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McArthur BA, Volkova V, Tomopoulos S, Madigan S. Global Prevalence of Meeting Screen Time Guidelines Among Children 5 Years and Younger: A Systematic Review and Meta-analysis. JAMA Pediatr 2022; 176:373-383. [PMID: 35157028 PMCID: PMC8845032 DOI: 10.1001/jamapediatrics.2021.6386] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Pediatric guidelines suggest that infants younger than 2 years avoid screen time altogether, while children aged 2 to 5 years receive no more than 1 hour per day. Although these guidelines have been adopted around the world, substantial variability exists in adherence to the guidelines, and precise estimates are needed to inform public health and policy initiatives. OBJECTIVE To derive the pooled prevalence via meta-analytic methods of children younger than 2 years and children aged 2 to 5 years who are meeting guidelines about screen time. DATA SOURCES Searches were conducted in MEDLINE, PsycINFO, and Embase up to March 2020. STUDY SELECTION Studies were included if participants were 5 years and younger and the prevalence of meeting (or exceeding) screen time guidelines was reported. DATA EXTRACTION AND SYNTHESIS Data extraction followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Two independent reviewers extracted all relevant data. Random-effects meta-analyses were used to derive the mean prevalence rates. MAIN OUTCOMES AND MEASURES Prevalence of meeting screen time guidelines. RESULTS From 63 studies, 95 nonoverlapping samples with a total of 89 163 participants were included. For children younger than 2 years, the pooled prevalence of meeting the screen time guideline (0 h/d) was 24.7% (95% CI, 19.0%-31.5%). Moderator analyses revealed that prevalence of meeting screen time guidelines varied as a function of year of data collection (increased over time), measurement method (higher when questionnaires compared with interview), and type of device use (higher when a combination of screen use activities compared with television/movies only). For children aged 2 to 5 years, the mean prevalence of meeting the screen time guideline (1 h/d) was 35.6% (95% CI, 30.6%-40.9%). Moderator analyses revealed that the prevalence of meeting screen time guidelines varied as a function of type of device use (higher when screen time was television/movies only compared with a combination of screen use activities). CONCLUSIONS AND RELEVANCE The findings of this meta-analysis indicate that only a minority of children 5 years and younger are meeting screen time guidelines. This highlights the need to provide support and resources to families to best fit evidence-based recommendations into their lives.
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Affiliation(s)
- Brae Anne McArthur
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada,Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
| | - Valeriya Volkova
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Suzy Tomopoulos
- Department of Pediatrics, New York University School of Medicine–Bellevue Hospital Center, New York
| | - Sheri Madigan
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada,Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
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Byrne R, Terranova CO, Trost SG. Measurement of screen time among young children aged 0-6 years: A systematic review. Obes Rev 2021; 22:e13260. [PMID: 33960616 PMCID: PMC8365769 DOI: 10.1111/obr.13260] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 12/16/2022]
Abstract
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.
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Affiliation(s)
- Rebecca Byrne
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
| | - Caroline O. Terranova
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
| | - Stewart G. Trost
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
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McKay FH, Haines BC, Dunn M. Measuring and Understanding Food Insecurity in Australia: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030476. [PMID: 30736305 PMCID: PMC6388276 DOI: 10.3390/ijerph16030476] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 01/29/2023]
Abstract
The number of Australians seeking food aid has increased in recent years; however, the current variability in the measurement of food insecurity means that the prevalence and severity of food insecurity in Australia is likely underreported. This is compounded by infrequent national health surveys that measure food insecurity, resulting in outdated population-level food insecurity data. This review sought to investigate the breadth of food insecurity research conducted in Australia to evaluate how this construct is being measured. A systematic review was conducted to collate the available Australian research. Fifty-seven publications were reviewed. Twenty-two used a single-item measure to examine food security status; 11 used the United States Department of Agriculture (USDA) Household Food Security Survey Module (HFSSM); two used the Radimer/Cornell instrument; one used the Household Food and Nutrition Security Survey (HFNSS); while the remainder used a less rigorous or unidentified method. A wide range in prevalence and severity of food insecurity in the community was reported; food insecurity ranged from 2% to 90%, depending on the measurement tool and population under investigation. Based on the findings of this review, the authors suggest that there needs to be greater consistency in measuring food insecurity, and that work is needed to create a measure of food insecurity tailored for the Australian context. Such a tool will allow researchers to gain a clear understanding of the prevalence of food insecurity in Australia to create better policy and practice responses.
