Parent Perceptions of Mobile Device Use Among Preschool-Aged Children in Rural Head Start Centers

Effects of physical activity and use of digital devices on visual acuity in children and adolescents during the COVID-19 pandemic: A cross-sectional study

Purpose

To determine the association between poor visual acuity, the use of digital devices and physical activity (PA) during the COVID-19 pandemic.

Methods

A total of 327,646 Chinese children and adolescents were included in the analysis using a cluster random sampling method; this is a case-control study, of those 144,708 children and adolescents with poor visual acuity were included in the case group, while 182,938 who did not have poor visual acuity were included in the control group. A logistic regression model was used to assess the contribution of PA and the use of digital devices to poor visual acuity.

Results

A total of 144,708 children and adolescents experienced poor visual acuity during the COVID-19 pandemic; 54.8% were male, and 55.2% live in rural areas. Compared to controls, children and adolescents with poor visual acuity exhibited more time for the use of digital devices (4.51 ± 2.44 vs. 3.79 ± 2.34 for cases and controls, respectively; P < 0.001) and PA (3.07 ± 0.92 vs. 2.85 ± 1.00 for cases and controls, respectively; P < 0.001). During the COVID-19 pandemic, risk factors related to poor visual acuity among children and adolescents included the use of digital devices (OR 1.135; 95% CI 1.132-1.139), and PA (OR 1.269; 95%CI 1.259-1.278). The results of interaction analysis show that for children and adolescents aged 12 to 17, the positive association between the use of digital devices and poor visual acuity decreased. The interaction effect between PA and digital devices is 0.987.

Conclusions

Children and adolescents were at risk of poor visual acuity during the COVID-19 pandemic. Extended use of the digital devices increased the risk of poor visual acuity, especially for children aged 6-11 years. But the risk of poor visual acuity among children and adolescents decreases as the time spent on PA increases.

Prevalence and description of digital device use among preschool children: A cross-sectional study in Kota Setar District, Kedah

INTRODUCTION

Digital device helps children enhance academic, cognitive and psychomotor skills. However, prolonged use causes physical inactivity, poor interpersonal skills and communication problems. Information on digital device use among young children in Malaysia is currently limited. Hence, this study aimed to determine the prevalence of digital device utilisation among preschool children in Kota Setar District, Kedah.

METHOD

A cross-sectional study at government preschools in Kota Setar District was conducted from February to April 2020. Selection of preschools and students was done using multistage simple randomisation. A self-administered questionnaire containing demographic and digital device use details was filled by parents.

RESULTS

The prevalence of digital device use among preschool children was 95.9% and mostly used smartphones (94.2%). Most children (95%) did not own the device, and usage was under supervision (95.7%). The reason for supervision was to prevent exposure to inappropriate content (70.5%). The common reasons for allowing digital device use were for educational (37.4%) and entertainment purposes (36%) through videos (30.9%) and games (30.2%). Approximately 21.5% and 50.3% of the children spent more than 1 and 2 hours on digital devices during weekdays and weekends, respectively.

CONCLUSION

The prevalence of digital device use among the preschool children in Kota Setar District was very high. Most of them used digital devices for educational and entertainment purposes under parental supervision. However, some exceeded the recommended screen time on weekends. These findings could promote awareness of digital device use among young children and help design public health awareness programmes and future policies.

"You're damned if you do, you're damned if you don't": a qualitative exploration of parent motives for provision of mobile screen devices in early childhood

BACKGROUND

Exploring parental motives for providing smartphones and tablets to young children is important to better understand ways to optimise healthy use of mobile screens in early childhood. To date, no study has qualitatively examined the factors underpinning parental motives of providing mobile screens to young children, using a theoretically driven approach.

METHODS

We conducted 45 in-depth, semi structured online interviews with primary caregivers of toddlers and pre-schoolers from diverse family backgrounds who participated in a large online survey in Australia. Themes were generated from the transcribed interviews using template thematic analysis. The coding was completed deductively using the Theory of Planned Behaviour (TPB) and data-driven induction.

