Parental Screen Time Research Articles

Family conflict and less parental monitoring were associated with greater screen time in early adolescence.

The current study investigated the prospective relationships between parental monitoring, family conflict, and screen time across six screen time modalities in early adolescents in the USA. We utilised prospective cohort data of children (ages 10-14 years) from the Adolescent Brain Cognitive Development (ABCD) Study (years baseline to Year 2 of follow-up; 2016-2020; N = 10 757). Adjusted coefficients (B) and 95% confidence intervals (CIs) were estimated using mixed-effect models with robust standard errors. A higher parental monitoring score was associated with less total screen time (B = -0.37, 95% CI -0.58, -0.16), with the strongest associations being with video games and YouTube videos. Conversely, a higher family conflict score was associated with more total screen time (B = 0.08, 95% CI 0.03, 0.12), with the strongest associations being with YouTube videos, video games, and watching television shows/movies in Years 1 and 2. The current study found that greater parental monitoring was associated with less screen time, while greater family conflict was linked to more screen time. These results may inform strategies to reduce screen time in adolescence, such as improving communication between parents and their children to strengthen family relationships.

Screen Time, Nature, and Development: Baseline of the Randomized Controlled Study "Screen-free till 3".

In the first years of life, increased screen media use is presumably associated with health consequences and developmental impairments. "Screen-free till 3" is a prospective Germany-wide randomized intervention study, started in May 2022 with a duration of 3 years. In the intervention group, 2581 pediatric practices received stickers, which were systematically placed in the screening booklet of all children, along with advice to parents to keep children free from screens until the age of 3. A volunteer sample of 17,436 parents received an invitation to take part in the preinterventional questionnaire. The outcomes were parents' internet use (CIUS test), parental screen time in the presence of children, time of screen media in the background, and children's development. Four thousand twenty-one parents answered the questionnaire. 16.7% of mothers and 31.0% of fathers reached the CIUS score of an internet-related disorder. Parents whose children use screen media at an early age had significantly higher CIUS values on average (M = 4.07) than the parents of children who do not yet have any screen time (p < 0.001). Combined developmental characteristics show a negative correlation with parental screen time (p < 0.001). Time spent in nature was positively associated with development (p < 0.001). The evaluation of the survey shows that screen media is to a large extent used on a daily basis. The study confirms the assumption that high screen media use by parents is linked to higher screen media use by children and also has a negative impact on child development. Trial Registration: Number: RKS00032258; https://drks.de/search/en/trial/DRKS00032258.

Screen time among preschoolers: exploring individual, familial, and environmental factors.

Screen-based activity refers to the use of screened devices, which are changing from stationary devices such as televisions and desktop computers to newer portable devices such as smartphones and electronic tablets. The exposure of younger children to all types of screened devices has increased. This review aimed to provide an overview of previous studies and identify the correlations associated with screen-based activities in preschoolers. We conducted a systematic literature review of databases including PubMed, Embase, and PsycInfo targeting quantitative studies published between 2010 and 2019. We then analyzed the associations between screen time and various individual, familial, and environmental factors in healthy children aged 0-6 years. We specifically included studies that provided a subgroup analysis for this age category to systematically identify the factors influencing screen time patterns among preschoolers. The search yielded 36 articles that met the inclusion criteria. We investigated age, sex, and social, family, and personal factors as well as media parenting. The results suggested that media parenting for screen-based activities was an important protective factor. Limited research has been conducted on preschoolers' screen-based activities with both stationary and portable screened devices. Most factors have been studied using stationary devices and are too infrequent for solid conclusions to be reached. Parental screen time and the setting of appropriate media limits were crucial protective factors against excessive media exposure. However, information about family and personal factors remain scarce, and further research is needed.

