Screen Time in Under-five Children

Effectiveness of a program to lower unwanted media screens among 2-5-year-old children: a randomized controlled trial

Background

Limited interventions exist on reducing unwanted screen time (ST) among children from low- and middle-income countries (LMICs), so we developed and assessed the effectiveness of the program to lower unwanted media screen time (PLUMS) among children aged 2-5 years in Chandigarh, Union Territory, North India.

Methods

An open-label randomized control parallel group trial per CONSORT guidelines was conducted among randomly selected 340 families with children aged 2-5 (±3 months) years in Chandigarh, India. PLUMS was implemented at the family level with a focus on modifying the home media environment and targeted individual-level interventions using parent and child modules for 2 months. A post-intervention (immediately) and a follow-up assessment after 6 months was done. During the follow-up period, the interaction was done passively via WhatsApp groups. The control group received routine healthcare services. Validated and standardized tools, including a digital screen exposure questionnaire with a physical activity component, preschool child behavior checklist, and sleep disturbance scale for children, were used to collect data at baseline, post-intervention, and follow-up periods. The primary outcome was the mean difference in ST (minutes/day) among children in the intervention group versus the control group. Generalized estimating equation (GEE) analysis was performed to adjust for clustering.

Results

An equal number of families (n = 170) were randomly assigned to the intervention and control arms. In the post-intervention assessment, 161 and 166 families continued while, at the follow-up assessment, 154 and 147 were in the intervention and control arm, respectively. The mean difference in ST on a typical day [27.7 min, 95% Confidence Interval (CI) 5.1, 50.3] at the post-intervention assessment significantly (p < 0.05) decreased in the intervention (102.6 ± 98.5 min) arm as compared with the control (130.3 ± 112.8 min) arm. A significant reduction in ST (β = -35.81 min, CI -70.6, -1.04) from baseline (β = 123.1 min) to follow-up phase (β = 116 min) was observed in GEE analysis. The duration of physical activity increased both at post-intervention (β = 48.4 min, CI = +6.6, +90.3) and follow-up (β = 73.4 min, CI = 36.2, 110.5) assessments in the intervention arm.

Conclusion

The PLUMS intervention significantly reduced the children's mean ST on a typical day and increased the physical activity immediately post-intervention and during the 6-month follow-up period. These results might guide the policymakers to include strategies in the national child health programs in the Southeast Asia Region to reduce unwanted ST.Clinical trial registration: https://clinicaltrials.gov/, identifier CTRI/2017/09/009761.

Evaluation of Screen Time in Children Under Five Years Old

INTRODUCTION

Due to the rapid advancement of technology, there has been a noteworthy increase in the diversity and abundance of activities involving children. The most effective methods to enhance and facilitate children's media interactions are to minimize, reduce, use with caution, and establish healthy patterns. We aimed to evaluate media exposure of children below five years of age.

MATERIAL AND METHODS

This is a prospective, observational, cross-sectional study that was conducted between December 2017 and September 2019 in Eskişehir, Türkiye. To assess the frequency of electronic device usage among children under the age of five, including televisions, laptops, tablets, and mobile phones, as well as its impact on their sleep patterns and physical measurements, and to evaluate families' understanding of the terms "screen time" and "back screen time," we developed a questionnaire.

RESULTS

We analyzed a total of 731 questionnaires: 334 (45.7%) were girls, 397 (54.3%) were boys, and the mean age was 33.55±16.37 months. Upon examining the technical equipment accessible to the children in our study, we found that 98.6% possessed a television, 96.9% owned a mobile phone, 54% had a laptop, 49.5% had a tablet, and 34.1% possessed a gaming console. The study revealed the following proportions of electronic devices in children's rooms: 13% televisions, 11.9% tablets, 7.4% laptops, and 7% mobile phones. There has been a substantial increase in the amount of time they spend watching television and playing computer games among children who have at least one sibling. There was a statistically significant disparity between the television viewing periods and the body mass index of children older than two years old. Additionally, we have seen a significant disparity in the presence of media devices in children's bedrooms and the subsequent impact on their sleep duration and patterns throughout both nighttime and daytime. Around 65.8% of parents did not know of the concept of screen time, while 88.4% of parents did not know of the concept of back screen time.

DISCUSSION

Parental compliance with the current guidelines for screen time is insufficient, among parents with children under the age of five, even though exposure to screens begins in the first months of life. Our analysis highlighted the necessity for parents to establish and enforce a unified and logical media usage policy for all children residing in the household. It is crucial to allocate sufficient time during the routine healthcare visit to discuss these recommendations.

