The Sedentary Behavior Research Network defined screen time as time spent on behaviors (sedentary or active) involving the use of screens.1 Currently, it is very common to spend a lot of time in front of screens as we live surrounded by technology.2 Importantly, it is mainly children who are increasing their use of technology.3 In Spain, it was estimated in 2017 that 29.3% of children under 14 used screens less than 1 hour a day for recreational purposes, 26.4% between 1 and 2hours, 28.6% between 2 and 3hours, and 15.7% more than 3hours.4

The widespread use of different screen devices in children is modifying their behavioral patterns, such as sedentary behavior, daily eating habits, and sleep patterns, as well as general health and psychological well-being.5 Despite the large number of deleterious outcomes asociated with excessive use of screen devices,6,7 the most controversial aspect and the one that generates public alarm is their potential for addiction.8–10 Beyond problematic use, some authors have suggested some benefits associated with the use of screen devices.11 Such benefits include the positive attitude towards oneself derived from relationships with friends,12 the ease of communication, and even the use of the smartphone as a device to overcome boredom.13 Likewise, the maintenance of family bonds14 and better educational outcomes11 can be highlighted as positive aspects of the use of screen devices.

Nowadays, smartphones may serve as a distraction tool in family situations where the child is stressed or must wait, such as eating away from home.15 However, excessive smartphone use could isolate children from social interactions with their families, missing the opportunity to converse and enjoy the company of those around them. Importantly, in the context of child development,16 family communication and interactions during mealtimes have a significant influence on both the physiological and psychological well-being of the child.17 As such, it is important to explore the physical and social contexts of screen engagement during mealtimes to better develop interventions that seek to encourage the optimal use of smartphones. However, there are not many studies exploring the use of screen devices during meals, in particular in Europe, where just a study in Italy found that 59.5% of families used a smartphone during mealtimes in fast-food restaurants.18 In Lithuania, 33.7% of children (aged 2 to 5 years old) were exposed to smartphones during meals periodically, a few times each week or month; and 22% daily or during every meal.19 Relevantly, it is becoming common to see children using smartphones while eating, in fast food restaurants20,21 which are part of obesogenic environments,22 and where families are more likely to allow the use of smartphones to entertain children.23

Regarding the predictors of the use of screen devices, many studies have shown that screen use is associated with socioeconomic level,24 caregiver education,25 and caregiver use of the device.26 Nevertheless, most of the evidence is derived from traditional forms of screen use (e.g., TV viewing, and computer use), and less is known about the predictor variables of newer forms of screen devices, such as smartphones. Overall, in Spain, there are no data on the prevalence and predictors of smartphone use by children in fast-food restaurants. Therefore, this study aimed to explore the use of smartphones at mealtimes by children in fast-food restaurants in the city of Barcelona (Spain).

Of the total sample of children (n=1616), 50.6% were classified as female, 54.0% were of an estimated age of 4-6 years, 89.6% were estimated to have underweight or normal weight, and 47.5% of the caregivers were of estimated ages 30-40 years (Table 1).

Overall, 28.1% of meals at fast-food restaurants with children involved smartphone use. Among the children who used smartphones in fast-food restaurants, 23.2% of the children used them while waiting for the meal, 34.9% used them during the meal itself, 17.36% during the after-meal, and 0.2% during the three observation times. There were no significant differences in smartphone use between males and females. Children with an estimated age between 7 to 10 years showed significantly higher smartphone use at any time of observation compared to children aged 4 to 6 years (32.4% vs. 24.5%; p=<0.001). Children with bad and neutral attitude had a significantly higher adjusted probability of used (aPR: 1.58; 95% CI: 1.36 1.82 and aPR: 2.06; 95% CI: 1.64 2.60) as compared with those with good attitude. Furthermore, the adjusted probability of using smartphones in children at any time of observation who were classified as overweight or obese was 35% higher than in children with estimated underweight or normal weight (aPR: 1.35; 95%CI: 1.13-1.60). According to districts, the highest smartphone use at any time of observation was observed in Nou Barris, while the lowest was observed in Horta-Guinardó (37.0% vs. 19.8%, respectively) (Fig. 1). The district with the highest adjusted smartphone usage was Sarrià-Sant Gervasi (aPR: 1.91; 95%CI: 1.19-3.08), compared to Horta-Guinardó (Table 2).

Figure 1.

Crude percentages of smartphone use in children were observed in the districts of the city of Barcelona (2021-2022).

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The percentage of smartphone use during meals was significantly higher in children accompanied by a male adult or both than in children accompanied by a female. The adjusted probability of using smartphones of children accompanied by caregivers younger than 30 was 38% higher than that in children accompanied by older caregivers (aPR: 1.38; 95%CI: 1.09-1.73). In addition, when there was no interaction between the caregiver and child, the adjusted probability of using a smartphone increased by 55% (aPR: 1.55; 95%CI: 1.34-1.80).

As shown in Table 2, the adjusted probability of using a smartphone in fast-food restaurants increased by 8% for children who finished the meal (aPR: 1.08; 95%CI: 0.95-1.24). In observations taken outdoors, the adjusted use of smartphones was significantly higher (aPR: 1.36; 95%CI: 1.18-1.56). In addition, in fast-food restaurants that did not have playgrounds or toys to play with, the use of smartphones was also higher (aPR: 1.39; 95%CI: 1.23-1.70). We found that on Thursdays there was a higher adjusted use of smartphones by children (aPR: 3.51; 95%CI: 1.59-7.77) compared with Wednesday (Table 2).