The impact of family factors and communication on recreational sedentary screen time among primary school-aged children: a cross-sectional study

BackgroundChildhood obesity is increasingly recognized as a major public health challenge worldwide, and excessive sedentary screen time is emerging as a key risk factor. This study aimed to assess the recreational screen sedentary time of Chinese primary school-aged children and investigate the relationship between screen-related family factors and the outcome variable.MethodsOur study used data from a cross-sectional survey collected from fifth-grade students and their parents in Beijing, China, from April to May 2018 (n = 2,373). The questions included basic demographic information, family socioeconomic status, students’ and parents’ sedentary and exercising habits, within-family communicational factors, and health belief patterns. The recreational screen sedentary time of the children was compared across demographic groups. The study employed multivariate linear regression models to examine associations between children’s screen time and various family factors, as well as the moderating effect of overall family communication.ResultsOur findings revealed an average daily recreational screen sedentary time of 2.4 h among participants. Screen time significantly varied across demographic categories, including children’s sex, age, residence, parents’ education, household income, family size, and primary family member. After adjustment, the proportion of child-owned digital devices (p < 0.01), child’s personal room (p < 0.05), family screen-viewing together (p < 0.01), and parental screen time (p < 0.01) were positively related to children’s recreational sedentary screen time. Parental restrictions on screen time (p < 0.001) and attitudes toward reducing sitting time (p < 0.01) were correlated with a decrease in children’s screen time. The overall family communication environment significantly moderated the effects of parental practice of restricting children’s screen time (p < 0.001), positive reinforcement by parents (p < 0.05), and parents’ recreational sedentary screen time (p < 0.001).ConclusionsOur findings underscored the significance of family dynamics, parental practices, and communication in shaping children’s screen time behaviors, providing valuable insights for tailored interventions and strategies to reduce childhood obesity.

Evaluation of the Impact of Screen Time and Parental Play on Children with an Autism Spectrum Disorder in Comparison with Normal Children

Background: There is a decremental trend seen in parental play in recent times, and there is a mounting trend in screen exposure in children. This changing trend in parental play and screen time exposure may affect child social and communication domains.Objective: To assess the impact of screen time and parental play in children with autism spectrum disorder.Methodology: This is a comparative cross sectional study with a sample of 60 children. Thirty children of age group 2-6 years diagnosed with Autism Spectrum Disorder as per DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) attending child guidance Clinic, Government Hospital for Mental care were included in the study.The Parental Play Questionnaire assessed parental play in children. The Digital Screen Exposure Questionnaire(DSEQ) evaluated child screen time exposure. The severity of ASD was assessed by using the CARS scale.Results: Out of thirty samples with Autism spectrum disorder (ASD), 60% of children had moderate ASD, while 20% accounted for mild and severe ASD. Nearly 53.3% of ASD children had a frequency of watching smartphones more than 5 times a week with an average duration of more than 2 hours a day. In contrast, in normal children, only 6.7% have such frequency and an average time of watching smartphones less than 1 hour, significant with a p-value of &lt;0.001. Among the ASD group, 80% of children had active physical parent-child play frequency of less than twice a week. In normal children, about 60% had a frequency of parent-child play several times daily.(p-value &lt;0.001). About 66.7% of ASD children never had to pretend play, and 30% had pretend play once a week.Conclusion: The result showed significantly higher screen time exposure and lack of parental play in childrenwith ASD than in normal children. The need of this digital era is mounting concern about reducing screen time exposure and increasing parental play in childhood.

Pilot Study of a Screen-Free Week: Exploration of Changes in Parent and Child Screen Time, Parent Well-Being and Attitudes, and Parent-Child Relationship Quality