Familial context influences media usage in 0- to 4-year old children

Background

The use of digital media (e.g., smartphones, tablets, etc.) and the Internet have become omnipresent for every age group and are part of children's and parents' everyday life. Focusing on young children, the availability of media devices, their use as well as associated problems (e.g., in social, emotional and motor development) have increased in recent years. Of particular interest for prevention of these problems in early childhood is the relationship between the familial context (parental digital media use, Problematic Internet Use, school graduation, presence of siblings) and the digital media use of infants and toddlers. The present study's goal was to describe media usage in 0-4-year-old children and to identify the potential relationship between familial context factors and child media usage.

Methods

The sample included N = 3,035 children aged 0 to 3;11 years (M = 17.37 months, SD = 13.68; 49.13% female). Recruitment took place within the framework of a restandardization study for a German developmental test. The parents of the participants answered a questionnaire on socio-demographics, on child media use, and on parental media use. Questions on parental media use included the full version of the Short Compulsive Internet Use Scale (S-CIUS).

Results

Significant increases in media usage times with child age were identified, but no significant gender differences. A multiple regression analysis revealed that increasing maternal total media usage time, a higher parental S-CIUS score, lower school leaving certificate of both mother and father, and increasing child's age led to higher child media usage time. Having siblings diminished young children's media usage in this study. Having more than one child and having children aged over a year was associated with a higher parental S-CIUS score.

Conclusion

Family factors such as maternal media use time, Problematic Internet Use and lower school graduation are significantly associated with young children's digital media use. Parents should be aware of their personal influence on their children's media use which might be due their role in terms of model learning.

High Problematic Screen Exposure among Children Aged 2-5 Years Visiting the Department of Pediatrics of a Tertiary Care Centre

Introduction

The effects of problematic screen exposure in the early years have adverse effects on cognition, reasoning, executive, and social skills, and physical health. The study aimed to assess the prevalence of problematic screen exposure in children between 2 to 5 years of age visiting the Department of Paediatrics of a tertiary care centre.

Methods

A descriptive cross-sectional study was conducted among caregivers of children aged 2 to 5 years of age in a tertiary care centre from 16 July 2023 to 30 September 2023 after an ethical clearance from the Institutional Review Committee. This study excluded children with chronic disease and behavioural disorders. The problematic screen exposure was assessed using the Problematic Screen Exposure Score. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval.

Results

Among 310 respondents, 216 (69.67%) (64.55-74.79, 95% Confidence Interval) children had a high problematic screen exposure score. The mean age of children was 3.46±1.033 with 89 (41.20%) children having their first exposure before 12 months of age, 131 (60.64%) exceeding daily usage of >2 hr, and 198 (91.66%) children viewing age-inappropriate media content.

Conclusions

The prevalence of high problematic screen exposure was comparable to that of the prevalence found in studies done in similar settings.

Keywords

children; preschool; screen time.

Mobile phone use by young children and parent's views on children's mobile phone usage

Aims

This study aims to explore the prevalence of mobile phone use among young children aged 6 months to 4 years. We studied the usage patterns, optimal age for use, and the attitudes of parents toward their child's mobile phone use.

Methods

We conducted a cross-sectional study in a pediatric OPD of a tertiary teaching hospital for a period of 2-months. Ethics committee approval and informed consent was taken before conducting the research. A predesigned and validated questionnaire was used to collect data. We calculated a sample size of 90 children at a 95% confidence level. Chi-square test and Fischer's exact test were used as a test of significance at 5% level of significance.

Results

We observed that 73.34% of children were using mobile phones and mobile phone usage increased with age. Children used mobile phones for educational purposes (43.9%), and for less than an hour a day (57.6%). In the 3-4 year age group, 19% used mobile phones for 3 hours or more. While 93.3% of parents felt they shouldn't give their child a phone, 71.4% children of these parents still used one.

Conclusions

Our study highlights a high prevalence of mobile phone use among young children aged 6 months to 4 years. Although parents aimed to limit their child's phone usage, the reality was different. We recommend that guidelines on mobile phone use be followed in India.

Measuring effects of screen time on the development of children in the Philippines: a cross-sectional study

BACKGROUND

Screen time in young children is discouraged because of its negative effects on their development. However, excessive screen media use has been rising, particularly during the global pandemic when stay-at-home mandates were placed on young children in several countries. This study documents potential developmental effects of excessive screen media use.

METHOD

This is a cross-sectional study. Participants were 24 to 36 month old Filipino children recruited through non-probable convenience sampling from August to October 2021. Regression analyses were performed to test the association between screen time and changes in scaled scores for skills and behaviors determined from the Adaptive Behavior Scale and to identify factors associated with increased screen media use.