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Affiliation(s)
| | - Bronte C Haines
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Waterfront campus, Geelong, Victoria 3220, Australia.
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Myers J, Riggs E, Lee JL, Gibbons K, Naughton G. Confident and Understanding Parents (CUPs) - a child nutrition and active play pilot intervention for disadvantaged families attending Supported Playgroups in Victoria, Australia. Health Promot J Austr 2019; 30 Suppl 1:43-51. [PMID: 30623503 DOI: 10.1002/hpja.229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/02/2019] [Indexed: 01/18/2023] Open
Abstract
ISSUE ADDRESSED Health and nutrition inequalities are prevalent among families from socio-economically disadvantaged backgrounds. However, there is limited evidence of targeted early childhood nutrition and active play approaches due to the methodological challenges in engaging vulnerable families in research. METHODS The aim of this paper was to report findings from a pilot intervention called Confident and Understanding Parents (CUPs). CUPs aims to improve child nutrition and active play-related outcomes for children in vulnerable families. The intervention was delivered in six Supported Playgroups (SPs) in two disadvantaged locations in Victoria. Surveys incorporated knowledge and confidence measures and were administered pre- and post-training of SP facilitators along with pre-, immediately post and and 3 months postintervention to SP facilitators and parents. Qualitative data were collected via debriefing discussions with SP facilitators and ethnographic observations during SP sessions. Thematic analyses of qualitative data and statistical quantitative analyses were conducted. RESULTS Nine SP facilitators completed training, of whom six delivered CUPs in SPs with 64 parents of children aged 0 to 4 years from socially disadvantaged backgrounds. Forty-three parents (66%) attended a minimum of 50% of SP sessions with CUPs delivery. SP facilitators and parents demonstrated improved knowledge and confidence following the pilot. Learnings for implementation were identified. CONCLUSION Overall, the CUPs intervention reached and engaged vulnerable families. A strength of the intervention is the flexibility offered to SP facilitators in selecting key messages and the strong focus on "local" translation of key child nutrition and active play messages within existing early childhood settings. A further strength was the adaptation of evaluation methodology to optimise the engagement of vulnerable families. SO WHAT?: This pilot study provides insights about engaging vulnerable families in a nutrition and active play intervention to promote child health. These promising findings warrant further implementation and rigorous evaluation of CUPs.
