Household chaos and screen media use among preschool-aged children: a cross-sectional study

Development of the Rural Perception Scale (RPS-18)

BACKGROUND

People living in rural areas often experience limited access to health resources, slow knowledge diffusion, and geographical isolation, and tend to be at higher risk for poor physical and mental health outcomes compared with nonrural populations. It is unclear, yet, how the concept of "rural" shapes observed differences from nonrural populations. We aim to develop a psychometrically sound scale to assess key dimensions that constitute individual-level perceived rurality.

METHODS

We first conducted a broad literature review to identify a priori concepts related to rurality and adapted survey items measuring relevant constructs, such as loneliness, attitudes toward people living in rural areas, and perceived social membership. We used these conceptual constructs and measures to develop a survey questionnaire focused on rural perceptions. We recruit residents in 3 rural states: Kentucky, New Hampshire, and Vermont. Using the explorative factor analysis and second-order measurement model in the structural equation model framework, we developed a rural perception scale consisting of 18 items.

RESULTS

We recruited 1,384 participants (n = 686 from KY; n = 698 from NH/VT) using Amazon Mechanical Turk (n = 897, 64.8%) and social media paid ads (n = 487, 35.2%). The average age of participants was 41 years old (SD = 15); 54.7% of respondents had less than college graduate education, and 94.2% reported their race as non-Hispanic White. Majority of the participants were from Rural Urban Commuting Area (RUCA)-designated urban areas (n = 798, 57.7%), followed by RUCA-designated large rural areas (257, 18.6%), RUCA-designated rural areas (n = 174, 12.6%) and RUCA-designated isolated areas (n = 133, 9.6%). Our final model revealed 4 latent constructs: "belonging" (Cronbach's α = 0.896), "attitudes toward rural life" (Cronbach's α = 0.807), "loneliness" (Cronbach's α = 0.898), and "community social ties to people in their community" (Cronbach's α = 0.846).

CONCLUSIONS

We identified 4 subfactors of the umbrella concept of rurality that explain how people in rural regions may perceive being in rural environments and having rural lifestyles.

Evaluation of Screen Time in Children Under Five Years Old

INTRODUCTION

Due to the rapid advancement of technology, there has been a noteworthy increase in the diversity and abundance of activities involving children. The most effective methods to enhance and facilitate children's media interactions are to minimize, reduce, use with caution, and establish healthy patterns. We aimed to evaluate media exposure of children below five years of age.

MATERIAL AND METHODS

This is a prospective, observational, cross-sectional study that was conducted between December 2017 and September 2019 in Eskişehir, Türkiye. To assess the frequency of electronic device usage among children under the age of five, including televisions, laptops, tablets, and mobile phones, as well as its impact on their sleep patterns and physical measurements, and to evaluate families' understanding of the terms "screen time" and "back screen time," we developed a questionnaire.

RESULTS

We analyzed a total of 731 questionnaires: 334 (45.7%) were girls, 397 (54.3%) were boys, and the mean age was 33.55±16.37 months. Upon examining the technical equipment accessible to the children in our study, we found that 98.6% possessed a television, 96.9% owned a mobile phone, 54% had a laptop, 49.5% had a tablet, and 34.1% possessed a gaming console. The study revealed the following proportions of electronic devices in children's rooms: 13% televisions, 11.9% tablets, 7.4% laptops, and 7% mobile phones. There has been a substantial increase in the amount of time they spend watching television and playing computer games among children who have at least one sibling. There was a statistically significant disparity between the television viewing periods and the body mass index of children older than two years old. Additionally, we have seen a significant disparity in the presence of media devices in children's bedrooms and the subsequent impact on their sleep duration and patterns throughout both nighttime and daytime. Around 65.8% of parents did not know of the concept of screen time, while 88.4% of parents did not know of the concept of back screen time.

DISCUSSION

Parental compliance with the current guidelines for screen time is insufficient, among parents with children under the age of five, even though exposure to screens begins in the first months of life. Our analysis highlighted the necessity for parents to establish and enforce a unified and logical media usage policy for all children residing in the household. It is crucial to allocate sufficient time during the routine healthcare visit to discuss these recommendations.

High Problematic Screen Exposure among Children Aged 2-5 Years Visiting the Department of Pediatrics of a Tertiary Care Centre

Introduction

The effects of problematic screen exposure in the early years have adverse effects on cognition, reasoning, executive, and social skills, and physical health. The study aimed to assess the prevalence of problematic screen exposure in children between 2 to 5 years of age visiting the Department of Paediatrics of a tertiary care centre.

Methods

A descriptive cross-sectional study was conducted among caregivers of children aged 2 to 5 years of age in a tertiary care centre from 16 July 2023 to 30 September 2023 after an ethical clearance from the Institutional Review Committee. This study excluded children with chronic disease and behavioural disorders. The problematic screen exposure was assessed using the Problematic Screen Exposure Score. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval.

Results

Among 310 respondents, 216 (69.67%) (64.55-74.79, 95% Confidence Interval) children had a high problematic screen exposure score. The mean age of children was 3.46±1.033 with 89 (41.20%) children having their first exposure before 12 months of age, 131 (60.64%) exceeding daily usage of >2 hr, and 198 (91.66%) children viewing age-inappropriate media content.

Conclusions

The prevalence of high problematic screen exposure was comparable to that of the prevalence found in studies done in similar settings.

Keywords

children; preschool; screen time.