RESULTS

Increased odds of excessive use of screen media of children by 4.19 when parents watch excessively and 8.56 times greater odds when children are alone compared to watching with a parent or other children. When adjusted for co-viewing, more than 2 h of screen time is significantly associated with decrease in receptive and expressive language scores. The effects on personal skills, interpersonal relationships and play and leisure skills were only statistically significant at 4 to 5 or more hours of screen time use.

CONCLUSION

The study found that spending no more than 2 h screen time had minimal negative effects on development and that use beyond 2 h was associated with poorer language development among 2 year olds. There is less excessive screen media use when a child co-views with an adult, sibling or other child and when parents likewise have less screen time themselves.

Association between screen time and suspected developmental coordination disorder in preschoolers: A national population-based study in China

Introduction

Excessive screen exposure (ESE) is a growing global public health concern. This study aims to investigate the potential association between ESE and suspected developmental coordination disorder (DCD) in Chinese pre-schoolers, with or without siblings.

Method

A retrospective cohort study was conducted, involving 126,433 children from 551 cities in China. The Little Developmental Coordination Disorder Questionnaire (LDCDQ) was employed to evaluate motor impairment in children, while parents provided information on their children’s screen time in the past year. A mixed and multi-level logistic regression model was used to analyze the associations of all screen exposure measurements from the past year with LDCDQ scores and the risk of suspected DCD.

Results

The prevalence of excessive screen exposure was 67.6% (&gt;1 h per day) and 28.9% (&gt;2 h per day) in Chinese pre-schoolers. One hour’s increase in weekday daily screen time, weekend daily screen time, and screen time before sleep in the past year was associated with a decreased total score of the LDCDQ (β were −0.690, −0.398, and −1.587, p &lt; 0.001) and an increased risk of suspected DCD by 15.3%, 9.1%, and 46.8% when adjusting for the child, family and maternal health characteristics. Excessive screen exposure decreased the total LDCDQ scores by 1.335 (&gt;1 vs. ≤1 h) and 1.162 (&gt;2 vs. ≤2 h) and increased risks of suspected DCD by 44.0% (&gt;1 vs. ≤1 h) and 31.1% (&gt;2 vs. ≤2 h) with statistical significance (each p &lt; 0.05). The stratified analysis showed that the association between screen time and LDCDQ score was stronger in children without siblings than in those with siblings.

Conclusion

The risk of suspected DCD was highest for screen time exposure before bed compared with average weekday and weekend exposures. Parents should be advised to prevent their children from using electronic screens unsupervised, especially in one-child families.

Prevalence and Determinants of Excessive Screen Viewing Time in Children Aged 3-15 Years and Its Effects on Physical Activity, Sleep, Eye Symptoms and Headache

Screen viewing time is the total time spent by a child on any digital/electronic device. The objective of the present study was to determine the prevalence and predictors of excessive screen viewing time in children in Ujjain, India. This cross-sectional, community-based study was conducted through a house-to-house survey using the three-stage cluster sampling method in 36 urban wards and 36 villages of Ujjain District, India. Excessive screen viewing time was defined as screen viewing for >2 h/day. The prevalence of excessive screen viewing time was 18%. Risk factors identified using the multivariate logistic regression model were age (OR: 1.63, p < 0.001); mobile phone use before bedtime (OR: 3.35, p = 0.004); parents' perception about the child's habituation to screen time (OR: 8.46, p < 0.001); television in the bedroom (OR: 35.91, p < 0.001); morning mobile screen viewing time (OR: 6.40, p < 0.001); not reading books other than textbooks (OR: 6.45, p < 0.001); and lack of outdoor play for >2 h (OR: 5.17, p < 0.001). The presence of eye pain was a protective factor for excessive screen viewing time (OR: 0.13, p = 0.012). This study identified multiple modifiable risk factors for excessive screen viewing time.

Exploring the influence of food labels and advertisements on eating habits of children: a cross-sectional study from Punjab, India

BACKGROUND

Maintaining healthy eating habits among children is challenging due to industrial tactics. There is little research on the effect of nutritional labels and tv ads on the eating habits of children. So the primary aim of the study was to explore the noticeability of the food packaging labels by the children, the information retrieved from the food nutrition labels, and their role in increased frequency of eating out in addition to the perceptions of their parents about the television ads.

METHODS

A cross-sectional study was conducted at schools in Punjab, India. Using multi-stage stratified random sampling, we included 722 school-going children aged 14-18 and their parents. A structured predefined questionnaire collected data using a four-point Likert scale. Descriptive statistics and binary logistic regression were used to draw our inferences.