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Affiliation(s)
- Judith Myers
- Murdoch Children's Research Institute, Policy and Equity Research Group, Parkville, Vic., Australia.,College of Health and Biomedicine, Victoria University, St Albans, Vic., Australia
| | - Elisha Riggs
- Murdoch Children's Research Institute, Intergenerational Health Research Group, Melbourne, Vic., Australia.,Department of General Practice, University of Melbourne, Melbourne, Vic., Australia
| | - Ju-Lin Lee
- Murdoch Children's Research Institute, Policy and Equity Research Group, Parkville, Vic., Australia
| | - Kay Gibbons
- Murdoch Children's Research Institute, Policy and Equity Research Group, Parkville, Vic., Australia.,College of Health and Biomedicine, Victoria University, St Albans, Vic., Australia.,Australian Catholic University, Fitzroy, Vic., Australia
| | - Geraldine Naughton
- Murdoch Children's Research Institute, Policy and Equity Research Group, Parkville, Vic., Australia.,Australian Catholic University, Fitzroy, Vic., Australia
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Laws R, Walsh AD, Hesketh KD, Downing KL, Kuswara K, Campbell KJ. Differences Between Mothers and Fathers of Young Children in Their Use of the Internet to Support Healthy Family Lifestyle Behaviors: Cross-Sectional Study. J Med Internet Res 2019; 21:e11454. [PMID: 30674450 PMCID: PMC6364206 DOI: 10.2196/11454] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 01/16/2023] Open
Abstract
Background In early life, both mothers and fathers are important influences on their children’s diet, active play, and obesity risk. Parents are increasingly relying on the internet and social media as a source of information on all aspects of parenting. However, little is known about the use of Web-based sources of information relevant to family lifestyle behaviors and, in particular, differences between mothers’ and fathers’ use and sociodemographic predictors. Objective The objective of this study was to examine if mothers and fathers differ in their use of the internet for information on their own health and their child’s health, feeding, and playing and to examine sociodemographic predictors of the use of the internet for information on these topics. Methods We conducted a secondary analysis on data collected from mothers (n=297) and fathers (n=207) participating in the extended Infant Feeding, Activity and Nutrition Trial (InFANT Extend) when their children were 36 months of age. The main outcome variables were the use of the internet for information gathering for parents’ own health and child health, feeding, and playing. Binary logistic regression was used to examine the sociodemographic predictors of outcomes. Results Compared with fathers (n=296), a higher proportion of mothers (n=198) used the internet for information on their own health (230, 78.5% vs 93, 46.5%), child health (226, 77.1% vs 84, 42.4%), child feeding (136, 46.3% vs 35, 17.5%), and child play (123, 42.1% vs 28, 14.0%) and intended to use Facebook to connect with other parents (200, 74.9% vs 43, 30.5%). Despite the high use of the internet to support family health behaviors, only 15.9% (47/296) of mothers reported consulting health practitioners for advice and help for their own or their child’s weight, diet, or physical activity. Sociodemographic predictors of internet use differed between mothers and fathers and explained only a small proportion of the variance in internet use to support healthy family lifestyle behaviors. Conclusions Our findings support the use of the internet and Facebook as an important potential avenue for reaching mothers with information relevant to their own health, child health, child diet, and active play. However, further research is required to understand the best avenues for engaging fathers with information on healthy family lifestyle behaviors to support this important role in their child’s life. Trial Registration ISRCTN Registry ISRCTN81847050; http://www.isrctn.com/ISRCTN81847050
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Affiliation(s)
- Rachel Laws
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.,Centre for Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia
| | - Adam D Walsh
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Kylie D Hesketh
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.,Centre for Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia
| | - Katherine L Downing
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Konsita Kuswara
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.,Centre for Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia
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Factors Influencing Parental Engagement in an Early Childhood Obesity Prevention Program Implemented at Scale: The Infant Program. Nutrients 2018; 10:nu10040509. [PMID: 29671815 PMCID: PMC5946294 DOI: 10.3390/nu10040509] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 04/12/2018] [Accepted: 04/16/2018] [Indexed: 02/07/2023] Open
Abstract
The ‘early years’ is a crucial period for the prevention of childhood obesity. Health services are well placed to deliver preventive programs to families, however, they usually rely on voluntary attendance, which is challenging given low parental engagement. This study explored factors influencing engagement in the Infant Program: a group-based obesity prevention program facilitated by maternal and child health nurses within first-time parent groups. Six 1.5 h sessions were delivered at three-month intervals when the infants were 3–18 months. A multi-site qualitative exploratory approach was used, and program service providers and parents were interviewed. Numerous interrelated factors were identified, linked to two themes: the transition to parenthood, and program processes. Personal factors enabling engagement included parents’ heightened need for knowledge, affirmation and social connections. Adjusting to the baby’s routine and increased parental self-efficacy were associated with diminished engagement. Organisational factors that challenged embedding program delivery into routine practice included aspects of program promotion, referral and scheduling and workforce resources. Program factors encompassed program content, format, resources and facilitators, with the program being described as meeting parental expectations, although some messages were perceived as difficult to implement. The study findings provide insight into potential strategies to address modifiable barriers to parental engagement in early-year interventions.