Screen use is associated with a variety of potential impacts on child development, which has led to recommendations to regulate screen use. The current pilot study was conducted to explore the potential effects of implementing screen-free times (Screen-Free Week) on parent and child screen use, parent feelings and well-being, and parent-child interactions and relationships. Specifically, we evaluated the outcomes utilizing pre and postintervention self-report surveys with 24 parents (of a child age 5 years or younger). Overall, the screen-free week program decreased parent depressive symptoms, increased the parenting of child screen time and establishments of screen time limits, and decreased both parent and child screen time. Though the decrease in overall parent and child screen time was not maintained by 4 weeks after, effects on parent depression, child TV watching, and parent phone use specifically during child time were maintained. These findings support previous research emphasizing screen-free times as a viable method to increase intentionality around screen use. Interestingly, the program appears to have had the strongest effects on parent phone use around their child, suggesting the program may build awareness in parents and may cause them to change or desire to change their screen habits during family time. Although we saw initial shifts in parent-child play, effects were not maintained by week 4. Yet, the small changes parents made across one week were not sufficient to shift the overall parent-child relationship. While effects cannot be viewed as definitive, it is promising that shifts were seen in parent well-being and screen use for a relatively small amount of effort across one week.

Media screen time use and mental health in school aged children during the pandemic

BackgroundChildren’s screen time activity has increased significantly during the pandemic. Extended school closures and heightened parent stress are associated with children’s behavioural difficulties and time spent watching screens. The primary aim of this study was to determine which school and household factors were associated with challenging behaviours in Canadian schoolchildren during the COVID-19 pandemic.MethodsThis longitudinal survey study examined the association amongst screen time, internalizing and externalizing behaviours in school-aged children at two time points over the 2020–2021 academic school year. Parents completed survey measures on their parental involvement, stress levels, and their child’s screen time use as well as their emotional and behavioural difficulties.ResultsChildren’s average daily screen time was 4.40 h (SE = 18.45) at baseline and 3.89 h (SE = 16.70) at 1-year follow up, with no significant change across the school year (p = .316). Increased screen time use was associated with a greater incidence of internalizing behaviours in children (p = .03). Children who spent more time on screens and who were in households with parents reporting higher stress levels had increased internalizing behaviours (p < .001). No association between screen time use and externalizing behaviours was evident; however, parent stress was positively associated with children’s externalizing behaviours (p < .001).ConclusionsChildren’s screen time use has remained high during the pandemic and is associated with anxious and depressive symptoms. Children who spent more time on screens and who were in households with parents reporting higher stress levels had increased internalizing behaviours. Parent stress was positively associated with children’s externalizing behaviours. Targeted family intervention plans focused on reducing parent stress and screen time use may aid in improving children’s mental health during the ongoing pandemic.

Parental influences on children’s dietary intake, screen time and its relationship to their weight status

It is important to know more about the influence of parent’s actions and behaviours on children’s dietary intake, screen time and weight of children in developing countries. This study aimed to understand parental influences on children’s dietary intake, screen time and its relationship to children’s weight in Bangalore urban district. Data was collected from parents of children aged 6 to 12 through a self administered questionnaire. Sample comprised of 140 children selected among a purposive method from a tertiary hospital and three private schools. BMI Percentile of children was calculated using the IAP application. Data were analysed using SPSS version 25. Pearson’s correlation and Spearman’s correlation was used to analyze correlation of various parameters. The frequency of consumption of fried foods, processed foods, fast foods and bakery foods was significantly associated with children’s BMI (p&amp;#60;0.05). Parental screen time was positively associated with child screen time, (r=0.368, p=0.001). A significant positive relationship was found between screen time and child’s BMI, (r=0.559, p= 0.001). Over one quarter of children aged 6 to 12 who took part in the study were overweight and obese. Healthy diet and lifestyle guidelines were provided to parents to understand the importance of it in preventing chronic diseases in their children. More such intervention programmes must be implemented to encourage parents to take appropriate measures concerning children’s unhealthy eating habits, long term screen exposure and reduced outdoor activities.

Patterns of parent screen use, child screen time, and child socio-emotional problems at 5 years.