RESULTS

Participants consistently reported a spectrum of attitudes, subjective norms and perceived behavioural control aspects which drove their decision to provide or not provide a mobile screen device to their child. Five main descriptive themes were generated, guided by the TPB: (1) Convenience, connection, and non-traditional learning experience; (2) Negative behavioural consequences and potential activity displacement through mobile screens; (3) Influences of society and resources; (4) Managing and achieving a balance; (5) External challenges.

CONCLUSIONS

Overall, the findings demonstrated that parents experienced cognitive dissonance between their attitudes and behaviour, primarily from perceived behavioural control and subjective norms negating the influence of attitudes on their motives to provide a device. These insights offer important avenues for public health messaging and resources to better involve and support parents in decision-making relating to mobile screens in everyday lives of young children.

Food insecurity is associated with higher food responsiveness in low-income children: The moderating role of parent stress and family functioning

BACKGROUND

Food insecurity (FI) may increase the odds for childhood obesity, yet little is known about the mechanism explaining this relationship. Parents experience greater psychosocial stress in the context of FI. In these environments, children from FI households may exhibit different appetitive behaviours.

OBJECTIVES

To examine associations between FI and appetitive behaviours in children (3-5 years) and to explore whether social, emotional and structural properties of the home environment moderate this relationship.

METHODS

In a low-income sample of 504 parent-child dyads, parents completed the household food security module and the Children's Eating Behavior Questionnaire. A subsample (n = 361) self-reported perceived stress, depressive symptoms, household chaos and family functioning. Children were categorized as food secure, household FI and child FI.

RESULTS

Food responsiveness (LSmeans ± SE; child FI: 2.56 ± 0.13; food secure: 2.31 ± 0.10, p < 0.05) and emotional overeating (LSmeans ± SE; child FI: 1.69 ± 0.10; food secure: 1.48 ± 0.08, p < 0.05) were higher among children in the child FI group compared to the food secure group. Child FI was only associated with higher food responsiveness among children of parents reporting high levels of perceived stress (p = 0.04) and low levels of family functioning (p = 0.01). There were no differences in food responsiveness by food security status at mean or low levels of perceived stress or at mean or high levels of family functioning (p > 0.05).

CONCLUSIONS

Child FI may contribute to obesity risk through differences in appetitive behaviours. For low-income families, stress management and improving family dynamics may be important factors for interventions designed to improve children's appetitive behaviours.

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.

Effect of early screen media multitasking on behavioural problems in school-age children

Screen media multitasking (SMM), the act of exposure ≥ 2 screen media simultaneously, is increasing nowadays. Single media use was associated with child's behavioural problems in previous studies. However, the associations between SMM since early childhood and behavioural problems in school-age children had not been elucidated. This study aimed to investigate the association between SMM from age 6 months to 4 years and behavioural problems in 6-year-old children. Two hundred and ninety-one (52.6% girls) healthy children were enrolled since age 6 months and 259 participants were followed-up until age 6 years. SMM was obtained at age 6, 12, 18, 24 months, 3 and 4 years. Behavioural concerns were assessed at age 4 years by the Child Behaviour Checklist and by both the Strengths and Difficulties Questionnaire with the Conners Kiddie Continuous Performance Test at age 6 years. Parenting style, cognitive ability, and baseline characteristics were also ascertained. Partial least squares path modelling was performed to determine both direct and indirect relationships among variables. Results showed that children who had been exposed to SMM for longer duration, specifically at age 18 months, showed more behavioural problems at age 4 and 6 years. Positive parenting during preschool and behavioural concerns at age 4 years were main mediators of those associations. Moreover, SMM in minutes at age 18 months was related to decreased preschool cognition. To minimise behavioural problems in school-age children, SMM should be avoided before 2 years of age so that positive parenting may be successfully implemented since early childhood.

Measurement of screen time among young children aged 0-6 years: A systematic review

The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.