RESULTS

About 46% of children were eating out > 3 times a week. Nearly 49% said they never looked at the expiry dates on the food packet, and 40% have yet to notice the quality certification. Nearly half do not understand the components of the food label, and 59% said they never changed their buying behavior because of the label. Only 37% of parents expressed their concerns about the timing of the ads when children watch television, while only 25.5% were concerned about the accuracy of the information. Concerns of the parents regarding the timing of the ads, and celebrity endorsements, were potential predictors for the increased frequency of eating out by the children.

CONCLUSIONS

Low awareness regarding the utility of nutrition labels and minimal concerns of the parents increase the frequency of eating out. Unification of our existing policies regarding food labels and tv advertisements to develop family-centric interventions will bring us one step closer to improving the enabling environment to curb the growing menace of childhood obesity.

Food in a plate or food in a plate with a sustainable toy: A thematic analysis of parents’ perception and children behavior

BACKGROUND: Using innovative and creative marketing promotional techniques for the children food items along with freebies with eco-friendly or sustainable toys which attract them to consume foods that are not particularly good for health is the area of research which is most concerning these days considering the United Nations Sustainable development goals of Good well-being and responsible productions and consumption. OBJECTIVE: This paper is intended to explore and analyze the effectiveness of the innovative marketing techniques like the use of sustainable toys, tattoos, and stickers employed as toys with food by leading FMCG companies in India for influencing children behavior. METHODS: This research presents the results of in-depth interviews conducted and participants’ were selected through quota sampling from working mothers, non-working mothers, and other non-working mothers with full-time maid support. Grounded theory and inductive approach were used in the study. RESULTS: Five themes were evident across all the groups of mothers’ with respect to toys with food. Results showed that the themes underlying the gift in food for kids are portrayal of snacking, exaggerating the claims, enriching the moods, ameliorate the popularity and denigration of core foods. So, the results suggested that toys even though sustainable in nature with food marketing negatively affect the child behavior and health of kids. CONCLUSION: The study suggested that toys with food strategy can positively be presented /deliver a message to kids and companies can use healthy food items with these eco-friendly premiums which would benefit both the parties. The paper presents the concepts and themes that present the understanding of the mothers’ perspective of toys with food offered by companies in Indian perspective.

Electronic screen device usage and screen time among preschool-attending children in a suburban area of Sri Lanka

Background

Excessive use of screen devices and screen time are increasing health problems in children. We aim to describe the electronic screen device usage and determine the factors associated with their use among preschool-attending children in a suburban population in Sri Lanka.

Methods

A cross-sectional study was conducted in a suburban Medical Officer of Health area of Sri Lanka from January to March 2020. All children aged between 36–59 months attending ten randomly selected preschools were recruited. Data were collected using a parent-administered questionnaire and analysed using binary logistic regression in SPSS. The prevalence of electronic device usage, the average time spent on each device, and factors associated with individual device usage were analysed.

Results

A total of 340 children (Male-48%; mean age-50.1 ± 6.9 months) were recruited. Electronic devices were used by 96% of children. The most common devices were the television (87%) and the smartphone (63%). Of the children who used electronic devices, 60% exceeded the recommended screen time limit of one hour per day, 21% used devices for more than two hours per day, and 51% commenced using devices by two years of age. The higher education level of the father was independently associated with the use of smartphones and laptops and daily screen time of more than one hour (p < 0.05 for all). Male sex and being the only child were significantly associated with the use of smartphones, whereas maternal employment was associated with the use of laptops (p < 0.05 for all).

Conclusions

Electronic screen devices were used by 96% of preschool-attending children, and over 60% used them for more than the recommended daily upper limit of one hour. Higher paternal education, maternal employment and being the only child were significantly associated with electronic screen device use.

Prevalence of Screen Time Among Children Aged 2 to 5 Years in Chandigarh, a North Indian Union Territory

OBJECTIVE

To estimate the prevalence of screen time (ST) and its associated effects, including emotional and behavioral changes, sleep disturbances, and physical activity levels, in children aged 2 to 5 years.

METHODS

We conducted a cross-sectional study among 400 randomly selected children aged 2 to 5 years in Chandigarh, North India. We used a validated, pretested, semistructured digital-screen exposure and physical activity questionnaire; an abbreviated standard Child Sleep Habit Questionnaire; and a standard Preschool Child Behavior Checklist. We considered ST as excessive if it was more than 1 hour per day as per the American Academy of Pediatrics 2016 guidelines. IBM SPSS Statistics for Macintosh, version 25.0, was used to perform linear regression model analysis and stepwise binary multivariate logistic regression.