Preschool children's screen time during the COVID-19 pandemic: associations with family characteristics and children's anxiety/withdrawal and approaches to learning

With schools closed due to the COVID-19, many children have been exposed to media devices for learning and entertainment, raising concerns over excessive screen time for young children. The current study examined how preschoolers' screen time was associated with their family characteristics and anxiety/withdrawal and approaches to learning during the COVID-19 pandemic. Participants were 764 caregivers of 3- to 6-year-old children (mean age = 59.07 months, SD = 12.28 months; 403 boys and 361 girls) from nine preschools in Wuhan, China, where the pandemic started. The effects of family characteristics on children's screen time during the pandemic outbreak and the associations between screen time and children's anxiety/withdrawal and approaches to learning were examined using path analysis. The results showed that children who spent more time on interactive screen use (e.g., playing with tablets) showed higher levels of anxiety/withdrawal and fewer positive learning behaviors. Unexpectedly, children who spent more time on noninteractive screen use (e.g., watching TV) showed lower levels of anxiety/withdrawal. Additionally, children's screen time was related to family characteristics: children living in more chaotic families with fewer screen time restrictions spent more time on screen use after the pandemic outbreak. The findings suggest that young children's frequent use of interactive screens, such as tablets and smartphones, might be harmful to their learning and wellbeing during the pandemic. To mitigate the potential negative effects, it is essential to manage the screen time of preschoolers by establishing rules for their interactive screen use and improving the household routines related to the overall screen use.

Association between screen time and suspected developmental coordination disorder in preschoolers: A national population-based study in China

Introduction

Excessive screen exposure (ESE) is a growing global public health concern. This study aims to investigate the potential association between ESE and suspected developmental coordination disorder (DCD) in Chinese pre-schoolers, with or without siblings.

Method

A retrospective cohort study was conducted, involving 126,433 children from 551 cities in China. The Little Developmental Coordination Disorder Questionnaire (LDCDQ) was employed to evaluate motor impairment in children, while parents provided information on their children’s screen time in the past year. A mixed and multi-level logistic regression model was used to analyze the associations of all screen exposure measurements from the past year with LDCDQ scores and the risk of suspected DCD.

Results

The prevalence of excessive screen exposure was 67.6% (>1 h per day) and 28.9% (>2 h per day) in Chinese pre-schoolers. One hour’s increase in weekday daily screen time, weekend daily screen time, and screen time before sleep in the past year was associated with a decreased total score of the LDCDQ (β were −0.690, −0.398, and −1.587, p < 0.001) and an increased risk of suspected DCD by 15.3%, 9.1%, and 46.8% when adjusting for the child, family and maternal health characteristics. Excessive screen exposure decreased the total LDCDQ scores by 1.335 (>1 vs. ≤1 h) and 1.162 (>2 vs. ≤2 h) and increased risks of suspected DCD by 44.0% (>1 vs. ≤1 h) and 31.1% (>2 vs. ≤2 h) with statistical significance (each p < 0.05). The stratified analysis showed that the association between screen time and LDCDQ score was stronger in children without siblings than in those with siblings.

Conclusion

The risk of suspected DCD was highest for screen time exposure before bed compared with average weekday and weekend exposures. Parents should be advised to prevent their children from using electronic screens unsupervised, especially in one-child families.

Adolescents' reports of chaos within the family home environment: Investigating associations with lifestyle behaviours and obesity

OBJECTIVE

Disorganised and chaotic home environments may hinder the adoption of healthy lifestyle behaviours and contribute to excessive weight gain among adolescents. We examined whether self-reported level of chaos within the family home environment is associated with lifestyle behaviours and obesity in adolescent girls and boys.

METHODS

Cross-sectional data from the 3rd wave of the Québec Adipose and Lifestyle Investigation in Youth (QUALITY) study were analyzed. The sample consisted of n = 377 White adolescents with a history of parental obesity. Home environment chaos was measured using the Confusion, Hubbub, and Order Scale (CHAOS) analyzed both continuously and dichotomized as high vs. low chaos. Body Mass Index z-scores (zBMI) were computed using WHO standards from measured weight and height. Physical activity (7-day accelerometry), vegetable and fruit intake (three 24-hour diet recalls), and leisure screen time and sleep duration (questionnaire) were assessed. Sex-specific linear regression models were used to estimate associations between level of family home environment chaos, lifestyle behaviours and zBMI.

RESULTS

The overall level of chaos was low in our study sample, with higher reported levels among girls compared to boys. Among girls, high (vs low) chaos was associated with shorter sleep duration (hours/day) (B = - 0.44, 95% CI: -0.75, -0.14). No associations were observed for other lifestyle behaviours or for zBMI.

CONCLUSION

In this sample of adolescents with a parental history of obesity, higher household chaos was not associated with obesity or lifestyle behaviours, except for sleep duration among girls. Replication of findings in more diverse samples is indicated.

The magnitude and importance of perceived health dimensions define effective tailor-made health-promoting interventions per targeted socioeconomic group

Recent insights and developments on health and society urge a critical look at the positive relationship between socioeconomic status (SES) and health. We challenge the notions that it is sufficient to distinguish only between two groups of SES (low and high) and that only overall health is taken into account. A new grouping of SES was developed based on both income and education, resulting in six SES groups. Health was defined in terms of a new positive health concept, operationalized into six health dimensions generating a measure of total general health (TGH). Next, six socioeconomic and demographic determinants of health were included. Linear regression, T-tests and one-way ANOVA were applied to investigate the relationships in a Dutch sample. A subjective way to measure health was applied: self-rated health (SRH). As a result, four out of six dimensions of health determined TGH: bodily functions, daily functioning, quality of life, and social and societal participation. Three out of six socioeconomic and demographic determinants impacted TGH: housing situation, age, and difficulties meeting financial obligations. While this is the general picture for the entire sample, there were interesting similarities and differences between the six SES groups. The similarities lie in the positive impact of the evaluation of bodily functions and daily functioning on TGH in all SES groups. The other dimensions affected TGH in some groups, and some dimensions only in one SES group. None of the socioeconomic and demographic determinants affected TGH in all SES groups. New insights on health inequalities are provided. It is concluded, first that the well-known positive relationship between SES and health is confirmed in this study. Second, further refining the health concept into six dimensions provides more detailed insights on which dimensions impact health the most. The subjective approach applied offers more refined information to better understand which health issues really matter to people. This yields new insights to develop tailor-made interventions aimed at increasing healthy behaviour in specific societal groups.

Interactive Effects of Temperament and Family-Related Environmental Confusion on Spoken Language in Children Who Are Deaf and Hard of Hearing

PURPOSE

The aim of this study was to examine the influence of caregivers' reports of family-related environmental confusion-which refers to the level of overstimulation in the family home environment due to auditory and nonauditory (i.e., visual and cognitive) noise-on the relation between child temperament and spoken language outcomes in children who are deaf and hard of hearing (DHH) in comparison to age-matched children with typical hearing (TH).

