Determinants of Excessive Screen Time among Children under Five Years Old in Selangor, Malaysia: A Cross-Sectional Study

Children's Attraction to Physical Activity and Its Relation to Physical Activity Level

Background

Understanding of psychosocial factors of physical activity (PA) in children is crucial in encouraging sustained PA, which in turn is associated with important health outcomes. This study aimed to examine how children's attraction to physical activity (CAPA) is associated with PA.

Methods

This cross-sectional study was conducted among 219 primary school children (105 boys; 114 girls) aged 7 years old-10 years old in Kuala Lumpur, Malaysia in 2016-2017. Children from three main ethnicities, namely Malay, Chinese and Indian, were recruited. Weight, height and waist circumference were measured; body composition was assessed by deuterium dilution technique. CAPA and level of PA were obtained through self-administered questionnaires and reported as CAPA and PA scores.

Results

Median CAPA and PA scores were 3.40 (Q1 = 3.00, Q3 = 3.80) and 2.31 (Q1 = 1.95, Q3 = 2.74), respectively. Significant gender differences were found in CAPA and PA scores, with boys being more attracted to PA (3.16 [Q1 = 2.90, Q3 = 3.44]; P = 0.001) and more physically active compared with girls (2.47 [Q1 = 2.07, Q3 = 3.07]; P = 0.001). CAPA and PA scores correlated positively in both sexes. Boys scored higher than girls in 'liking of games and sports' (ρ = 0.301, P = 0.002) and 'liking of vigorous PA' (ρ = 0.227, P = 0.02) CAPA subscales, which also correlated positively with PA scores. Girls' PA scores correlated with 'peer acceptance in games and sports' (ρ = 0.329, P < 0.001).

Conclusion

Boys are more physically active and have higher attraction to PA compared with girls. Differences in PA scores between the sexes were related to gender differences in CAPA scores. Thus, attention should be given to gender differences in CAPA related psychosocial factors when planning interventions to promote PA among children.

A Scoping Review of Digital Well-Being in Early Childhood: Definitions, Measurements, Contributors, and Interventions

Digital well-being concerns the balanced and healthy use of digital technology, and the existing studies in this area have focused on adolescents and adults. However, young children are more vulnerable to digital overuse and addiction than adults; thus, their digital well-being deserves empirical exploration. In this scoping review, we synthesized and evaluated 35 collected studies on young children's digital use and their associated well-being that were published up to October of 2022 to understand the related definitions, measurements, contributors, and interventions. The synthesis of the evidence revealed that (1) there was no consensus about the definition of the concept of digital well-being; (2) there were no effective ways of measuring young children's digital well-being; (3) both child factors (the duration and place of digital use, as well as the child's demographic characteristics) and parent factors (digital use, parental perception, and mediation) contribute to young children's well-being; and (4) there were some effective applications and digital interventions reported in the reviewed studies. This review contributes to the development of this concept by mapping the existing research on young children's digital well-being, as well as proposing a model and identifying the research gaps for future studies.

ABCs or Attack-Boom-Crash? A longitudinal analysis of associations between media content and the development of problematic media use in early childhood

Researchers have begun to extensively examine pathological (or addictive-like) media use during adolescence and adulthood. However, few studies have examined precursors to these types of behavior (termed problematic media use) in early childhood, with even fewer examining predictors of this behavior over time. The current longitudinal study examined bi-directional associations between television content (educational, prosocial, and violence) and problematic media use over a 1-year period during early childhood. Participants included 443 children (M age at Wave 1 = 29.68 months) and their parents. Results revealed that early educational media was protective against developing problematic media use over time. However, early problematic media use was not predictive of future media content choices longitudinally. Additionally, problematic media use was moderately stable over time. Implications for parents and policy makers regarding the importance of early media content for later outcomes and consideration of media use trajectories are discussed.

‘Stop & Play’ digital health education intervention in reducing excessive screen time among preschoolers from low socioeconomic families in Malaysia: A Cluster Randomized Control Trial (Preprint)

BACKGROUND

High prevalence of excessive screen time among preschool children is attributable to certain parental factors such as lack of knowledge, false perception about screen time, and inadequate skills. Lack of strategies to implement screen time guidelines, in addition to multiple commitments that may hinder parents from face-to-face interventions, demands the need to develop a technology-based parent-friendly screen time reduction intervention.

OBJECTIVE

This study aims to develop, implement, and evaluate the effectiveness of Stop and Play, a digital parental health education intervention to reduce excessive screen time among preschoolers from low socioeconomic families in Malaysia.

METHODS

A single-blind, 2-arm cluster randomized controlled trial was conducted among 360 mother-child dyads attending government preschools in the Petaling district, who were randomly allocated into the intervention and waitlist control groups between March 2021 and December 2021. This 4-week intervention, developed using whiteboard animation videos, infographics, and a problem-solving session, was delivered via WhatsApp (WhatsApp Inc). Primary outcome was the child's screen time, whereas secondary outcomes included mother's screen time knowledge, perception about the influence of screen time on the child's well-being, self-efficacy to reduce the child's screen time and increase physical activity, mother's screen time, and presence of screen device in the child's bedroom. Validated self-administered questionnaires were administered at baseline, immediately after the intervention, and 3 months after the intervention. The intervention's effectiveness was evaluated using generalized linear mixed models.

RESULTS

A total of 352 dyads completed the study, giving an attrition rate of 2.2% (8/360). At 3 months after the intervention, the intervention group showed significantly reduced child's screen time compared with the control group (β=-202.29, 95% CI -224.48 to -180.10; P<.001). Parental outcome scores also improved in the intervention group as compared with that in the control group. Mother's knowledge significantly increased (β=6.88, 95% CI 6.11-7.65; P<.001), whereas perception about the influence of screen time on the child's well-being reduced (β=-.86, 95% CI -0.98 to -0.73; P<.001). There was also an increase in the mother's self-efficacy to reduce screen time (β=1.59, 95% CI 1.48-1.70; P<.001) and increase physical activity (β=.07, 95% CI 0.06-0.09; P<.001), along with reduction in mother's screen time (β=-70.43, 95% CI -91.51 to -49.35; P<.001).

CONCLUSIONS

The Stop and Play intervention was effective in reducing screen time among preschool children from low socioeconomic families, while improving the associated parental factors. Therefore, integration into primary health care and preschool education programs is recommended. Mediation analysis is suggested to investigate the extent to which secondary outcomes are attributable to the child's screen time, and long follow-up could evaluate the sustainability of this digital intervention.

TRIAL REGISTRATION

Thai Clinical Trial Registry (TCTR) TCTR20201010002; https://tinyurl.com/5frpma4b.

Influence of Family Environment on the Scientific Fitness Literacy of Preschool and School Children in China: A National Cross-Sectional Study

Scientific fitness literacy (SFL) is a holistic concept based on physical literacy but has a smaller scope and is more specific to exercise and scientific fitness. We developed an instrument to assess SFL and explored the differences and similarities in the effects of the home environment on children’s SFL. Data from a nationwide stratified random sample of children were analyzed using multiple linear regression. SFL scores were significantly lower for preschoolers than for school-age children. The family environment has an impact throughout the preschool and school years, with school-age children’s SFL being less influenced by family members than preschool children; screen time has a negative impact on their SFL but reducing the number of electronic devices and increasing parental physical activity and modeling can alleviate its impact. The economic status of the family is crucial, with sports consumption expenditure and household sports equipment ownership being favourable factors for children’s SFL. Positive parental attitudes and sporting habits have a positive impact on their children’s SFL. The findings of this study can be used to improve children’s SFL in the home environment and to take effective measures to avoid the risk factors.