Digital media screens have become an essential part of our family life. However, we have insufficient knowledge about parental screen use patterns and how these affect children's socio-emotional development. In total, 867 Canadian parents of 5-year-old children from the TARGet Kids! Cohort (73.1% mothers, mean ± SD age=38.88 ± 4.45 years) participated in this study from 2014 to the end of 2019. Parents reported parental and child time on television (TV) and handheld devices and completed the Strengths and Difficulties Questionnaire (SDQ). Latent profile analysis identified six latent profiles of parent screen use: low handheld users (P1, reference; n=323), more TV than handheld (P2; n=261), equal TV and handheld (P3; n=177), more handheld than TV (P4; n=57), high TV and handheld (P5; n=38), and extremely high TV and handheld (P6; n=11). Parents that were more likely to belong to P6 were also more likely to be living in single-parent households compared to P1 (estimate=-1.49 ± 0.70), p=.03). High membership probability for P2 (estimate=-0.67 ± 0.32, p=.04) and P4 (estimate=-1.42 ± 0.40, p < 0.001) was associated with lower household income compared to P1. Children of parents with higher P4 (χ2 =12.32, p < 0.001) or P5 (χ2 =9.54, p=.002) membership probability had higher total screen time compared to P1. Finally, a higher likelihood to belong to P6 (χ2 =6.82, p=.009) was associated with a higher SDQ Total Difficulties Score compared to P1. Thus, patterns of parent screen use were associated with child screen use and child socio-emotional problems. The emerging link between parental screen use profiles and child behaviors suggests the need for more research on parent screen time.

Co-occurrence of Screen Time and Eating Behaviors among Young Children Aged 5 to 9 Years.

High screen time, high energy dense food and low fruits and vegetables are important risk factors among children. The study aimed to find out co-occurrence of screen-time and unhealthy eating behavior among young children aged 5 to 9 years in Pokhara Metropolitan. A cross-sectional study was conducted among children. Face to face interviews were done with 352 parents of the selected children. The study was conducted from March to October, 2020. High screen time was defined as >2 hours screen viewing each day; low fruit vegetable defined as <3 servings a day; and ≥ one serving a day of energy dense food was categorized as high consumption. Out of total, 33.0% did not met recommendation for single health behavior, 38.9% did not meet for two and 23.9% did not for three health behaviors; and 62.8% had two or more risk behaviors. Of total, 19.6% had low fruit vegetable and high energy dense intake, 17.0% had high screen time and low fruit vegetable, 2.3% high screen time and high energy dense and 23.9% had high screen time, high energy dense and low fruit vegetable. Proportion of co-occurrence of multiple risk behaviors was higher among those whose parents had higher screen time, offered screen devices to them; and the children who had television and television cable at home, and had personal screen device (P<0.05). About two-third children had multiple risk behaviors; proportion is higher among those who had access to screen devices and higher parental screen time. It may require a combination of efforts to improve healthy behaviors.

Media regulation strategies in parents of 4- to 16-year-old children and adolescents: a cross-sectional study

BackgroundSince children can only control and limit their own media use to a limited extent, it is often the parents who regulate their children’s media use. However, there is insufficient research on which strategies they use and on how these strategies are related to socio-demographic and behavioral parameters.MethodsThe parental media regulation strategies co-use, active mediation, restrictive mediation, monitoring, and technical mediation were assessed in a sample of 563 four- to 16-year-old children and adolescents from middle to high social strata participating in the German cohort study LIFE Child. We investigated cross-sectional associations with socio-demographic characteristics (age and sex of child, age of parent, and socio-economic status (SES)) and other behavioral parameters of children (media use, ownership of media devices, engagement in extracurricular activities) and their parents (media use).ResultsAll media regulation strategies were applied frequently, with restrictive mediation occurring most frequently. Overall, parents of younger children and of boys mediated media use more frequently, while we observed no differences depending on SES. Regarding child behavior, the ownership of a smartphone and a tablet/personal computer/laptop was associated with more frequent technical restriction, while screen time and engagement in extracurricular activities was not associated with parental media regulation. In contrast, parental screen time was related to more frequent co-use and less frequent use of restrictive and technical mediation.ConclusionParental regulation of child media use is influenced by parental attitudes and a perceived need for mediation (e.g., in younger children or children owning internet-enabled devices) rather than child behavior.