METHOD

Two groups of families with children between 3 and 7 years of age (TH = 59, DHH = 58) were sequentially recruited from a larger longitudinal study on developmental outcomes in children who are DHH. Caregivers (all TH) completed questionnaires measuring three dimensions of child temperament (i.e., effortful control, negative affectivity, and surgency-extraversion) and family-related environmental confusion. A norm-referenced language measure was administered to children. Testing took place within the families' homes.

RESULTS

For children who are DHH, effortful control was positively related to spoken language outcomes, but only when levels of family-related environmental confusion were low to moderate. Family-related environmental confusion did not interact with temperament to influence spoken language in children with TH.

CONCLUSIONS

Homes with low-to-moderate levels of environmental confusion provide an environment that supports DHH children with better effortful control to harness their self-regulatory skills to achieve better spoken language comprehension than those with lower levels of effortful control. These findings suggest that efforts to minimize chaos and auditory noise in the home create an environment in which DHH children can utilize their self-regulatory skills to achieve optimal spoken language outcomes.

Thinking inside the box: The future of young children's physical activity and the home environment

Parrish et al.'s (2021) investigation of caregiver perceptions of preschoolers' physical activity (PA) within the home environment posits important opportunities for public policy to consider space and available opportunities for PA for preschoolers. This study uncovered qualitative themes on preschoolers' PA in the home, referencing the use of indoor and outdoor spaces, adaptations within the home, interplay between space and caregiving, and variability in child's PA. This work sparks a discussion into the current understanding of the home environment for preschooler PA and future research directions. We propose three main areas to bring forward physical activity and public health research, including 1) role of policies and community (e.g., societal norms) on the home environment and child physical activity, 2) reimagination of the home environment beyond the physical components as a complex system, and 3) advanced measurement of child physical activity using modern technology. Merging these new opportunities with past efforts may help design and facilitate healthier PA and movement patterns for preschoolers now and into the future.

Predictors of television at bedtime and associations with toddler sleep and behavior in a medicaid-eligible, racial/ethnic minority sample

This study examined predictors of TV use at bedtime and associations with toddlers' sleep and behavior using data from the Smart Beginnings study with 403 Medicaid-eligible, racial/ethnic minority participants from two cities in the United States. We first estimated predictors of TV use at bedtime at 18 months. We then examined whether TV at bedtime was associated with concurrent parent-report of nighttime sleep duration and quality, and later problem behavior at 24 months. Results showed that around half of the sample reported using TV at bedtime with their toddlers, and particularly first-time mothers and those receiving public assistance. We also found that use of TV at bedtime was related to concurrent sleep issues and increases in later problem behavior. Mediational path analyses revealed that TV at bedtime affected behavior via sleep quality. Despite the heterogeneity within this Medicaid-eligible sample, the results underscore the universally harmful effects of TV use at bedtime and lend support for structuring nighttime routines for toddlers to promote better sleep and behavioral outcomes.

Exploring Associations of Household Chaos and Child Health Behaviors in Rural Families

Objectives: Regular physical activity (PA) and limited sedentary behavior (SB) and screen-time are essential for children's health, and rural children are more likely to have overweight and obesity. Household chaos (HHchaos), defined as disorganization characterized by noise and crowding, is associated with negative behavioral outcomes in children. In this study, we examined associations between HHchaos and PA, SB, and screen-time among rural children. Methods: Parent/child dyads (N=105) were enrolled in NU-HOME, a family-based, obesity prevention randomized-controlled trial. We used hierarchical regression analyses of baseline data to examine unadjusted and adjusted (child age, sex, BMI z-scores and economic assistance) associations between HHchaos and outcomes. Results: Children were 8.96 ± 1.06 years old; 58% were female; and 53% were categorized as normal weight. Total daily PA, SB, and weekday screen-time were 259.1 ± 58.22 minutes, 499.9 ± 77.46 minutes, and 1.79 ± 1.48 hours, respectively. Unadjusted HHchaos scores (mean = 5.04 ± 3.6; range = 0-15 with higher score indicating more chaos) were not associated with child PA or SB. HHchaos was positively associated with child screen-time in all models (p<.05), except the fully adjusted model for weekday screen-time. Conclusions: Our findings suggest that decreasing household chaos may be useful in reducing child screen-time. Our findings align with current literature in viewing household chaos as a risk factor for children's health.

Assessment of the influence of physical activity and screen time on somatic features and physical fitness in 6 to 7-year-old girls

Aim of the study is to assess the relationship between screen time, physical activity and physical fitness among girls 6–7 years-old.

21,528 girls aged 6 and 7 from Poland were assessed in terms of physical fitness. Arm strength, abdominal strength and explosive strength of the lower limbs were measured using the EUROFIT test. Basic somatic features were measured and BMI and WHtR indices were calculated. Spontaneous and organized physical activities as well screen time were assessed by the parents utilizing a questionnaire. The multiple logistic regression method was used to evaluate the influence of screen time and spontaneous physical activity on various components of physical fitness.

Physically active (PA) girls (≥1h/day) and those who participated in additional physical activities (APA) during the week had significantly higher height, weight, and BMI (p<0.001), but not WHtR. They had a higher level of flexibility, explosive strength of the lower limbs and arm strength (p<0.001). With an increase in screen time, the BMI, WHtR increased significantly and explosive strength of the lower limbs, abdominal strength and arm strength were lower. Regression analysis showed that more frequent participation in extracurricular activities increased the values of BMI and WHtR in quartile 4 (Q4), and strength components: Q2–Q4 (p<0.05). Spontaneous physical activity was positively related to the values of BMI, WHtR (both: Q4; p<0.05), explosive force of lower limbs (Q3–Q4; p=0.001), and negatively related to arm strength (Q2; p=0.001). Screen time (≥2hrs/day) increased odds for higher BMI values (p<0.05). Each screen time category decreased the odds of achieving abdominal muscle strength related to the quartiles: Q2–Q4 (p<0.05), arm strength (Q4: p<0.05). ST (1 <2hrs/day) decreased arm strength (Q3; p= 0.045). Our research has shown that screen time-related sedentary behavior and physical activity affect overweight and obesity indices (especially BMI) and strength abilities. The observed associations more often affected girls with a higher level of fitness The results observed in girls aged 6-7 indicate a need for early intervention aimed at limiting time spent watching TV and computer use, as well as to encourage both spontaneous and organized physical activities.