RESULTS

Approximately 59.5% of children (mean age 3.5 ± 0.9 years) had excessive ST. ST was higher on weekdays (58.5%) compared with the weekends (56.8%). Higher ST correlated positively with the mother's level of education (r = +0.219) and higher per capita family income (r = +0.227). Screen time was also positively correlated with attending daycare centers (adjusted odd's ratio [aOR] = 1.82, confidence interval [CI] = 1.18-2.81), caregivers ST of more than 2 hours (aOR = 1.68, CI = 1.12-2.56), and the absence of digital-media rules at home (aOR = 3.3, CI = 0.92-11.65). It was negatively correlated (i.e., protective) with lower mother's education (i.e., up to middle school) (aOR = 0.62, CI = 0.41-0.96) and watching educational digital-media content (aOR = 0.53, CI = 0.33-0.87).

CONCLUSION

We observed a high prevalence of excessive ST among children aged 2 to 5 years. Screen time was significantly associated with being in daycare centers, higher caregivers' ST, lower mothers' educational status, and educational digital content.

Excessive screen time and lower psychosocial well-being among preschool children

OBJECTIVE

Too much screen time is a common and severe threat to child health and excessive screen exposure exists in the early childhood population in Turkey. We aimed to investigate the associations between excessive screen time and psychosocial well-being in a sample of Turkish preschool children.

METHODS

Mothers and their healthy children aged 2-5 years who applied to general pediatric outpatient clinics for well-child examinations were enrolled in this descriptive cross-sectional study. Children with a daily screen time of less than 1 h (low) or more than or equal to 4 h (excessive) were included. Psychosocial well-being was assessed using the parent version of the Strengths and Difficulties Questionnaire.

RESULTS

In all, 220 mother-child pairs participated in this study. Emotional symptoms, conduct problems, peer relationship problems, and total difficulties scores were significantly higher in the children with excessive screen time (p<0.05), while the hyperactivity-inattention and prosocial scores were not different between the low and excessive screen time groups (p>0.05). After adjusting for potential confounders, the children with excessive screen time had significantly increased odds ratios for having conduct and peer relationship problems (OR [95% CI]: 2.62 [1.11-6.19], p = 0.028 and 2.57 [1.25-5.26], p = 0.010, respectively).

CONCLUSION

Turkish preschool children with excessive screen time were significantly more likely to have poor psychosocial well-being. Preschool children with behavioral problems should be evaluated for excessive screen time.

Evaluation of problematic screen exposure in pre-schoolers using a unique tool called "seven-in-seven screen exposure questionnaire": cross-sectional study

Background

Screen media exposure has been increasing in the preschool years. Risky aspects of screen exposure have many potential negative effects on children’s health. We aimed to evaluate problematic screen exposure in Turkish preschool children by using a unique tool called the “Seven-in-Seven Screen Exposure Questionnaire” and to investigate factors associated with problematic screen exposure.

Methods

A questionnaire form was designed including general descriptive questions in the first part. In the second part, a questionnaire we designed called the “Seven-in-Seven Screen Exposure Questionnaire” was conducted to evaluate problematic screen exposure characteristics. The questionnaire included seven items: daily screen time, viewing with parent(s), setting screen limits, screen exposure during meals and in the hour before bedtime, age of onset of screen exposure, and viewing low-quality content. The total problematic screen exposure score (range 0–13) was generated by summing scores from the seven items. Total scores are classified into two categories: low (< 7) and high (≥ 7). Logistic regression was performed to search for independent parameters associated with problematic screen exposure.

Results

One thousand two hundred forty-five mother-child pairs participated in this study. The median age of the children was 3.9 (IQR: 2.9–4.7) years and 51% were males. Overall, 280 children (22.5%) had a problematic screen exposure score of ≥7 (high). The median problematic screen exposure score was 4 (IQR: 3–6). Maternal age of < 30 years; paternal age of ≥30 years; maternal educational level of ≤12 years; the age of 24–48 months; home-based daycare; postponing eating, toileting, or sleeping while using a screen; and using touchscreen devices were found to be associated with an increased risk of having a high problematic screen exposure score.

Conclusion

Developing national scales to monitor problematic screen use in children would be more effective than monitoring screen time alone. All of the screen use characteristics not recommended in children would be evaluated using problematic screen exposure scales. The “Seven-in-Seven Screen Exposure Questionnaire” may serve as an example for further studies.