Parents’ Perception on Mobile Phone Usage of Their Children and Knowledge on Its Hazards in Selected Hospital, Mangalore

Introduction Cell phones have achieved a milestone in modern technology where they have become handy to everyone. Advancement taken place in mobile phone technology has enabled its use in online purchasing as well as communication. On one hand, it is a helping tool for faster communication; on other hand, we cannot deny the fact of its harmful effects. The young teens are the age group who have been addicted to the mobiles. It is only the parents who can mould child’s behavior and personality. In this regard, parents can play an important role in enhancing the sense of responsibility in vigilant use of mobile at the early age.

Materials and Methods A quantitative descriptive research design was used in this study to collect data from 340 parents of 12 to 20 years age group who are visiting all the outpatient departments of selected Medical College Hospital, Mangaluru. Data was collected by administering demographic proforma, self-prepared perception checklist, and knowledge questionnaire on hazards of mobile phone usage.

Results Majority 230 (67.6%) parents had generally perceived that their children were spending too much of time on mobile phone and also 187(55%) parents perceived that children use mobile with earphones while traveling and 200(58.8%) parents perceived that their children have become lazy and lost interest in studies too. A total of 210 (61.8%) of parents had inadequate knowledge and 130 (38.2%) of them had adequate knowledge on hazards of mobile usage. There was association between knowledge on hazards of mobile phone usage and selected demographic variables as the p-value computed was found to be significant at 0.05 level of significance. There was no association found between knowledge and gender (0.052).

Conclusion As per the study findings, it was very clear that parents were observing some of the behavioral and emotional changes that were happening in their children. Hence, parents need to be educated and made aware of the possible hazards of mobile usage that may help them to tackle all the childhood issues and help in child’s overall development.

Parents' Perceptions of Educational Apps Use for Kindergarten Children: Development and Validation of a New Instrument (PEAU-p) and Exploration of Parents' Profiles

Contemporary mobile technologies offer tablets and smartphones that elicit young children's active participation in various educational apps, dramatically transforming playing, learning, and communication. Even the most knowledgeable users face difficulties in deciding about the value and appropriateness of the so-called educational apps because of many factors that should be considered. Their importance for children's attitudes is affected by the perceived positive and negative aspects, which vary across a multiplicity of criteria. Filling the gap in the relevant literature, a new instrument, named PEAU-p (Perceptions about Educational Apps Use-parents), was developed and validated in the present study designed to measure parents' perception of educational apps for kindergarten pupils. Data (N = 435) were collected via online procedures, and the psychometric properties of PEAU-p were studied via exploratory and confirmatory methods. Principal Components Analysis extracted six factors, namely Usability, Enjoyment, Involvement, Learning, Worries, and Values, which explained 72.42% of the total variance. Subsequently, by implementing Latent Class Analysis based on the above factors, four Clusters (i.e., parents' Profiles) were extracted corresponding to their perceptions and attitudes towards the educational apps used for kindergarten pupils. Those were named as 'mild attitude', 'negative attitude', 'positive attitude', and 'indifferent attitude'. This categorization, besides the statistical support, is fully interpretable, and the profiles were associated with certain covariates, such as age, the number of children, knowledge on new technologies, or distal outcomes, e.g., the frequency of using apps, the general position towards apps or their intention to recommend apps use. The findings are discussed within the current research field, investigating the influential role parents play in young children's media selection and use.

Parents' Attitudes Toward School Students' Overuse of Smartphones and Its Detrimental Health Impacts: Qualitative Study

BACKGROUND

Parents' awareness of the risks of the overuse of smartphones (SPs) among their children and parents' attitudes toward this societal phenomenon are crucial factors to consider when investigating the causes and effects of, as well as interventions to control, this public health issue.

OBJECTIVE

This study aimed to explore the awareness and attitudes of parents regarding SP overuse among their children and the detrimental impacts associated with it.

METHODS

The qualitative method of semistructured face-to-face interviews was used to collect data from fathers and mothers of children aged 6-18 years from all 6 educational/governorate regions in the governmental sector in Kuwait.