Growing concern; the relationship between screen time and behavior problems in digital era

Although the physical and psychological effects of digital screens have been shown in studies, its relationship with the behavior of children is still unclear. When, how, and at what ages screen time is associated with behavioral problems continues to be investigated. The study aimed to evaluate the relationship between screen time and behavioral problems. 378 children (preschooler:64, schooler:206, adolescent:108) were included in our study. The Strengths and Difficulties Questionnaire, screen and sociodemographic data were filled in by the mothers. An increase in the SDQ score (except for the social score) indicates an increase in behavioral problems. In each group, &lt;25p screen time was evaluated as low, 25-75p as medium, &gt;75p as high screen time. The median screen time of the preschool, school and adolescent groups was calculated as 3.00hrs.(25p-75p:1.125-5.00), 3.00hrs.(25p-75p:2.00-6.00), 5.00hrs.(25p-75p:3.00-8.00), respectively. The hyperactivity/inattention score of preschoolers who watched screen ≤1hr was significantly lower compared to those with &gt;1hr screen time (p=0.02); In the schooler group, the social score was statistically higher and the scores of the other subscales were lower in those who watch screen ≤2hrs. While high screen time was found to be associated with behavioral problems in school and adolescents, it was found to be associated with less hyperactivity problems in preschool period in regression analysis. It was determined that low-screen time was associated with less hyperactivity in preschool period and more behavioral problems in adolescents. While moderate screen time had a positive effect on behaviors in adolescents in paired analyzes, no effect was observed in multiple regressions. Parental screen time was associated with emotional/behavioral problems of preschool and school age children. Child’s screen time and parental screen time should be evaluated for intervention of behavioral problems. Large-scale studies are needed to compare the effect of low and medium-screen time on children's well-being.

Impact of COVID-19 on the sleep-wake patterns of preschool children

ObjectiveTo explore the impact of the COVID-19 pandemic on the sleep-wake patterns of preschool children. MethodsA cohort of preschoolers established before the COVID-19 pandemic was invited to participate in this study. Data including children's demographics, their own and parental sleep-wake patterns, physical activities, and screen time were collected through an online questionnaire from August to September 2020. A comparison was made on the collected data from the same cohort of children before and during the pandemic. ResultsThe cohort which was established before the pandemic consisted of 3720 preschoolers. For this current study, 642 (17%) participated, and 497 (13%) children who fulfilled the eligibility criteria were included in the final analysis. They showed a delay in their bedtime and wake time on both weekdays and weekends with a 15–30 min increase in nocturnal sleep duration. However, with a reduction in nap time, the average daily sleep duration was shortened by 16.3 ± 64.3 min (p < 0.001) and 27.5 ± 72.9 min (p < 0.001) during weekdays and weekends, respectively. Screen time was increased while outdoor activity duration was decreased. Parental sleep/wake times were also delayed with an increase in sleep duration. Children's sleep habits were associated with screen time and parental sleep/wake patterns. ConclusionDespite school suspension during the COVID-19 pandemic, preschoolers were not sleeping longer. Screen time and parental sleep/wake patterns were the major factors driving the preschoolers' sleep habits. Health education is required to control screen time in children and to promote sleep hygiene among all family members.

Evidence for Changes in Screen Use in the United States During Early Childhood Related to COVID-19 Pandemic Parent Stressors: Repeated Cross-Sectional Study.

