Abstract
This study examines the prevalence of Canadian children ages 2 and 3 years meeting vs exceeding screen time guidelines and the strongest individual and family-level factors associated with failing to meet these guidelines.
Global debates among researchers, clinicians, policy makers, and parents on the benefits vs consequences of children’s screen time exposure are ubiquitous. Research suggests that excessive screen time is likely consequential for early child development and health.1,2 Accordingly, the World Health Organization and various pediatric societies have issued guidelines on screen time, suggesting that preschoolers receive no more than 1 hour of high-quality programming daily.3 To inform policy and educational initiatives, the objectives of this study were 2-fold: (1) determine the prevalence of children ages 2 and 3 years meeting vs exceeding screen time guidelines and (2) determine the strongest individual and family-level factors associated with failing to meet these guidelines.
Methods
Longitudinal data from the All Our Families study were used and collected from 2011 to 2014. Sample characteristics can be found in Table 1 and elsewhere.1 This study was approved by the University of Calgary Conjoint Health research ethics board. Written informed consent was obtained. Consistent with previous research, we tested the most commonly examined factors associated with screen time usage in young children, including number of children in the home, the year of data collection, child sex, single vs dual parent household, family income, child sleep and physical activity, childcare arrangements, and maternal screen time use. See Table 1 for the variable operationalization.
Table 1. Factors Associated With Meeting vs Exceeding Preschooler Screen Time Guidelines.
| Characteristic | No. (%) |
|---|---|
| No. of children in home, mean (SD) | |
| Age 2 y | 1.60 (.69) |
| Age 3 y | 2.01 (.79) |
| Year of data collection,a mean (SD) | |
| Age 2 y | 2.28 (.62) |
| Age 3 y | 2.93 (.77) |
| Child sex | |
| Girls | 768 (48.2) |
| Boys | 826 (51.8) |
| Single-parent household | 99 (5.0) |
| Family income, CAD $b | |
| <39 999 | 87 (6.7) |
| 40 000-79 999 | 321 (24.63) |
| 80 000-124 999 | 474 (36.38) |
| >125 000 | 421 (32.31) |
| Child sleepc | |
| Age 2 y (trouble sleeping) | 446 (27.96) |
| Child meets physical activity guidelinesd | |
| Age 2 y (>3 h per d) | 1067 (66.9) |
| Age 3 y (>3 h per d) | 679 (55.5) |
| Childcaree | |
| Age 2 y | 575 (36.1) |
| Age 3 y | 698 (35.0) |
| Maternal high screen viewingf | |
| Age 2 y (h per wk) | 184 (11.5) |
| Age 3 y (h per wk) | 209 (10.5) |
| Child exceeds screen time guidelinesg | |
| Age 2 y | 1266 (79.4) |
| Age 3 y | 1889 (94.7) |
To control for a potential time trend on account of the rapid rise in technology over the course of data collection, the year in which the family completed the questionnaires was dummy coded as 1 = 2011, 2 = 2012, 3 = 2013, and 4 = 2014.
To convert to USD $: 39 999 to 30 799; 40 000 to 30 800; 79 999 to 61 599; 80 000 to 61 600; 124 999 to 96 249; and 125 000 to 96 250.
At age 2 years, child sleep was measured using a question from the Brief Infant-Toddler Social and Emotional Assessment about whether the child had trouble falling or staying asleep in the last month (1 = not true/rarely, 2 = somewhat true/sometimes, 3 = very true/often).
Maternal reports of the number of hours the child engaged in physical activity (eg, playing, walking, running, jumping, climbing, or dancing) on weekdays were obtained. Children were categorized as 0 equals not meeting 3 hours per day of physical activity or 1 equals meeting guidelines of 3 hours or more of physical activity per day based on World Health Organization guidelines.3
Maternal reports of whether the child attended nonparental day care or childcare (0 = childcare/day care, 1 = care by mother, relative, or nanny).
Mothers self-reported on how their screen time exposure (ie, watching television) on a typical weekday and a weekly score was calculated. Mothers were dichotomized using a median split, which was either fewer than 14 hours per week or more than 14 hours per week.