Sleep, screen time and behaviour problems in preschool children: an actigraphy study

Inadequate sleep and excessive exposure to media screens have both been linked to poorer mental health in youth. However, the ways in which these interact to predict behaviour problems have yet to be examined using objective sleep measurement. The lack of objective evidence for these relationships in young children has recently been defined by the World Health Organization (2019) as a gap in the field. We thus aimed to test the interacting effects of screen exposure and objectively measured sleep on behaviour problems in the preschool age. A total of 145 children aged 3-to-6-years participated in this cross-sectional study. Sleep was assessed objectively using actigraphy for 1-week, and subjectively using parent-reported daily sleep diaries. Parents reported the child's daily duration of screen exposure, and completed the Strengths and Difficulties Questionnaire. Results showed that actigraphic sleep duration, timing and efficiency were associated with screen exposure. The link between screen time and behaviour problems was moderated by sleep duration, as it was significant only for children with sleep duration of 9.88 h or less per night. Sleep duration also moderated the relation between screen time and externalizing-but not internalizing-problems. Hence, the combination of increased screen exposure and decreased sleep duration may be particularly adverse for child mental health. While these key relationships should be further examined in longitudinal and experimental investigations, our findings shed light on their complexity, underscoring the importance of the moderating role of sleep.

Evaluation of problematic screen exposure in pre-schoolers using a unique tool called "seven-in-seven screen exposure questionnaire": cross-sectional study

Background

Screen media exposure has been increasing in the preschool years. Risky aspects of screen exposure have many potential negative effects on children’s health. We aimed to evaluate problematic screen exposure in Turkish preschool children by using a unique tool called the “Seven-in-Seven Screen Exposure Questionnaire” and to investigate factors associated with problematic screen exposure.

Methods

A questionnaire form was designed including general descriptive questions in the first part. In the second part, a questionnaire we designed called the “Seven-in-Seven Screen Exposure Questionnaire” was conducted to evaluate problematic screen exposure characteristics. The questionnaire included seven items: daily screen time, viewing with parent(s), setting screen limits, screen exposure during meals and in the hour before bedtime, age of onset of screen exposure, and viewing low-quality content. The total problematic screen exposure score (range 0–13) was generated by summing scores from the seven items. Total scores are classified into two categories: low (< 7) and high (≥ 7). Logistic regression was performed to search for independent parameters associated with problematic screen exposure.

Results

One thousand two hundred forty-five mother-child pairs participated in this study. The median age of the children was 3.9 (IQR: 2.9–4.7) years and 51% were males. Overall, 280 children (22.5%) had a problematic screen exposure score of ≥7 (high). The median problematic screen exposure score was 4 (IQR: 3–6). Maternal age of < 30 years; paternal age of ≥30 years; maternal educational level of ≤12 years; the age of 24–48 months; home-based daycare; postponing eating, toileting, or sleeping while using a screen; and using touchscreen devices were found to be associated with an increased risk of having a high problematic screen exposure score.

Conclusion

Developing national scales to monitor problematic screen use in children would be more effective than monitoring screen time alone. All of the screen use characteristics not recommended in children would be evaluated using problematic screen exposure scales. The “Seven-in-Seven Screen Exposure Questionnaire” may serve as an example for further studies.

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.

Compliance with the 24-Hour Movement Behavior Guidelines and Associations with Adiposity in European Preschoolers: Results from the ToyBox-Study

In 2019, the World Health Organization (WHO) published 24 h movement behavior guidelines for preschoolers with recommendations for physical activity (PA), screen time (ST), and sleep. The present study investigated the proportion of preschoolers complying with these guidelines (on a total week, weekdays and weekend days), and the associations with adiposity. This cross-sectional study included 2468 preschoolers (mean age: 4.75 years; 41.9% boys) from six European countries. The associations were investigated in the total sample and in girls and boys separately. PA was objectively assessed by step counts/day. Parent-reported questionnaires provided ST and sleep duration data. Generalized estimating equations were used to analyze the association between guideline compliance and adiposity indicators, i.e., body mass index (BMI) z-score and waist to height ratio (WHR). Only 10.1% of the preschoolers complied with the 24 h movement behavior guidelines, 69.2% with the sleep duration guideline, 39.8% with the ST guideline and 32.7% with the PA guideline. No association was found between guideline compliance with all three movement behaviors and adiposity. However, associations were found for isolated weekday screen time (BMI z-scores and WHR: p = 0.04) and weekend day sleep duration (BMI z-scores and WHR: p = 0.03) guideline compliance with both lower adiposity indicators. The latter association for sleep duration was also found in girls separately (BMI z-scores: p = 0.02; WHR: p = 0.03), but not in boys. Longitudinal studies, including intervention studies, are needed to increase preschoolers’ guideline compliance and to gain more insight into the manifestation of adiposity in children and its association with 24 h movement behaviors from a young age onwards.