The COVID-19 pandemic transformed the home lives of many families in the United States, especially those with young children. Understanding the relationship between child and parent screen time and family stressors exacerbated by the pandemic may help inform interventions that aim to support early child development. We aim to assess the changing relationship between family screen time and factors related to pandemic-induced remote work and childcare or school closures. In the spring of 2021 we administered a survey, similar to one administered in the spring of 2019, to a national sample of parents of young children (aged 6 to 60 months). Using iterative sampling with propensity scores, we recruited participants whose sociodemographic characteristics matched the 2019 survey. Participants were aged >18 years, proficient in English or Spanish, and residing in the United States. The main outcomes were changes in child screen time (eg, mobile phone, tablet, computer, and television) and parenting technoference, defined as perceived screen-related interference with parent-child interactions. Additional survey items reported pandemic-related job loss, and changes to work hours, work location, caregiving responsibilities, day care or school access, and family health and socioeconomic status. We enrolled 280 parents, from diverse backgrounds. Parents reported pandemic-related changes in child screen time (mean increase of 1.1, SD 0.9 hours), and greater parenting technoference (3.0 to 3.4 devices interfering per day; P=.01). Increased child screen time and parenting technoference were highest for parents experiencing job loss (mean change in child screen time 1.46, SD 1.03; mean parenting technoference score 3.89, SD 2.05), second highest for working parents who did not lose their job (mean change in child screen time 1.02, SD 0.83; mean parenting technoference score 3.37, SD 1.94), and lowest for nonworking parents (mean change in child screen time 0.68, SD 0.66; mean parenting technoference score 2.66, SD 1.70), with differences significant at P<.01. School closure and job loss were most associated with increased child screen time during the pandemic after controlling for other stressors and sociodemographic characteristics (d=0.52, P<.001; d=0.31, P=.01). Increased child screen time and school closure were most associated with increased parenting technoference (d=0.78, P<.001; d=0.30, P=.01). Work and school changes due to the COVID-19 pandemic were associated with increased technology interference in the lives of young children. This study adds to our understanding of the interaction between technology use at home and social factors that are necessary to support early childhood health and development. It also supports possible enhanced recommendations for primary care providers and childcare educators to guide parents in establishing home-based "screen time rules" not only for their children but also for themselves.

The effects of technology use on children's physical activity: a cross-sectional study in the Eastern province of Saudi Arabia.

Recently, a considerable amount of literature has been concerned with the impact of screen time on physical activity. Furthermore, recent evidence reveals that children under 14 spend an average of 23 hours each week looking at screens, including watching TV and DVDs, playing video games, or using a computer or mobile device. This study aimed to determine the relationship between technology use and physical activity. 277 parents completed an online questionnaire in this cross-sectional investigation. The questionnaire comprised 44 closed-ended questions divided into three sections: demographics, the impact of technology on children, and the Children's Physical Activity Questionnaire (CPAQ). 88 (31.8%) of children reported up to 5 hours of screen time per day, while 189 (68.2%) reported 6 hours or more. According to the CPAQ, 131 (47.3%) children had a low level of physical activity, 96 (34.7%) had a moderate level, and 50 (18.1%) had a high level. There was a strong relationship between parental age and child screen time, with 24.9% of children with screen time greater than 6 hours having parents aged 35-40 years, compared to 28.4% of children with screen time less than 5 hours having parents aged 25-30 years. Inadequate physical activity in children was linked to the number of siblings, ownership of electronic devices, and screen time. Physical activity should be increased through lifestyle changes that the entire family can implement.

Sociodemographic and behavioural factors of adherence to the no-screen guideline for toddlers among parents from the French nationwide Elfe birth cohort