Infant media use: A harm reduction approach

There are a myriad of potentially harmful developmental outcomes associated with infant digital media use. Studies revealing risk associated with early media use have informed the current American Academy of Pediatrics (AAP) recommendations that discourage most digital media use among children under 18 months of age. Recent research advances, however, suggest potential benefits of technology engagement in this age group. Additionally, surveys of parents reveal that most infants engage with digital media for at least 30 min a day, exceeding the AAP recommendations. In response to these discoveries and cultural trends, some scholars have made compelling cases to adapt the AAP guidelines for infants. A helpful model for developing infant digital media use guidelines for families may be the harm reduction approach. The intent of this review is to suggest adaptations to the AAP guidelines for infant media engagement using a harm reduction framework. This review describes the challenge of restrictive guidelines, briefly summarizes the harm reduction approach, provides a review of risks and benefits associated with infant media use in each developmental domain (physical, cognitive, and socioemotional), summarizes correlates of infant screen media use, and examines intervention strategies for reducing screen time. The paper concludes with examples of possible adaptations to current AAP infant media use recommendations using harm reduction and bioecological frameworks.

Prevalence of excessive screen time and its association with developmental delay in children aged <5 years: A population-based cross-sectional study in India

The global growth of electronic media usage among children has caused concerns regarding screen time (ST) impact on child development. No previous population-based studies have evaluated ST and child development in India. This study aimed to determine the burden of ST, associated sociodemographic factors, and its impact on domains of child development. A population-based cross-sectional study was conducted in the field practice area of rural and urban health centers in Tamil Nadu, India. A total of 718 children (396 rural and 322 urban) were selected, using a cluster random sampling method. ST estimates were obtained from parents/guardian after a 7-day observation period. The Communication DEALL Developmental Checklist was used to assess child development. The mean ST was 2.39 hours/day (95% confidence interval [CI]: 2.23-2.54), and the prevalence of excessive ST was 73% (95% CI: 69.2-76.8). Excessive ST was significantly associated with the mothers' ST, screen usage at bedtime, birth order (in children < 2 years), and attending school (in children ≥ 2 years). Increased ST was significantly associated with developmental delay, in particular, in the domains of language acquisition and communication. In children aged ≥ 2 years, a delay in ≥ 3 domains was associated with ST (adjusted odds ratio [AOR] = 17.75, 95% CI: 5.04-62.49, p < 0.001), as was language delay (AOR = 52.92, 95% CI: 12.33-227.21, p < 0.001). In children aged < 2 years, a delay in ≥ 2 domains was associated with ST (AOR = 16.79, 95% CI: 2.26-124.4, p < 0.001), as was language delay (AOR = 20.93, 95% CI: 2.68-163.32, p < 0.01). A very high prevalence of excessive ST was identified, with a significant association with developmental delay in children. There is an urgent need to include education on ST limits at the primary healthcare level.

Development and evaluation of the digital-screen exposure questionnaire (DSEQ) for young children

Background

Over the last three decades, the accessibility and usage of mobile devices have increased among young children. This study’s objective was to develop a validated caregiver-reported digital-screen exposure questionnaire (DSEQ) for children aged 2–5 years.

Methods

DSEQ was developed in five phases. Phase 1, a draft questionnaire was developed by reviewing the literature on existing tools (n = 2) from 2009–2017. Phase 2, face-to-face interviews with primary caregivers (n = 30) were conducted in a tertiary-care-hospital for acculturation. Nine experts assessed the face and content validity of the draft Hindi and English questionnaire. Phase 3, a pilot study conducted among randomly selected families (n = 40) to evaluate the feasibility of DSEQ in field settings. Phase 4, test-retest reliability was done among 30 primary caregivers selected randomly in another urban cluster. Phase 5, the internal consistency of DSEQ was checked by conducting a cross-sectional study among randomly selected 400 primary caregivers in Chandigarh, North India. IBM SPSS Statistics for Macintosh, version 25.0, was for data management and analysis.

Results

A valid DSEQ with 86 items under five domains, including sociodemographic, screen-time exposure and home media environment, level of physical activity, media-related behaviors, and parental perceptions was developed. The pilot study showed that it was feasible to use the DSEQ in the field. DSEQ was reliable with kappa value ranging from 0.52 to 1.0, and intra-class coefficient of 0.62–0.99 (p<0.05). A strong internal consistency was observed for three domains including, screen-time exposure and home media environment (Cronbach’s alpha of 0.82), media-related behaviors (Cronbach’s alpha of 0.74) and physical activity (Cronbach’s alpha 0.73).

Conclusions

The developed DSEQ has good face and content validity and acceptable evidence of internal consistency and test-retest reliability. The DSEQ can be used for measuring digital screen exposure and its correlates among children aged 2 to 5 years.

Explaining Screen-Time Behavior Among Preschoolers in Northern India Using Multi Theory Model: A Parental Cross-Sectional Survey

BACKGROUND

Screen-time (ST) is the time spent on digital media. The American Academy of Pediatrics recommends the daily ST of less than an hour for preschoolers. However, increased ST among preschoolers is becoming a public health concern.