Prevalence of excessive screen time and its association with developmental delay in children aged <5 years: A population-based cross-sectional study in India

The global growth of electronic media usage among children has caused concerns regarding screen time (ST) impact on child development. No previous population-based studies have evaluated ST and child development in India. This study aimed to determine the burden of ST, associated sociodemographic factors, and its impact on domains of child development. A population-based cross-sectional study was conducted in the field practice area of rural and urban health centers in Tamil Nadu, India. A total of 718 children (396 rural and 322 urban) were selected, using a cluster random sampling method. ST estimates were obtained from parents/guardian after a 7-day observation period. The Communication DEALL Developmental Checklist was used to assess child development. The mean ST was 2.39 hours/day (95% confidence interval [CI]: 2.23-2.54), and the prevalence of excessive ST was 73% (95% CI: 69.2-76.8). Excessive ST was significantly associated with the mothers' ST, screen usage at bedtime, birth order (in children < 2 years), and attending school (in children ≥ 2 years). Increased ST was significantly associated with developmental delay, in particular, in the domains of language acquisition and communication. In children aged ≥ 2 years, a delay in ≥ 3 domains was associated with ST (adjusted odds ratio [AOR] = 17.75, 95% CI: 5.04-62.49, p < 0.001), as was language delay (AOR = 52.92, 95% CI: 12.33-227.21, p < 0.001). In children aged < 2 years, a delay in ≥ 2 domains was associated with ST (AOR = 16.79, 95% CI: 2.26-124.4, p < 0.001), as was language delay (AOR = 20.93, 95% CI: 2.68-163.32, p < 0.01). A very high prevalence of excessive ST was identified, with a significant association with developmental delay in children. There is an urgent need to include education on ST limits at the primary healthcare level.

Associations between health-related family environment and objective child sleep quality

AIM

This study aimed to assess the relationship between the family environment and behaviours with objective child sleep quality.

METHODS

Twenty-four children (aged 2-5 years) and their parents participated. Child sleep was assessed by accelerometer. Health of the family environment was quantified using the Family Nutrition and Physical Activity Screening Tool (FNPA). Exact Wilcoxon rank sum tests and linear regression were used to determine associations between FNPA scores and child sleep.

RESULTS

Healthier Total FNPA, Physical Activity FNPA, and Sleep Routine scores were associated with earlier bedtime. Healthier Sleep Routine score was associated with more total minutes of sleep per night. Healthier screen time-related FNPA construct scores were associated with earlier bedtime.

CONCLUSIONS

A composite score of family environment and behaviours, including physical activity- and nutrition-related constructs, was related to child sleep quality. Focus should be placed on the obesogenic family environment and healthy sleep routines to promote overall health among pre-school-aged populations.

Household chaos, maternal stress, and maternal health behaviors in the United States during the COVID-19 outbreak

Objectives:

Household chaos, including disorder, noise, and crowding within the home, is a risk factor for poor mental and physical health. Household chaos may act upon maternal behaviors of physical activity and sleep, potentially via higher stress. The purpose of this study is to evaluate the relationships among household chaos, maternal stress, and maternal physical activity and sleep, and identify barriers to home organization during the COVID-19 outbreak.

Methods:

A cross-sectional study using an online survey of 1721 mothers of preschoolers (ages = 3.0–5.9 years) in the United States was conducted in May 2020 during COVID-19 stay-at-home orders and early reopening. Mothers reported demographic characteristics, household chaos, stress, physical activity and sleep, and barriers to home organization during the outbreak. Mediation models were conducted among household chaos, stress, and physical activity and sleep with adjustment for covariates.

Results:

About half of mothers were middle income (48.2%), employed full-time prior to the outbreak (59.1%), and met the physical activity (47.7%), and sleep guideline (49.7%, 7–9 h/day). Household chaos and stress were both negatively related to physical activity and sleep. For every 1 unit increase in mother’s current stress, mothers were 11% (95% confidence interval = 6% to 16%) less likely to meet the physical activity guideline and 19% (95% confidence interval = 14% to 23%) less likely to meet the sleep guideline. Household chaos was positively related to stress. Stress partially mediated the relationship between household chaos and physical activity and sleep. Virus concerns, occupational changes (i.e. teleworking), and lack of childcare were barriers to home organization.

Conclusion:

During the COVID-19 outbreak, many mothers had poor sleep and physical activity, which was associated with household chaos and stress. Opportunities to promote order at the individual, household, and community level may result in beneficial mental and physical health in mothers of young children during the COVID-19 outbreak and beyond.

Household chaos, family routines, and young child movement behaviors in the U.S. during the COVID-19 outbreak: a cross-sectional study

BACKGROUND

The home environment is an important facilitator of young child movement behaviors, including physical activity (PA), sleep, and screen-time. Household chaos, characterized by crowding, noise, and disorder in the home, may hinder efforts to obtain adequate amounts of movement behaviors. The COVID-19 outbreak impacted many families, and social distancing during this time may create conditions for more household chaos. Family routines can help establish order in the home and encourage an appropriate balance of movement behaviors, such as less screen-time and more sleep. The purpose of this study was to evaluate the association between household chaos and young child movement behaviors during the COVID-19 outbreak in the United States, and the role of family routines in this relationship.

METHODS

A national online survey including 1836 mothers of preschoolers (3.0-5.9 years) was conducted during May 2020. Mothers reported demographic characteristics, household chaos, family routines, and the preschooler's movement behaviors during the outbreak. Mothers completed a household chaos questionnaire and were grouped into chaos categories (low, moderate/low, moderate/high, and high) for analysis. Linear regression was used to assess the association between chaos category, family routines, and movement behaviors with adjustment for covariates.

RESULTS

Mothers were 35.9 ± 4.1 years of age, middle income (47.8%), and preschoolers were 3.8 ± 0.8 years of age. Most mothers reported their preschooler was less physically active (38.9%), slept the same amount of time (52.1%), and increased their screen-time (74.0%) after the COVID-19 outbreak. Preschoolers in the high chaos households performed less total PA (β = - 0.36 days/week, 95% CI:-0.62 to - 0.09, p = 0.008), slept less (β = - 0.42 h, 95% CI:-0.59 to - 0.25, p = 0.001) and had more screen-time (β = 0.69 h, 95% CI:0.45 to 0.92, p = 0.001) compared to those in low chaos households. In most chaos categories, having a bed-time ritual was related to more child sleep, and mothers who viewed routines as "less/not important" reported more preschooler screen-time compared to mothers who viewed routines as "very important".

CONCLUSION

Promoting bed-time rituals and prioritizing routines, even somewhat, may be related to an improved balance of child movement behaviors. Innovative measures are needed to support families during periods of disruption such as that experienced in the COVID-19 pandemic.

