psychiatry. 2015 Oct;39(5):503-
511.
28. Wen X, Cai Y, Li K, Wang Z, Zhang W, Qin M. A cross-sectional association between
screen-based sedentary behavior and anxiety in academic college students: mediating
role of negative emotions and moderating role of emotion regulation. Psychology
Research and Behavior Management. 2023 Dec 31:4221-35.
29. Zhang C, Shi L, Tian T, Zhou Z, Peng X, Shen Y, Li Y, Ou J. Associations between
academic stress and depressive symptoms mediated by anxiety symptoms and
hopelessness among Chinese college students. Psychology Research and Behavior
Management. 2022 Mar 5:547-556.
30. Almousa NA, Al-Shobaki N, Arabiyat R, Al-Shatrat W, Al-Shogran R, Sulaiman BA.
Academic Problems Facing High Achieving Students at Universities. Pegem Journal
of Education and Instruction. 2022;12(4):12-9.
31. Manwa L. University students' dietary patterns: A case of a university in Zimbabwe.
Journal of Emerging Trends in Educational Research and Policy Studies. 2013 Feb
1;4(1):191.
32. Yun TC, Ahmad SR, Quee DK. Dietary habits and lifestyle practices among
university students in Universiti Brunei Darussalam. The Malaysian journal of
medical sciences: MJMS. 2018 Jun 28;25(3):56.
33. Saha S, Okafor H, Biediger-Friedman L, Behnke A. Association between diet and
symptoms of anxiety and depression in college students: a systematic review. Journal
of American college health. 2023 May 4;71(4):1270-80.

DEPARTMENT OF CLINICAL NUTRITION AND DIETETICS

 SCHOOL OF ALLIED AND HEALTHCARE SCIENCES

34. Deshpande S, Basil MD, Basil DZ. Factors influencing healthy eating habits among
college students: An application of the health belief model. Health marketing
quarterly. 2009 May 8;26(2):145-64.
35. Almoraie NM, Alothmani NM, Alomari WD, Al-Amoudi AH. Addressing nutritional
issues and eating behaviours among university students: a narrative review. Nutrition
Research Reviews. 2024 Feb 15:1-45.
36. Abraham S, Noriega BR, Shin JY. College students eating habits and knowledge of
nutritional requirements. Journal of Nutrition and Human Health. 2018;2(1):13-7.
37. Pop LM, Iorga M, Muraru ID, Petrariu FD. Assessment of dietary habits, physical
activity and lifestyle in medical university students. Sustainability. 2021 Mar
23;13(6):3572.
38. Park JY, You JS, Chang KJ. Dietary taurine intake, nutrients intake, dietary habits and
life stress by depression in Korean female college students: a case-control study.
Journal of biomedical science. 2010 Aug;17:1-5.
39. Clerkin KD, Pohl CJ, Shupe ER, Kim MJ. Influencing nutritional habits of college
students using a food pantry. Journal of American College Health. 2021 Nov
17;69(8):937-41.
40. Ilow R, Regulska-Ilow B, Rozanska D. Dietary habits of Wroclaw Medical University
students (Poland). Roczniki Państwowego Zakładu Higieny. 2017;68(1).
41. Olagunju M, Aleru EO, Abodunrin OR, Adedini CB, Ola OM, Abel C, Adewole IE,
Okunbor HN, Akinsolu FT. Association between meal skipping and the double burden
of malnutrition among university students. The North African Journal of Food and
Nutrition Research. 2024 Jun 12;8(17):167-77.
42. Reuter PR, Forster BL, Brister SR. The influence of eating habits on the academic
performance of university students. Journal of American College Health. 2021 Nov
17;69(8):921-7.
43. Shafiq I, Fatima R, Waheed W, Batool S, Khan MA, Fatima M, Ghaffar T. Mental
Health and Nutrition: A Study on the role of Anxiety and Depression in Eating Habits
in College Students. Journal of Health and Rehabilitation Research. 2024 Aug
20;4(3).
44. Ahmed H, Rizwan B, Fatima A, Tariq M, Zafar R, Naeem M, Ali S, Moazzam A,
Tahir N. Association Between Screen-Time and Dietary Habits Among Students Of
11-25 Years: Screen-Time and Dietary Habits Among students. Pakistan BioMedical
Journal. 2022 Jul 31:240-5.

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45. Dietrich SK, Francis-Jimenez CM, Knibbs MD, Umali IL, Truglio-Londrigan M.
Effectiveness of sleep education programs to improve sleep hygiene and/or sleep
quality in college students: a systematic review. JBI Evidence Synthesis. 2016 Sep
1;14(9):108-34.
46. Altun İ, Cınar N, Dede C. The contributing factors to poor sleep experiences in
according to the university students: A cross-sectional study. Journal of research in
medical sciences: the official journal of Isfahan University of Medical Sciences. 2012
Jun;17(6):557.
47. Vélez JC, Souza A, Traslaviña S, Barbosa C, Wosu A, Andrade A, Frye M, Fitzpatrick
AL, Gelaye B, Williams MA. The epidemiology of sleep quality and consumption of
stimulant beverages among Patagonian Chilean college students. Sleep disorders.
2013;2013(1):910104.
48. Lee SY, Wuertz C, Rogers R, Chen YP. Stress and sleep disturbances in female
college students. American journal of health behavior. 2013 Nov 1;37(6):851-8.
49. Wang F, Bíró É. Determinants of sleep quality in college students: A literature
review. Explore. 2021 Mar 1;17(2):170-7.
50. Saxena R, Parmar N, Kaur P, Allen T. Effect of screen-time on sleep pattern and
dietary habits among college-going students in COVID-19 pandemic. Indian Journal
of Community Health. 2021 Mar 31;33(1):65-74.
51. Hershner SD, Chervin RD. Causes and consequences of sleepiness among college
students. Nature and science of sleep. 2014 Jun 23:73-84.
52. Kljajević V, Stanković M, Đorđević D, Trkulja-Petković D, Jovanović R, Plazibat K,
Oršolić M, Čurić M, Sporiš G. Physical activity and physical fitness among university
students—A systematic review. International journal of environmental research and
public health. 2021 Dec 24;19(1):158.
53. Joseph RP, Royse KE, Benitez TJ, Pekmezi DW. Physical activity and quality of life
among university students: exploring self-efficacy, self-esteem, and affect as potential
mediators. Quality of life research. 2014 Mar; 23:659-667.

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