RESULTS

A total of 120 parents agreed to participate in the study; there were more female (75/120, 62.5%) than male (45/120, 37.5%) respondents. Almost all of the participants (118/120, 98.3%) were aware that the overuse of SPs could lead to their children becoming addicted to the devices; they were also aware that there could be side effects on their children's health (117/120, 97.5%). Although the participants, mostly the mothers, supervised their children's use of SPs closely (106/120, 88.3%), the majority could not control their children's length of time using SPs, as the children considered this a deprivation of their rights. Eye-related problems, headaches, and anger were the most common side effects experienced by the children.

CONCLUSIONS

Although the parents were aware of the detrimental impacts of SP overuse, the majority could not control the length of time their children spent using the devices. It was found that strong social bonds among family members play a large role in controlling the use of SPs. A number of solutions for families and the government to combat the overuse of SPs are suggested.

Screen Time for Preschool Children: Learning from Home during the COVID-19 Pandemic

Because of the COVID-19 pandemic, the Indonesian Government enacted a study at home policy for all students. This policy also applied to preschool children aged 2 to 6 years old. The purpose of the research was to examine the duration and impact of digital media use by preschool children in urban areas in Indonesia during weekdays and weekends. Data were collected using a validated questionnaire called the Surveillance of digital-Media hAbits in earLy chiLdhood Questionnaire (SMALLQ^®). A total of 951 parents or guardians (17-70 years old) who had preschool children volunteered to complete the questionnaire online. Preschool children have been using screen media since infancy, and the time they spend on-screen time is more than 1 hour per day. The digital media most used were mobile phones (91.6%), followed by television (86.1%) and computers (61%). The parents realized the impact and the importance of limiting time of screen media, but it difficult to prevent their children from using it, especially when learning from home. Hence, there is a need different approach to learning from home, especially to manage the duration of screen time for preschool children.

Smartphone Overuse and Visual Impairment in Children and Young Adults: Systematic Review and Meta-Analysis

BACKGROUND

Smartphone overuse has been cited as a potentially modifiable risk factor that can result in visual impairment. However, reported associations between smartphone overuse and visual impairment have been inconsistent.

OBJECTIVE

The aim of this systematic review was to determine the association between smartphone overuse and visual impairment, including myopia, blurred vision, and poor vision, in children and young adults.

METHODS

We conducted a systematic search in the Cochrane Library, PubMed, EMBASE, Web of Science Core Collection, and ScienceDirect databases since the beginning of the databases up to June 2020. Fourteen eligible studies (10 cross-sectional studies and 4 controlled trials) were identified, which included a total of 27,110 subjects with a mean age ranging from 9.5 to 26.0 years. We used a random-effects model for meta-analysis of the 10 cross-sectional studies (26,962 subjects) and a fixed-effects model for meta-analysis of the 4 controlled trials (148 subjects) to combine odds ratios (ORs) and effect sizes (ES). The I² statistic was used to assess heterogeneity.

RESULTS

A pooled OR of 1.05 (95% CI 0.98-1.13, P=.16) was obtained from the cross-sectional studies, suggesting that smartphone overuse is not significantly associated with myopia, poor vision, or blurred vision; however, these visual impairments together were more apparent in children (OR 1.06, 95% CI 0.99-1.14, P=.09) than in young adults (OR 0.91, 95% CI 0.57-1.46,P=.71). For the 4 controlled trials, the smartphone overuse groups showed worse visual function scores compared with the reduced-use groups. The pooled ES was 0.76 (95% CI 0.53-0.99), which was statistically significant (P<.001).

CONCLUSIONS

Longer smartphone use may increase the likelihood of ocular symptoms, including myopia, asthenopia, and ocular surface disease, especially in children. Thus, regulating use time and restricting the prolonged use of smartphones may prevent ocular and visual symptoms. Further research on the patterns of use, with longer follow up on the longitudinal associations, will help to inform detailed guidelines and recommendations for smartphone use in children and young adults.

Benefits and damages of the use of touchscreen devices for the development and behavior of children under 5 years old-a systematic review

AIM

Several health organizations have been expressing concern about the amount of time children spend using electronic devices and about the benefits and damages of the use of touchscreen devices, such as smartphones or tablets, for the development and behavior of children under the age of 5. A systematic review was carried out in order to understand the impact of touchscreen device usage toward children's development and behavior under the age of 5.