Exposure to electronic media between 6 and 24 months of age: An exploratory study

This study explores the associations between electronic media exposure, age, and socioeconomic status (SES) in a longitudinal sample of 24 infants from English-speaking families. Leveraging Language ENvironment Analysis (LENA) technology, the study seeks to characterize the relation between electronic media exposure and parental and child vocal activity. We analyzed ecologically valid, daylong audio recordings collected in infants' homes when they were 6, 10, 14, 18, and 24 months old. SES was measured with the Hollingshead Index, and exposure to electronic media and adult and infant vocal activity were measured automatically with LENA. On average, the children in the sample were exposed to 58 min of electronic media daily. We found that electronic media exposure was negatively associated with SES and decreased with child age, but only amongst high-SES families. We also found that electronic media exposure negatively impacted concurrent adult and child vocal activity, irrespective of SES and infant age. The present findings are an important step forward in examining the role of demographic factors in exposure to electronic media and enhance our understanding of the mechanisms through which exposure to electronic media may impact linguistic development in infancy and beyond.

Association between Home Environment in Infancy and Child Movement Behaviors

Introduction: An adequate balance of movement behaviors, including physical activity (PA), sleep, and screen time, is important for preventing excess weight gain in children. This study examined the relationship between the infant home environment and movement behaviors later in life. Methods: Pregnant women were recruited for a cohort study related to maternal and child development. The home environment was assessed for developmental stimulation, organization, and toys by the Pediatric Review of Children's Environmental Support and Stimulation (PROCESS) questionnaire when the child was 6 months of age. At 2 years of age, mother-reported child screen time, and child PA and sleep duration were estimated by accelerometry. Child behaviors were compared with the 24-hour Movement Guidelines (≥180 minutes/day of total PA, 11-14 hours/day of sleep, and ≤1 hour/day of screen time). Logistic regression was used to assess the relationship between the home environment and movement behaviors, adjusting for maternal and child covariates. Results: Mother/child dyads (n = 141) were mainly white (84.4%), and middle (32.8%) or low income (48.9%). All children (100%) met the PA guideline, some met the sleep guideline (71.6%), fewer met the screen-time guideline (44.7%), and only one-third (34.0%) met all three guidelines. Children who met the screen-time guideline lived in homes with more developmental stimulation and toys (p < 0.05). Children who met all 3 guidelines lived in homes with more organization and toys (p < 0.05). Conclusion: The infant home environment was associated with appropriate amounts of movement behaviors at 2 years. Promoting organization (i.e., routines) and toys in infancy may help facilitate nonscreen-based habits and healthy development. The clinical trial registration number is NCT01131117.

Risk and Protective Factors for Frequent Electronic Device Use of Online Technologies

A sample of 10,460 U.S. elementary schoolchildren was analyzed to identify early predictors of frequent use of online technologies (i.e., messaging, online gaming, and social networking). Children (Mage  = 67.44 months) at greater risk displayed more externalizing problem behaviors in kindergarten (messaging OR = 1.11; online gaming OR = 1.21; social networking OR = 1.12) or were Black (messaging OR = 1.65; online gaming OR = 1.64; social networking OR = 1.68). Children from higher-income families were at lower risk (online gaming OR = 0.89; social networking OR = 0.89). Boys were more frequent users of online gaming (OR = 3.35) but less frequent users of messaging (OR = 0.62) and social networking (OR = 0.80). Protective factors included specific parenting behaviors.

Results of the 3 Pillars Study (3PS), a relationship-based programme targeting parent-child interactions, healthy lifestyle behaviours, and the home environment in parents of preschool-aged children: A pilot randomised controlled trial

BACKGROUND

Early childhood is a critical period for the development of obesity, with new approaches to prevent obesity in this age group needed. We designed and piloted the 3 Pillars Study (3PS), a healthy lifestyle programme informed by attachment theory for parents of preschool-aged children.

METHODS

A 2-arm, randomised controlled pilot study was conducted to assess the effectiveness of 3PS, a 6-week programme involving a half-day workshop plus 6-week access to a study website. The programme was designed to promote routines around healthy lifestyle behaviours, including sleep, limited screen use, and family meals, within the context of positive, reciprocal parent-child interactions. Parents (n = 54) of children aged 2-4 years who regularly exceeded screen use recommendations (≥1 hour per day), were randomised to the 3PS programme (n = 27) or a wait-list control group (n = 27). Child screen time at 6 weeks was the primary endpoint. Frequency of family meals, parent feeding practices, diet quality, sleep, Child Routine Inventory (to assess predictability of commonly occurring routines), and household chaos were also assessed. Study data were collected online at baseline, 6 weeks, and 12 weeks via REDCap.

RESULTS

No group differences were observed for changes from baseline in screen time (primary endpoint), feeding behaviour scores, Child Routine Inventory scores, or total night time sleep duration at 6 and 12 weeks, although all measures improved in the hypothesised direction in the 3PS group. Compared with controls, the intervention group demonstrated significant improvements from baseline in household chaos scores (i.e. a reduction in chaos) and a number of measures of sleep outcomes, indicating improved sleep continuity. The programme was highly acceptable to parents.

CONCLUSIONS AND RECOMMENDATIONS

A relational approach appears promising as a novel way to promote healthy lifestyle behaviours associated with the prevention of childhood obesity in children aged 2-4 years. A larger study is warranted.