OBJECTIVE

This study assessed the multi-theory model (MTM)'s applicability in explaining the ST behavior change among preschoolers through parents.

METHODS

A quota sample of 72 parents was drawn from Northern India. Data were analyzed using multiple regression.

RESULTS

Behavioral confidence (p < 0.001) and changes in the physical environment (p < 0.001) significantly predicted the initiation of reducing ST. The sustenance of limiting ST was significantly predicted by the emotional transformation (p < 0.001), practice for change (p < 0.001), and changes in the social environment (p = 0.001).

CONCLUSIONS

The study highlights the usability of the MTM model in designing and testing interventions for parents to limit ST among their children.

A Multicomponent Intervention to Reduce Screen Time Among Children Aged 2-5 Years in Chandigarh, North India: Protocol for a Randomized Controlled Trial

Background

Excessive digital screen exposure (≥1 hour per day) is associated with limited growth and development in children.

Objective

This study aims to develop and assess a multicomponent intervention program's effectiveness in reducing excessive screen time among children aged 2-5 years.

Methods

A theory-based multicomponent intervention known as Program to Lower Unwanted Media Screens (PLUMS) at the household level has been developed. It is based on the social cognitive theory for children and self-determination theory for caregivers. After pretesting, a randomized control trial will be conducted to assess this intervention's effectiveness among healthy children aged 2-5 (±3 months) years and their primary caregivers who have at least one digital media gadget at home in zone three of Chandigarh (population of 2,730,035). A sample size of 428 children is estimated per arm. PLUMS includes disseminating specific information, education, communication in the form of videos and posters to the primary caregivers, and conducting motivational interviewing as and when needed. Children will be provided suggestions for playful activities as alternatives to digital media gadgets. The primary outcome is the mean change in the duration of screen time, and secondary outcomes are sleep duration and patterns, emotional-behavioral problems, and level of physical activity of the children. Per-protocol and intention-to-treat analyses will be conducted using SPSS for Macintosh, Version 25.0.

Results

The intervention package will be disseminated once a week for 8 weeks to the participants via the caregivers' preferred means of communication. The endline assessment will be done immediately postintervention and after the 6 months of follow-up. The Institute's ethics committee, Postgraduate Institute of Medical Education and Research, Chandigarh, India, has approved this study (INT/IEC/2019/000711). The Indian Council of Medical Research, New Delhi (3/1/3/Next-100/JRF-2015/HRD), and PGIMER, Chandigarh (71/2-Edu-16/92, Dated 08/01/2018) funded this study.

Conclusions

PLUMS might be effective in reducing excessive screen time among children aged 2-5 years in a North Indian Union Territory.

Trial Registration

Clinical Trial Registry India CTRI/2017/09/009761; https://tinyurl.com/53q6dpjs

International Registered Report Identifier (IRRID)

DERR1-10.2196/24106

Digital Media Exposure and Predictors for Screen Time in 12-Month-Old Children: A Cross-Sectional Analysis of Data From a German Birth Cohort

Background: Early exposure to digital media may affect the physical and cognitive development in young children. The American Academy of Pediatrics and national guidelines recommend no digital media use at all under the age of 18 months. The aim of our study was to determine the actual exposure to digital media in 12-month-old infants and to reveal potential risk factors for screen time. Methods: In this prospective cross-sectional survey, data was collected from the KUNO Kids birth cohort study using parent-report questionnaires regarding the media exposure of the study child. We determined age at first contact with different digital media, mean screen time on an average weekday, and the influence of major demographic and socioeconomic factors. Results: Data for screen time analysis was available for 630 children. In summary, 45% of children had already been exposed to digital media by their first birthday. The most frequent first digital media exposure was the TV (33.0%) followed by smartphones (16.9%), both most commonly exposed to around the age of 8 months. On a regular weekday, 20% of the children spent 0.5-1 h in front of a TV and 9% were exposed to a smartphone for the same time frame, compared to 31% of joint parent-child media use. Predictors for screen time were having one sibling, less living space per person, and excessive TV use in the household, the latter of which doubled the chance of the child being exposed to digital media. Conclusion: A proportion of 10% of 1-year-old children were already regularly exposed to digital media. The TV remains the most predominant device but new media, particularly smartphones, might be catching up. Our study provides further support that family TV time is a major predictor of infant screen time. Pediatric recommendations should be re-evaluated in the light of the actual exposure to digital media already in infancy and parents should be proactively counseled regarding possible effects on child development.