METHODS

Using the PRISMA method, from a total of 6314 studies found in online databases, searched in English, between 01/01/2000 and 01/10/2018, 11 studies were selected for analysis.

RESULTS

The results revealed that, in children under the age of 5, the damages of the use of touchscreen devices are superior to the benefits that may result, especially when there are more hours of screen time. More importance is given to the quality of the child-adult relationship and not to the use of touchscreen devices. Nevertheless, some studies emphasize some aspects that may reduce the negative effects, such as moderate use, less screen time, parental monitoring, and viewing educational programs in an academic environment.

CONCLUSIONS

Guidelines that should be given to parents about the use of touchscreen devices by children are discussed. The limitation of this study was the difficulty in finding studies directed to the desired age and type of electronic device. This may be taken as a potential cause of bias.

Parents' Beliefs About the Benefits and Detriments of Mobile Screen Technologies for Their Young Children's Learning: A Focus on Diverse Latine Mothers and Fathers

Young children’s use of mobile screens is increasing despite the American Academy of Pediatrics’ recommendations to limit screen use. Research on TV has found that maternal beliefs about the effects of screens on children’s learning and parental socioeconomic status influence children’s media consumption. However, few studies have explored parents’ beliefs about mobile screens and whether there are differences in beliefs by socioeconomic status, particularly within the largest ethnic minoritized group — Latines. Because Latines are a socioeconomically and linguistically heterogenous group, but are often represented by low-income mothers in research, it is important to understand whether there are socioeconomic and linguistic differences on how and why Latine mothers AND fathers permit their children to use mobile screens. This study used in-depth, semi-structured interviews to understand how and why Latine mothers (low-income = 10, middle-to-high income = 10) and fathers (low-income = 10, middle-to-high income = 10) permitted their children (0–4 years) to use mobile screens. Specifically, we discussed their beliefs about how mobile screens support and hinder their children’s learning and how their children used them. Results from qualitative content analysis showed that mothers and fathers, across income, education levels, and language use, believed that they, as parents, were the key decision-makers in determining the extent to which mobile screens supported and hindered their young children’s learning. They described mediation strategies of selecting appropriate content, setting time limits, and monitoring use, to ensure that their children primarily benefited from device use. However, two distinctions were noted. Parents with a high school diploma or beyond stressed the importance of co-using devices with their children. This was not mentioned by less formally educated parents. Additionally, low-income parents with diverse educational levels, mentioned the importance of continuously monitoring device use to avoid their children encountering inappropriate content. Findings can inform work seeking to promote optimal media habits among Latine families.

Exploring the Reliability and Validity of the TechU-Q to Evaluate Device and Purpose Specific Screen Use in Preschool Children and Parents

Young children are increasingly using mobile technology, with potential for positive and negative developmental consequences. Parents are responsible to guide children in their use of technology based on recommendations and guidelines. Guidelines for screen use in young children have been based on little empirical information on contemporary screen use. This study surveyed parents of young children (n = 96, mean child age 3.0, SD 1.0 years) from three settings (Australia, United States) to test the reliability and validity of a new tool to capture richer data on technology use within a techno-microsystem. The TechU-Q demonstrated reasonable test-retest reliability and face and construct validity. Young children averaged more than 60 min per day of total technology use, mostly using TV, tablet computers, and mobile phones. The primary purposes for child use were educational and watching videos. Parental attitudes towards technology and parent use were associated with their child's use. Future guidelines should utilize detailed descriptions of technology use by device and purpose to provide more relevant advice on technology use for young children.