Maternal reports of screen time were defined as time spent using particular electronic media (eg, computer, gaming systems, or devices) on a typical weekday and weekend day. A weighted weekly average was computed and children were classified as meeting (≤7 hours per week) vs not meeting (<7 hours) pediatric guidelines.
Descriptive analyses as to meeting vs exceeding guidelines were conducted using SPSS, version 25 (IBM). At ages 2 and 3 years, 1595 and 1994 children were available for analyses, respectively. To examine factors associated with exceeding screen time guidelines, logistic regressions were performed in MPlus, version 8.0 using full information maximum likelihood. Odds ratios (ORs) and 95% confidence intervals are presented. Statistical significance was set at P < .05.
Results
Most children did not meet screen time guidelines at ages 2 years (1266 [79.4%]) or 3 years (1889 [94.7%]). As detailed in Table 2, at age 2 years, factors that were significantly associated with exceeding the screen time guidelines were maternal screen time (OR, 2.75; 95% CI, 1.64-4.61), being cared for at home vs in day care (OR, 1.67; 95% CI, 1.30-2.19), and the year of data collection (OR, 1.33; 95% CI, 1.09-1.62). At age 3 years, only maternal screen time was significant (OR, 3.02; 95% CI, 1.10-8.27).
Table 2. Factors Associated With Exceeding Preschooler Screen Time Guidelinesa.
| Characteristic | Odds Ratio (95% CI) |
|---|---|
| Age 2 y, No. | 1595 |
| No. of children in home | 1.15 (0.93-1.42) |
| Year recruited | 1.33 (1.09-1.62) |
| Child sex | 0.97 (0.76-1.25) |
| Single-parent household family | 1.47 (0.75-2.88) |
| Income | .99 (0.94-1.04) |
| Sleep | 1.12 (0.90-1.41) |
| Physical activity | 1.14 (0.88-1.47) |
| Childcare | 1.69 (1.30-2.19) |
| Maternal screen viewing | 2.75 (1.64-4.61) |
| Age 3 y, No. | 1994 |
| No. of children in home | 1.13 (0.87-1.48) |
| Year recruited | 0.99 (0.75-1.30) |
| Child sex | 1.06 (0.71-1.60) |
| Single-parent household family | 1.53 (0.46-5.10) |
| Income | 0.95 (0.86-1.04) |
| Sleepb | 1.24 (0.79-1.93) |
| Physical activity | 1.08 (0.64-1.80) |
| Childcare | 0.89 (0.57-1.40) |
| Maternal screen viewing | 3.02 (1.10-8.27) |
For some pediatric societies, recommended guidelines prior to 2016 were no more than 2 hours per day (as opposed to 1 hour per day) for children aged 2 to 5 years. Analyses were run predicting those who met vs did not meet screen time guidelines based on a cutoff of 2 hours per day, and the patterning of findings were similar.
Child sleep at 2 years was used as a proxy as this was not collected at 3 years.
Conclusions
Study findings indicate that most preschoolers are not meeting screen time guidelines.3 The outcome most consistently associated with exceeding guidelines was maternal screen time use, which remained significant after accounting for all other factors at both ages. At age 2 years, additional factors were the year of data collection, likely because of the rapid rise and accessibility of digital platforms, and, consistent with previous research, being cared for at home (vs day care) where screens may be more accessible. Fewer associations at age 3 vs 2 years could be attributed to the small number of preschoolers meeting the guidelines at age 3 years (105 [5%]).
Findings from the current study have significant implications for health initiatives and educational campaigns aiming to reduce screen time exposure in preschool-aged children. To do so effectively, it will be important to consider the family media ecology.4 In high screen-viewing families, it may be difficult for parents to implement screen time guidelines without a supportive approach. Accordingly, it will be important to work together with families to devise family media plans that can be effectively implemented.5 This includes promoting opportunities for joint media engagement; deciding when, where, and how often screens are used; and reinforcing the need for sleep, physical activity, and device-free interactions to be prioritized to optimize child development. It is also incumbent on those in policy and practice to continue to advocate for increased transparency and regulations in media platforms and designs.6 The limitations of this study include the use of maternal self-report and the lack of information on how screen time was used (eg, solitary or coviewed). Initiatives to track screen time using diary methods could be adopted in future research to address these limitations.
References
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