Interventions to control children's screen use and their effect on sleep: A systematic review and meta-analysis

Prolonged viewing of screen-based media is associated with poor sleep in children. Previous systematic reviews have analysed the effectiveness of interventions that aim to limit children's screen use; however, none have evaluated its effect on sleep. The aim of this systematic review was to evaluate the effect of interventions that incorporate strategies to control children's screen use on screen use and sleep. The databases Pubmed, Embase, Eric, Scopus and PsycInfo were searched during October 2017 and updated in February 2019 for experimental studies with a control that assessed interventions to control screen use in children aged 2-14 years and reported both screen use and sleep outcomes. From 3,872 initial records, 11 studies (six randomized control [RCT], four cluster RCT and one cluster, quasi-experimental) were eligible for inclusion. A total of 4,656 children aged 2-13 years were included in the studies. The mean reduction in screen time was 0.56 hr (33 min)/day (95% confidence interval [CI], 0.92, 0.20) and the mean sleep duration increased by 0.19 hr (11 min)/day (95% CI, 0.05, 0.33). Bedtime was advanced by 0.16 hr (10 min) on weekdays and by 1.0 hr at the weekend. Subgroup analyses indicated stronger intervention effects for interventions of shorter duration (<3 months), which specifically targeted screen use or sleep, and those with direct participant contact. In conclusion, small improvements in screen time and sleep duration can be achieved in children. It is not possible to determine if a reduction in screen time directly improves sleep, due to the limited number of studies, the presence of co-interventions, issues with studies' methodological quality and heterogeneity.

Sex Differences in the Association between Household Chaos and Body Mass Index z-Score in Low-Income Toddlers

Background: Associations between household chaos and childhood overweight have been identified, but the mechanisms of association are not clearly established in young children, with some studies linking higher chaos to increased obesity risk, whereas other studies link higher chaos to lower obesity risk. Given the lack of consistent findings and early sex differences in vulnerability to chaos, we examined child sex as a moderator of the chaos-child overweight association. We also tested these associations with self-regulation, as self-regulation has been implicated in understanding the chaos-obesity risk association in low-income toddlers. Methods: Parent-reported household chaos and observed child self-regulation were collected at baseline [n = 132; M age 23.0 months (standard deviation 2.8)]. Children's body mass index z-score (BMIz) was measured at 33 months. Multivariate linear regression models were used to assess whether child sex moderated the chaos-BMIz association. A three-way interaction between chaos, child sex, and self-regulation was also tested. Results: Child sex moderated the chaos-BMIz association (b = -0.11, p = 0.04) such that chaos was positively associated with BMIz among boys (b = 0.12, p = 0.003), but unrelated in girls (b = 0.01, p = 0.78). A three-way interaction with self-regulation indicated that a positive chaos-BMIz association existed only for boys with average (b = 0.12, p = 0.004) and low (b = 0.22, p < 0.001) self-regulation. Conclusions: Boys with poor self-regulation may be particularly vulnerable to obesogenic effects of chaotic households.

Screen Time Exposure and Altered Sleep in Young Children With Epilepsy

PURPOSE

To examine the association between daily screen time exposure and both sleep patterns (sleep onset, sleep offset, and nighttime, and daily sleep durations) and sleep disturbances among a clinical sample of children with epilepsy.

DESIGN

A cross-sectional actigraphic sleep study.

METHODS

A convenience sample of 141 children with epilepsy (1.5-6 years of age) was recruited from an outpatient pediatric neurology clinic of a university-affiliated children's hospital in northern Taiwan. Participating families completed questionnaires and reported children's screen time use, with children wearing an actigraphy monitor for 7 days to assess sleep patterns. Multivariable linear regression analyses were conducted to examine the association of screen time exposure with the child's sleep patterns and sleep disturbance scores.

FINDINGS

Mean minutes per day of screen time exposure was 89.79 ± 83.94 min, with 62 parents (44.0%) reporting their child having >1 hr of screen time daily. Mean daily sleep duration was 9.26 ± 1.01 hr, with 106 children (93.0%) sleeping <10 hr in a 24-hr period. In multivariate regression models, daily screen time exposure of >1 hour was associated with 23.4-min later sleep onset (b = 0.39, p = .02), 20.4-min later sleep offset (b = 0.34, p = .04), and more severe sleep disturbances (b = 2.42, p = .04).

CONCLUSIONS

In toddlers and preschool-age children with epilepsy, daily screen time exposure is greater and sleep duration is shorter than the recommended amount, with increased screen time exposure associated with disturbed sleep.

CLINICAL RELEVANCE

Parents need to be informed about the possible adverse impact of screen time exposure on children's sleep and health as well as the importance of limiting screen time exposure to <1 hr per day for their toddlers and preschool-age children with epilepsy.

Household chaos: a risk factor for adverse child outcomes gains attention in public health

Household chaos, characterized by high levels of confusion, disorganization and hurriedness in the home, is increasingly recognized as an important risk factor for adverse child outcomes. Early research on household chaos and child well-being was largely within the field of developmental psychology, where greater levels of household chaos has been associated with greater behavioral, attention and learning problems in young children. The potential influence of household chaos on child health behaviors is more recently gaining attention within public health. A recent study by Marsh et al., entitled, the Relationship between Household Chaos and Child, Parent, and Family Outcomes: A Systematic Scoping Review, presents the findings from 112 studies that assessed the influence of household chaos on a wide range of child outcomes. Findings highlight the various adverse child health outcomes across multiple domains that may be negatively affected by greater levels of household chaos including a few that reflect child health behaviors such as sleep, diet and weight gain. The review additionally presents findings from mediation and moderation analyses. This commentary highlights key aspects of the Marsh et al. review and outlines the implications of the work within health behavior research. This commentary further identifies child screen media use as a critically understudied area when considering the interplay between household chaos and child well-being.

The relationship between household chaos and child, parent, and family outcomes: a systematic scoping review

BACKGROUND

Household chaos, represented by the level of disorganisation or environmental confusion in the home, has been associated with a range of adverse child and family outcomes. This review aims to (1) identify how household chaos is measured, (2) chart study details of household chaos literature, and (3) map the existing literature with respect to the relationship between household chaos and child, parent, and family outcomes. We expect that this review will highlight the need to consider the importance of household chaos in child well-being research, particularly in those families where children may be more vulnerable to the adverse effects of household chaos.

METHODS

We searched five electronic databases (last updated September 1st 2018) in addition to Google Scholar, and identified publications via a 3-stage screening process, which was conducted by two researchers. Published studies were included if they investigated the association between household chaos and child, parent, or family outcomes. Research that investigated household chaos as a mediator or moderator, or that investigated how the relationship between household chaos and the outcome of interest was mediated or moderated, were also included.