Caregiver's Self-Confidence in Food Resource Management Is Associated with Lower Risk of Household Food Insecurity among SNAP-Ed-Eligible Head Start Families

Food resource management (FRM) behaviors are key components within nutrition education programs designed to help food insecure households maximize their food dollars. However, little is known about the association between FRM self-confidence and financial practices with household food insecurity (HFI) among families with young children. Using a sample of SNAP-Ed-eligible Head Start families, this study examined associations between FRM self-confidence, FRM behaviors and financial practices by HFI. A needs assessment survey was conducted with caregivers of Head Start children (n = 365). HFI was measured using the US Household Food Security Survey Module. Chi-square and logistic regression analyses were conducted to examine if FRM self-confidence, FRM behaviors, and financial practices differed by HFI. Participants with high FRM self-confidence had lower odds of HFI (OR = 0.54, 95%CI: 0.33, 0.87), yet FRM behaviors, financial practices, and HFI were not related after adjusting for covariates. All FRM self-confidence questions significantly differed by HFI, whereas only one of six FRM behaviors and two of three financial practices differed by HFI (all p-values < 0.05). Promoting caregivers' self-confidence in FRM skills within nutrition education programs may be explored as a potential strategy to assist low-income households to stretch their food dollars in an attempt to address HFI.

Food insecurity is associated with suboptimal sleep quality, but not sleep duration, among low-income Head Start children of pre-school age

OBJECTIVE

To examine the association between food insecurity and child sleep outcomes and to investigate whether parent psychosocial factors mediate such associations.

DESIGN

Cross-sectional study. Usual wake time and bedtime, bedtime routine and sleep quality were reported by parents using the adapted Brief Infant Sleep Questionnaire. Food insecurity was assessed using the eighteen-item US Department of Agriculture Household Food Security Module. Parent psychosocial factors, including perceived stress, parenting self-efficacy and depressive symptomology, were assessed using validated scales. Multivariable logistic regression models were performed to determine the association between food insecurity and sleep outcomes controlling for potential confounders. Mediation analyses and Sobel tests were applied to test the mediating effect of psychosocial factors.

SETTING

Head Start pre-school classrooms in four regions across central Pennsylvania, USA.

PARTICIPANTS

Low-income children of pre-school age (n 362) and their caregivers.

RESULTS

Prevalence of household, adult and child food insecurity was 37·3, 31·8 and 17·7 %, respectively. Food security status at any level was not associated with child sleep duration or bedtime routine. Child food insecurity, but not household or adult food insecurity, was associated with 2·25 times increased odds (95 % CI 1·11, 4·55) of poor child sleep quality in the adjusted model. Perceived stress, self-efficacy and depressive symptomology mediated less than 2 % of the observed effect (all Sobel test P > 0·6).

CONCLUSION

Food insecurity, particularly at the child level, is a potential modifiable risk factor for reducing sleep-related health disparities in early childhood. Future studies are needed to explore the plausible mechanisms underlying the associations between food insecurity and adverse child sleep outcomes.

Evaluation of a Custom-Developed Computer Game to Improve Executive Functioning in 4- to 6-Year-Old Children Exposed to Alcohol in Utero: Protocol for a Feasibility Randomized Controlled Trial

Background

Fetal alcohol spectrum disorder (FASD) is one of the most common causes of preventable intellectual disability, and the key associated deficits are in executive function (EF). Aspects of EF can be improved using cognitive training interventions. The highest prevalence of FASD globally (at a rate of 135.1 per 1000) has been found in a South African population in the Western Cape province. There is a shortage of specialized health service personnel, and there are limited remedial services. Computer-based cognitive training, if age and culturally appropriate, could be an effective way to provide the interventions with minimal need for skilled personnel and other resources. The Foundation for Alcohol Related Research has developed such a program for the South African context.

Objective

This protocol aimed to evaluate whether it is feasible to use computerized cognitive training in a resource-poor context to improve cognitive function in children exposed to alcohol in utero.

Methods

We are conducting a randomized controlled trial in the Saldanha Bay Municipal area, evaluating a custom-developed cognitive training program to improve the cognitive function of children aged between 4 and 6 years who were exposed to alcohol in the prenatal stage. Participants will be recruited from local Early Childhood Development centers. Community workers will interview biological mothers to identify alcohol-exposed pregnancies. Alcohol-exposed children will be randomized into an intervention or a control group of 40 participants each using block randomization. A group of 40 children not exposed to alcohol will be included in a normative group using individual randomization. The intervention group will play the game for 6 months (40 sessions). Normative and control groups will receive no intervention. Neurodevelopmental assessments will be done at baseline and upon completion of the study with all participants.