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Stanhope KK, Kay C, Stevenson B, Gazmararian JA. Measurement of obesity prevention in childcare settings: A systematic review of current instruments. Obes Res Clin Pract 2016; 11:52-89. [PMID: 27377860 DOI: 10.1016/j.orcp.2016.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/26/2016] [Accepted: 06/11/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The incidence of childhood obesity is highest among children entering kindergarten. Overweight and obesity in early childhood track through adulthood. Programs increasingly target children in early life for obesity prevention. However, the published literature lacks a review on tools available for measuring behaviour and environmental level change in child care. The objective is to describe measurement tools currently in use in evaluating obesity-prevention in preschool-aged children. METHODS Literature searches were conducted in PubMed using the keywords "early childhood obesity," "early childhood measurement," "early childhood nutrition" and "early childhood physical activity." Inclusion criteria included a discussion of: (1) obesity prevention, risk assessment or treatment in children ages 1-5 years; and (2) measurement of nutrition or physical activity. RESULTS One hundred thirty-four publications were selected for analysis. Data on measurement tools, population and outcomes were abstracted into tables. Tables are divided by individual and environmental level measures and further divided into physical activity, diet and physical health outcomes. Recommendations are made for weighing advantages and disadvantages of tools. CONCLUSION Despite rising numbers of interventions targeting obesity-prevention and treatment in preschool-aged children, there is no consensus for which tools represent a gold standard or threshold of accuracy.
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Affiliation(s)
- Kaitlyn K Stanhope
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
| | - Christi Kay
- HealthMPowers, 3200 Pointe Pkwy NW # 400, Norcross, GA 30092, United States
| | - Beth Stevenson
- HealthMPowers, 3200 Pointe Pkwy NW # 400, Norcross, GA 30092, United States
| | - Julie A Gazmararian
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Burnham L, Matlak S, Makrigiorgos G, Braun N, Knapp BP, Merewood A. Breastfeeding and coffee consumption in children younger than 2 years in Boston, Massachusetts, USA. J Hum Lact 2015; 31:267-72. [PMID: 25678326 DOI: 10.1177/0890334415570971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 01/13/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although introduction of inappropriate foods and liquids in early childhood and their association with breastfeeding is commonly reported in US children, coffee use in very young US children and its association with breastfeeding is not. OBJECTIVES This study aimed to determine the proportion of 1- and 2-year-olds in an urban population consuming coffee, their rate of consumption, and predictors of consumption, including breastfeeding status. METHODS We used data from a prospective cohort study on infant weight gain and diet, and body mass index at age 2. We used bivariate analyses to examine variables associated with coffee consumption at 1 and 2 years and multivariate logistic regression to control for variables of interest. RESULTS This study included 315 mother-infant dyads. At 1 year, the rate of coffee consumption reported was 2.5%; at 2 years, it was 15.2% and average daily consumption was 1.09 oz (range, 0.01- 4.00 oz). The only characteristic associated with coffee consumption at 1 year was breastfeeding at 1 year (P = .0275), which did not remain significant after controlling for confounding variables. Variables significantly associated with coffee consumption at year 2 were lower maternal education (P = .0016), non-US maternal place of birth (P = .0015), maternal Hispanic ethnicity (P < .0001), infant female sex (P = .0495), and receiving any breast milk at 1 year of age (P = .0189). After multivariate logistic regression, maternal Hispanic ethnicity (P = .0139) and infant female sex (P = .0371) remained significant. CONCLUSION Coffee consumption is not uncommon among toddlers in Boston, Massachusetts, USA. After controlling for possible confounding factors, maternal ethnicity and infant sex were significantly associated with this practice.
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Affiliation(s)
| | | | | | | | | | - Anne Merewood
- Boston University School of Medicine, Boston, MA, USA
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