Screen time and autistic-like behaviors among preschool children in China

Screen time is becoming increasingly common in daily life. Early and excessive screen use has raised growing concerns for children's neuropsychological development. The purpose of this study was to evaluate the association between exposure to screen time in early life and the presence of autistic-like behaviors among preschool children. 29,461 child-caregiver dyads at kindergartens in Longhua New District of Shenzhen, China, were enrolled in this cross-sectional study. Information concerning socio-demographic characteristics, frequency and duration of children's electronic screen exposure for each year since birth, and autistic-like behaviors (measured by the Autism Behavior Checklist) were collected using a self-administered structured questionnaire completed by the primary caregivers. A series of logistic regression models assessed the association between screen time and autistic-like behaviors. Results indicated that younger initial age, longer daily screen time and longer cumulative years of screen exposure since birth were associated with the presence of autistic-like behaviors at preschool age. The risk was enhanced with the increase of both daily screen time and cumulative years of screen exposure during preschool period. Moreover, the cross-over analysis indicated that the first three years following birth might be a sensitive period for children when screen exposure increases the risk of experiencing autistic-like behaviors. In conclusion, our study implied that screen exposure in early life might increase the occurrence of autistic-like behaviors among preschoolers. These findings support the need for early interventions into preschoolers' screen use, however longitudinal studies are necessary to further confirm the causal relationship between early screen time and the incidence of later autistic-like behaviors among preschool children.

Developing a Mobile App (iGAM) to Promote Gingival Health by Professional Monitoring of Dental Selfies: User-Centered Design Approach

BACKGROUND

Dental visits are unpleasant; sometimes, patients only seek treatment when they are in intolerable pain. Recently, the novel coronavirus (COVID-19) pandemic has highlighted the need for remote communication when patients and dentists cannot meet in person. Gingivitis is very common and characterized by red, swollen, bleeding gums. Gingivitis heals within 10 days of professional care and with daily, thorough oral hygiene practices. If left untreated, however, its progress may lead to teeth becoming mobile or lost. Of the many medical apps currently available, none monitor gingivitis.

OBJECTIVE

This study aimed to present a characterization and development model of a mobile health (mHealth) app called iGAM, which focuses on periodontal health and improves the information flow between dentists and patients.

METHODS

A focus group discussed the potential of an app to monitor gingivitis, and 3 semistructured in-depth interviews were conducted on the use of apps for monitoring gum infections. We used a qualitative design process based on the Agile approach, which incorporated the following 5 steps: (1) user story, (2) use cases, (3) functional requirements, (4) nonfunctional requirements, and (5) Agile software development cycles. In a pilot study with 18 participants aged 18-45 years and with different levels of health literacy, participants were given a toothbrush, toothpaste, mouthwash, toothpicks, and dental floss. After installing iGAM, they were asked to photograph their gums weekly for 4 weeks.

RESULTS

All participants in the focus group believed in the potential of a mobile app to monitor gingivitis and reduce its severity. Concerns about security and privacy issues were discussed. From the interviews, 2 themes were derived: (1) "what's in it for me?" and (2) the need for a take-home message. The 5 cycles of development highlighted the importance of communication between dentists, app developers, and the pilot group. Qualitative analysis of the data from the pilot study showed difficulty with: (1) the camera, which was alleviated with the provision of mouth openers, and (2) the operation of the phone, which was alleviated by changing the app to be fully automated, with a weekly reminder and an instructions document. Final interviews showed satisfaction.

CONCLUSIONS

iGAM is the first mHealth app for monitoring gingivitis using self-photography. iGAM facilitates the information flow between dentists and patients between checkups and may be useful when face-to-face consultations are not possible (such as during the COVID-19 pandemic).

Physical Activity and Sedentary Behaviors of Young Children: Trends from 2009 to 2018

Over the last decade, the lives of children in several countries, including Greece, have been affected by recession. The aim of the present study was (a) to examine time trends in physical activity (PA) and screen time (ST) of Greek preschool children, together with their family affluence (FA), from 2009 until 2018, and to explore the associations among them; and (b) to investigate the connections of parental educational level and children's BMIs to their achieving ST (<1h/day) and PA (11,500 steps/day) guidelines. A total of 652 children from four cross-sectional cohorts participated. PA was recorded with Omron HJ-720IT-E2 pedometers, whereas ST, family affluence (FA) and parental educational level were reported by participants' parents. The results of the one-way ANOVAs that were computed revealed statistically significant differences among cohorts, albeit of no practical importance, in PA, ST and FA. According to the regressions calculated, neither BMI nor the educational level was related to membership in ST and PA guidelines groups. ST was a significant predictor of children's PA in all week periods (school-time, leisure-time, weekend), whereas FA was not such a strong predictor. Multilevel interventions aiming at both ST and PA seem to be imperative for the benefit of young children's health.