RESULTS

One hundred twelve studies in 111 publications were included. The majority were conducted in the United States (n = 71), and used either cross-sectional (n = 60) or longitudinal (n = 49) study designs. Outcomes of interest were categorised into seven categories: (1) cognitive and academic (n = 16), (2) socio-emotional and behavioural (n = 60), (3) communication (n = 6), (4) parenting, family, and household functioning (n = 21), (5) parent outcomes (n = 6), (6) hormone (n = 8), and (7) physical health and health behaviours (n = 19). There was consistent evidence for significant correlations between household chaos and adverse outcomes across all seven categories in diverse populations with respect to age, disease status, and socio-economic status (SES).

CONCLUSION

There is consistent evidence for associations between household chaos and a number of adverse child, parent, and family-level outcomes. Household chaos may also help describe variations in outcomes between low SES and child development.

Physical Activity and Sedentary Behaviors of Young Children: Trends from 2009 to 2018

Over the last decade, the lives of children in several countries, including Greece, have been affected by recession. The aim of the present study was (a) to examine time trends in physical activity (PA) and screen time (ST) of Greek preschool children, together with their family affluence (FA), from 2009 until 2018, and to explore the associations among them; and (b) to investigate the connections of parental educational level and children's BMIs to their achieving ST (<1h/day) and PA (11,500 steps/day) guidelines. A total of 652 children from four cross-sectional cohorts participated. PA was recorded with Omron HJ-720IT-E2 pedometers, whereas ST, family affluence (FA) and parental educational level were reported by participants' parents. The results of the one-way ANOVAs that were computed revealed statistically significant differences among cohorts, albeit of no practical importance, in PA, ST and FA. According to the regressions calculated, neither BMI nor the educational level was related to membership in ST and PA guidelines groups. ST was a significant predictor of children's PA in all week periods (school-time, leisure-time, weekend), whereas FA was not such a strong predictor. Multilevel interventions aiming at both ST and PA seem to be imperative for the benefit of young children's health.

Do bedroom screens and the mealtime environment shape different trajectories of child overweight and obesity? Research using the Growing Up in Scotland study

OBJECTIVE

To investigate how mealtime setting, mealtime interaction and bedroom screens are associated with different trajectories of child overweight and obesity, using a population sample.

METHODS

Growth mixture modelling used data from children in the Growing Up in Scotland Study born in 2004/5 (boys n = 2085, girls n = 1991) to identify trajectories of overweight or obesity across four time points, from 46 to 122 months. Using data from children present at all sweeps, and combining sexes (n = 2810), mutually adjusted associations between primary exposures (mealtime setting, mealtime interaction and bedroom screens) and trajectory class were explored in multinomial models; controlling for early life factors, household organisation and routines, and children's diet patterns, overall screen use, physical activity and sleep.

RESULTS

Five trajectories were identified in both sexes: Low Risk (68% of sample), Decreasing Overweight (9%), Increasing Overweight (12%), High/Stable Overweight (6%) and High/Increasing Obesity (5%). Compared with the Low Risk trajectory, High/Increasing Obesity and High/Stable Overweight trajectories were characterised by early increases in bedroom screen access (respective relative risk ratios (RRR) and 95% confidence intervals: 2.55 [1.30-5.00]; 1.62 [1.01-2.57]). An informal meal setting (involving mealtime screen use, not eating in a dining area and not sitting at a table) characterised the High/Increasing Obesity and Increasing Overweight trajectories (respective RRRs compared with Low Risk trajectory: 3.67 [1.99-6.77]; 1.75 [1.17-2.62]). Positive mealtime interaction was associated with membership of the Increasing Overweight trajectory (RRR 1.64 [1.13-2.36]).

CONCLUSION

Bedroom screen access and informal mealtime environments were associated with higher-risk overweight and obesity trajectories in a representative sample of Scottish children, after adjusting for a wide range of confounders. Findings may challenge the notion that positive mealtime interaction is protective. Promoting mealtimes in a screen-free dining area and removing screens from bedrooms may help combat childhood obesity.

Sociodemographic Differences in Young Children Meeting 24-Hour Movement Guidelines

BACKGROUND

Little is known about variation in meeting the 24-Hour Movement Guidelines (including physical activity [PA], sleep, and screen time [ST]) in early childhood. The aim was to evaluate sociodemographic differences in meeting the 24-Hour Movement Guidelines.

METHODS

Parents of 3-4 year old children reported sociodemographic information and ST. Sleep and PA were measured using accelerometry, and height and weight were objectively measured. The 24-Hour Movement Guidelines include daily PA (total PA: ≥3 h; including ≥1 h of moderate to vigorous), sleep (10-13 h), and ST (≤1 h). Meeting guidelines by age, sex, race, poverty level, and weight status were assessed using chi-square and linear regression models.

RESULTS

Of 107 children, 57% were white and 26% lived in households at or below the poverty level. Most children met the PA (91.5%) and sleep (86.9%) guidelines, but few met ST (14.0%) or all 3 (11.3%) guidelines. African American children and children who lived at or below the poverty level were less likely to meet the sleep, ST, and all 3 guidelines compared with others (P < .01 for all). There were no other differences.

CONCLUSION

These results suggest future interventions should focus on reducing differences in movement, namely in sleep and ST.

Parenting and Child Development: A Relational Health Perspective

A child's development is embedded within a complex system of relationships. Among the many relationships that influence children's growth and development, perhaps the most influential is the one that exists between parent and child. Recognition of the critical importance of early parent-child relationship quality for children's socioemotional, cognitive, neurobiological, and health outcomes has contributed to a shift in efforts to identify relational determinants of child outcomes. Recent efforts to extend models of relational health to the field of child development highlight the role that parent, child, and contextual factors play in supporting the development and maintenance of healthy parent-child relationships. This review presents a parent-child relational health perspective on development, with an emphasis on socioemotional outcomes in early childhood, along with brief attention to obesity and eating behavior as a relationally informed health outcome. Also emphasized here is the parent-health care provider relationship as a context for supporting healthy outcomes within families as well as screening and intervention efforts to support optimal relational health within families, with the goal of improving mental and physical health within our communities.