BackgroundExcessive screen time in infancy and childhood has been associated with consequences on children’s development and health. International guidelines call for no screen time before age 2 years, whereas in France, the most prominent guidelines recommend no screen before age 3 years. However, data are lacking on parental adherence to the no-screen guideline for toddlers and factors of adherence in France. Using data from the French nationwide Elfe birth cohort, we estimated adherence to the no-screen guideline at age 2 years and examined related factors, including sociodemographic characteristics, parental leisure activities and screen time.MethodsIn 2011, 18,329 newborns and their parents were enrolled in 349 randomly selected maternity units across mainland France. At age 2 years, screen exposure of 13,117 toddlers was reported by parents in phone interviews. Data on sociodemographic characteristics, parental leisure activities and screen time were collected from both parents. Three patterns of parental leisure activities were derived by principal component analysis: literate (e.g.,reading), screen-based, and physical/artistic activities. Multivariable logistic regression models were used to examine the associations of sociodemographic characteristics, parental leisure activities and parental screen time with adherence to the no-screen guideline for toddlers.ResultsOverall, 1809/13,117 (13.5%) families adhered to the no-screen guideline for toddlers. Adherence was reduced with maternal age < 40 years, low parental education, single-parent household and parental migration status. After adjusting for sociodemographic characteristics, adherence to the guideline was positively associated with a parental literate activity pattern (mothers: odds ratio [95% confidence interval]: 1.15 [1.08, 1.22]); fathers: 1.15 [1.07, 1.23]) and negatively with a screen-based activity pattern (mothers: 0.73 [0.69, 0.77]; fathers: 0.81 [0.76, 0.87]). With each additional hour of parental screen time, mothers and fathers were less likely to adhere to the guideline (mothers: adjusted odds ratio 0.80 [0.77, 0.83]; fathers: 0.88 [0.85, 0.91]).ConclusionsAdherence to the no-screen guideline for toddlers in France was low. Parental leisure activities and parental screen time are major factors of adherence to the no-screen guideline and could be considered in targeted public health interventions.

Racial/Ethnic Disparities in Parent Activation: Implications for Developing Interventions Addressing Early Childhood Obesity.

Examine racial/ethnic differences in parent activation and associations with child obesity risk behaviors in low-income families. Cross-sectional survey study of 300 low-income Black, Latinx, and White parents of patients aged 2 to 5 years receiving primary care within 2 health care systems (Systems 1 & 2). In-person and phone surveys were conducted. Parent activation, defined as parents' knowledge, confidence, and willingness to act concerning their child's health, was measured using the standardized 13-item Parent Patient Activation Measure (P-PAM). Differences in parent activation by race/ethnicity were assessed using analysis of variance. Multivariate regression analyses were used to test associations between parent activation and child obesity risk behaviors. In pooled unadjusted analyses, Latinx parents had significantly lower activation compared to Black parents (P=.023), but these differences were no longer statistically significant after adjusting for other sociodemographic characteristics (P=.06). Higher activation was associated with slightly greater odds of consuming ≥ 5 daily servings of fruits and vegetables for System 2 only (odds ratio: 1.04, 95% confidence interval: 1.01, 1.07). Associations between parental activation and child screen time or physical activity were not significant. Findings highlight potential measurement limitations of the P-PAM including the inability of the measure to capture barriers to health system navigation and cultural and linguistic considerations. Further attention to the nuanced interplay between parental activation and contextual and sociodemographic risk factors (eg, food availability, immigrant status, economic opportunity, language proficiency) should be considered in the development of early childhood obesity interventions in primary care settings.

PREVALENCE AND FACTORS ASSOCIATED WITH EXCESSIVE SCREEN TIME AMONG YOUNG CHILDREN OF 5 TO 9 YEARS IN POKHARA METROPOLITAN OF KASKI DISTRICT

Background: Excessive screen time has been increasing among children and adolescents globally. The study aimed to find out the prevalence and associated factors of excessive screen time among young children. Methods: A cross-sectional study was conducted among children aged 5 to 9 years attending schools in Pokhara metropolitan. Face to face interview was conducted with one of the parents of 352 children. The study was carried out from March to October, 2020. Excessive screen time (ST) was defined as &gt;2 hours screen viewing a day. Chi-square test and binary logistic regression were applied at 5% level of significance. Results: Of total, 47.4% of children had ST&gt;2 hours a day. Among socio-demographic factors, being a boy (adjusted odds ratio (AOR), 1.65; 95% CI,1.05-2.57)), living in nuclear family (AOR, 0.62; 95% CI, 0.39-0.99) and age of the children (AOR, 1.28; 95% CI,1.03-1.58) were significantly associated with excessive ST. Having television at home, parental ST, offering screen devices to children had increased likelihood of reporting excessive ST. Odds of reporting of excessive ST was 8.97 times higher among those who had one television at home as compared to those who do not have. Excessive ST was more than three times among those children whose parents offered screen devices to make them eat as well as to have free time for the parents themselves. Conclusions: Few socio-demographic characteristics, parental ST and parental offering of screen devices were significantly associated with excessive ST. Interventions should target screen device accessibility and ST related behavior of parents.