Our study showed that children used smartphones in 28.1% of meals with children observed in fast-food restaurants. To our knowledge, this is one of the first studies to explore childrens’ use of smartphones in fast-food restaurants in Spain. Our main results are consistent with the previous studies that have directly examined children's use of smartphones during mealtimes in restaurants from other countries.18–20 Other studies have examined the use of smartphones by caregivers in similar settings.20,29,30 This finding is consistent with the global trends of increasing access to digital devices, integration of technology into daily life, and early use of technology.31 The relaxed environment of fast-food restaurants may be a key contributing factor to the increase in children's smartphone use during mealtimes. In these establishments, where the atmosphere is more informal, families tend to be more permissive with the use of digital devices as a tool to entertain their children during waiting times for meals. The increasing usage of screen devices has created distance between children and their caregivers.32 For that reason, it is therefore important that children follow screen-use recommendations of pediatric guidelines.33 Experts recommend limiting screen time for children between the ages of 0 to 5,34 due to the detrimental effects of screen time on their health and well-being.6,7,35

The causes and consequences of smartphone use differ depending on whether it occurs before, during, and after meals. In the present study, the smartphone was used at any time during the observation in almost one in three of the observed mealtimes. According to our study among children using smartphones, 23.9% of the children used their device while waiting for the meal, may be associated with boredom during waiting time. 34.9% of children use their devices during meals, which may be due to a cycle of anxiety13 that is temporarily reduced through increasing caloric intake.36 Lastly, 17.36% of children used their devices post-meal.

In our study, smartphone use during meals was higher in the older age group (7-10 years). Older children (7-10 years) tend to have more autonomy, which resulted in a higher level of perceived freedom to use their smartphones. In addition, children with a neutral attitude (when the child remained absent/silent) may seek more external stimulation or entertainment to satisfy their emotional needs, and the smartphone may provide an easy distraction. Compared to children with positive and neutral attitudes, those with a bad attitude had a significantly greater adjusted likelihood of being exposed to the smartphone (aPR: 1.58; 95% CI: 1.36 1.82). This may be because caregivers use the smartphone to calm or entertain the child when the child is misbehaving. Additionally, the use of smartphones during meals was 35% higher in overweight or obese children in comparison to those who were underweight or normal weight. This may be due to the fact that higher smartphone usage is often associated with a more sedentary lifestyle, contributing to weight gain and obesity. Based on the findings of a Spanish study, the prevalence of overweight and obesity was higher in children whose screentime was above 120minutes, compared to those whose screentime was less than 59minutes a day.37

In our study, we observed that during mealtimes (at any time of observation) smartphone use had varying effects on social interaction. In some instances, smartphone use led to a decrease in social interaction, while in other cases, it appeared to increase interactions once the child began using their smartphone. Specifically, our findings indicated that in the absence of a caregiver-child interaction in fast-food restaurants, the adjusted likelihood of smartphone use rose by 55%, independent of the time of observation. Our results demonstrated that children accompanied by younger caregivers (under the age of 30) were more likely to use their smartphones at any time of observation (37.1%). This may be because younger caregivers are influenced by social trends that encourage the use of technology in parenting. Along these lines, according to our study, children were more likely to use a smartphone when their caregiver was a male. This could be due to the tendency of male caregivers to be more permissive with their children and to provide smartphones as a means of relaxation and enjoyment for both parties.38 Some caregivers also believe that screen use is beneficial for children,39 due to its provision of educational and entertaining content while allowing the caregivers to enjoy a quiet mealtime; nevertheless, other caregivers remain concerned about the negative impacts that screens may have on the child's social development.11

Finally, playgrounds or toys provided by restaurants for children can entertain children by reducing the use of smartphones. In this context, establishments supplying paper and pencils for children can also help reduce the use of technology. This initiative should be promoted in more establishments to make healthier use of screen devices by children.

Nearly one in three meals in fast-food restaurants involves the use of a smartphone by children. The prevalence of smartphone use during meals was higher in older children, those with bad attitudes, those who were overweight or obese, those accompanied by younger female caregivers, and when there was no interaction between the child and the caregiver. The results of this study will be valuable to caregivers, educators, and restaurant owners, as they could help raise awareness (especially among caregivers of children) of the prevalence of smartphone usage in fast-food restaurants. It is therefore important to enforce limits regarding screen use in hospitality settings to encourage quality family mealtime.

Databases are not available for public use.

José Manuel Jiménez Rodríguez.

The corresponding author on behalf of the other authors guarantee the accuracy, transparency and honesty of the data and information contained in the study, that no relevant information has been omitted and that all discrepancies between authors have been adequately resolved and described. Databases are not available for public use.

S. de Paz-Cantos: design and conceptualisation, investigation, writing-original draft, methodology, acquisition, curation, analysis and interpretation of data, software, formal analysis, writing-critical review and editing. A. González-Marrón: conceptualisation, methodology, data interpretation, writing-critical review and editing. C. Lidón-Moyano: conceptualisation, methodology, and writing-critical revision. I. Cabriada: data analysis and interpretation. M. Cerrato-Lara and R. Gómez-Galán: methodology and data interpretation. JM. Martínez Sánchez: conceptualisation, methodology, data interpretation, writing-critical review and editing.

To all the members of the Health Determinants and Health Policies team at the International University of Catalunya, whose dedication and experience have greatly enriched the research work. We also thank Isabela Reis and Angelina Kozhokar, medical students at the International University of Catalunya, for their contribution to the data collection.

This study has been funded by the Ministry of Science and Innovation of the Government of Spain (ref.: PID2021-122272OBI00) and by ERDF/European Regional Development Fund (ERDF) funds - a way to build Europe. The Health Determinants and Health Policy Evaluation Group is supported by the Department of Universities and Research of the Generalitat de Catalunya (grant number 2021SGR00186).

None.