Results

The intervention has started, and all baseline assessments have been done at the time of submission.

Conclusions

This study will provide insight into whether computerized cognitive training is viable and effective in the South African context. It has the potential to provide a means of intervention globally and in other resource-poor context and expand the knowledge base regarding executive functioning and FASD. This paper presents the research protocol and intervention design of the study.

Trial Registration

ISRCTN Registry ISRCTN17244156; http://www.isrctn.com/ISRCTN17244156.

International Registered Report Identifier (IRRID)

DERR1-10.2196/14489

Beyond Nutrient Intake: Use of Digital Food Photography Methodology to Examine Family Dinnertime

OBJECTIVE

To explore the feasibility of using an image-based food photography methodology (Remote Food Photography Method) in a rural, low-resource audience and use the photos to examine the context of family dinner.

DESIGN

Parents used the SmartIntake app on study-issued tablets to take before and after photos of their and their child's dinner for about 7 nights and participated in a mini-focus group to discuss their experience with the Remote Food Photography Method.

SETTING

Six Head Start/preschool centers in rural Colorado.

PARTICIPANTS

Mother-child dyads (n = 31).

VARIABLES MEASURED

Number and quality of photos received, participant feedback, meal timing, concordance, location, preparation, and quality.

ANALYSIS

The researchers assessed feasibility via practicality (percent photos received) and acceptability (general inductive approach used to analyze mini-focus group transcripts for participant feedback); time stamps, meal quality, and food preparation scales were used to analyze dinner photos.

RESULTS

The majority of photographs (738 of 864) were received. Participants reacted favorably to the methodology; for some, it led to greater self-reflection about mealtime. Mother-child dyads usually ate dinner at the same time and often ate the same food. Children were frequently served protein and refined grains and were rarely served whole grains or fruit. Many families relied on convenience foods.

CONCLUSIONS AND IMPLICATIONS

Digital food photography was feasible in this audience. Photos yielded a holistic picture of family dinnertime: meal timing, location, concordance in parent-child meals, level of preparation, and meal quality.

Mobile Device Use Among Rural, Low-Income Families and the Feasibility of an App to Encourage Preschoolers' Physical Activity: Qualitative Study

BACKGROUND

As mobile devices are becoming ubiquitous, technology-based interventions provide a promising strategy to positively influence health behaviors of families with young children. However, questions remain about the feasibility and acceptability of intervention delivery via mobile apps in low-income, rural settings and among families with preschoolers.

OBJECTIVE

The aims of this study were to understand the content and context of mobile device use for preschoolers; explore parent beliefs on this topic, including the acceptability of intervention delivery via mobile devices; and test a prototype of an app to encourage preschoolers' physical activity with both parents and children.

METHODS

Parents (n=29) were recruited from 5 preschool centers in eastern, rural Colorado to complete a semistructured telephone interview regarding preschoolers' mobile device use. A second sample of parents (n=31) was recruited from the same preschool centers to view the app prototype independently and provide feedback. A third sample of preschool children (n=24) was videotaped using the app in small groups to measure engagement and record their responses to the app.

RESULTS

Five key content areas emerged from the telephone interviews: (1) mobile devices are an important part of families' everyday routines, and parents have parameters governing their use; (2) parents often use mobile devices as a tool for behavior management; (3) parents clearly distinguish between mobile device use for learning versus entertainment; (4) parents have an overarching desire for balance in regard to their child's mobile device use; and (5) parents were generally supportive of the idea of using mobile apps for intervention delivery. From the app prototype testing with parents, participants reacted positively to the app and felt that it would be useful in a variety of situations. Testing with preschoolers showed the children were highly engaged with the app and a majority remained standing and/or actively moving through the entire length of the app.

CONCLUSIONS

Mobile devices are already integrated into most families' daily routines and appear to be an acceptable method of intervention delivery in low-income families in rural Colorado. The physical activity app represents an innovative way to reach these families and, with further improvements based on participant feedback, will provide children with a unique opportunity to practice key movement skills.