Prevalence of refractive errors and risk factors for myopia among schoolchildren of Almaty, Kazakhstan: A cross-sectional study

Very little is known about the prevalence of refractive errors among children in Kazakhstan. The aim of this study was to investigate the prevalence of refractive errors and risk factors of myopia among schoolchildren in Almaty, Kazakhstan. In the cross-sectional study of 2293 secondary school students (age 6-16), we examined cycloplegic autorefraction and offered a questionnaire in three age groups: 1st grade (N = 769), 5th grade (N = 768) and 9th grade (N = 756). The questionnaire covered main risk factors such as parental myopia, screen time, time outdoors, sports activities, near work, gender, grade, and school shift. Adjusted logistic regression analysis was applied to test the association of risk factors with myopia. The mean spherical equivalent (SER) was -0.54 ± 1.51 diopters (D). The overall prevalence of refractive errors was 31.6% (95% confidence interval (CI) 29.7; 33.5); myopia 28.3% (95% CI 26.5; 30.1); hyperopia 3.4% (95% CI 2.7-4.1) and astigmatism 2.8% (95% CI 2.1; 3.5). In the multivariate adjusted regression analysis, higher class level (5th grade (odds ratio (OR) 1.78; 95% CI 1.26; 2.52) and 9th grade (OR 3.34; 95% CI 2.31; 4.82)) were associated with myopia, whereas outdoors activity more than 2 hours a day (OR 0.64; 95% CI 0.46; 0.89) and sports (OR 0.70; 95% CI 0.52; 0.93) were associated with a lower incidence of myopia. Myopia is a leading refractive error in schoolchildren in Almaty, Kazakhstan. Myopia prevention measures, including more time outdoors, should guide public health interventions in this population.

Rules, role models or overall climate at home? Relative associations of different family aspects with adolescents' problematic social media use

AimThis study aimed to enhance knowledge on which aspects of the family context are most relevant in identifying at-risk/problematic social media users among adolescents. Therefore, we examined the relative contribution to adolescents' at-risk/problematic social media use (SMU) of general and Internet-specific family factors related to three different family (sub)systems: parent-child (Internet-specific rule-setting, reactive restrictions towards Internet use, co-use, adolescents' involvement in rule-setting and positive parenting), parent (parental screen time, phubbing, stress, anxiety and depression) and family (family functioning, family intactness and SES) (sub)system. MethodsQuestionnaire data came from 403 adolescents (M = 13.51, SD = 2.15) and 396 parents (M = 46.59, SD = 5.29) who participated in wave 1 of the Dutch ‘Digital Family project’. ResultsLogistic regression analyses showed that only factors related to the parent-child subsystem remained significant in predicting being an at-risk/problematic social media user when examining predictors related to the parent-child, parent and family (sub)system simultaneously. Specifically, general and Internet-specific parenting practices contributed to the prediction above and beyond each other. Positive parenting and Internet-specific rule-setting seem protective, while parental reactive restrictions towards Internet use could be a risk factor. Positive parenting showed the largest effect size. ConclusionThe results suggest that parental behaviors directed towards the child should be a focus of attention in prevention of adolescents' problematic SMU. In addition, our findings highlight the importance of untangling restrictive mediation (impulsive, in the moment, attempts to limit SMU versus communicating clear rules in advance) when examining its effects.