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Background: Individual, home social and physical environment correlates of electronic media (EM) use
among children were examined and pattern of differences on school and weekend days. Methods: Youth (n
= 298) aged 11 to 12 years self-reported time spent using EM (TV, video/DVD, computer use, and electronic
games) on a typical school and a weekend day, each dichotomized at the median to indicate heavy and light
EM users. Anthropometric measurements were taken. Logistic regression examined correlates of EM use.
Results: In total, 87% of participants exceeded electronic media use recommendations of ≤ 2 hrs/day. Watch-
ing TV during breakfast (OR = 3.17) and after school (OR = 2.07), watching TV with mother (OR = 1.96), no
rule(s) limiting time for computer game usage (OR = 2.30), having multiple (OR = 2.99) EM devices in the
bedroom and BMI (OR = 1.15) were associated with higher odds of being heavy EM user on a school day.
Boys (OR = 2.35) and participants who usually watched TV at midday (OR = 2.91) and late at night (OR =
2.04) had higher odds of being a heavy EM user on the weekend. Conclusions: Efforts to modify children’s
EM use should focus on a mix of intervention strategies that address patterns and reinforcement of TV view-
ing, household rules limiting screen time, and the presence of EM devices in the child’s bedroom.
Keywords: youth, family, television viewing, physical activity, body mass index
Electronic media (EM) use occupies the largest EM for entertainment during daylight hours on any given
amount of sedentary activity among children,1 and may day.14,15 Of concern, however, in the US, 11- to 14-year-
involve engagement with television (TV), videos (VHS), old youth spend an average of 4.25 hrs/day watching TV,
DVDs, nonacademic computer use, and electronic games. videos and DVDs.16 Although most Australian studies
This type of EM use, especially TV viewing,2 has been have reported lower average screen times [typically
linked to the increasing problem of overweight and between 3–4 hrs/day, of which 2–3 hrs/day constituted
obesity in youth. Although, the relationship between TV TV (only) time], these studies still report estimates of
viewing and adiposity is well established,3–6 its clinical higher than 2 hrs/day on average,17–21 with boys usually
relevance is currently considered small.3 Nevertheless, spending more time engaged with EM than girls across
overall EM use may be a risk factor for the development childhood.17,18 In addition, screen time has been shown
of chronic conditions that track into later years.7 Despite to increase with age,16,18 but typically only until late
social and educational benefits,8 TV viewing has also adolescence.22 Olds and colleagues23 have questioned
been associated with low academic achievement,9 anti- the assessment of screen-time recommendations, where
social behavior,10 sleeping problems11 and poor dietary the adoption of different calculation methods may yield
habits.12 Console gaming and computer and internet use different prevalence estimates for screen time. Neverthe-
have also been shown to have both positive and adverse less, by averaging daily engagement in screen time across
health benefits among youth.13 the week, it was found that children whose mean daily
In light of the evidence linking children’s screen time screen time exceeded 2 hrs/day had 63% greater odds of
with overweight and obesity, it has been recommended being overweight for their sex and age compared with
that children should not spend more than 2 hrs/day using those who met current recommendations.24 Given these
odds, the possibility of those who failed to meet the rec-
ommendation having cardio-metabolic implications25 is
Granich and Rosenberg are with the School of Sport Science, likely. Thus, preadolescence appears to be an opportune
Exercise, and Health, The University of Western Australia, time to intervene and modify EM use before significant
Perth, Australia. Knuiman is with the School of Population increases occur26 and adverse health effects develop.
Health, The University of Western Australia, Perth, Australia. As EM use mainly occurs at home, the family home
Timperio is with the School of Exercise and Nutrition Sciences, environment may be an important setting for the develop-
Deakin University, Burwood, Australia. ment of electronic-based sedentary behavior. Most homes
613
614 Granich et al
are media-rich environments, with nearly all households Measures and Test-Retest Reliability
having access to a TV. In the US, the average home has
4 TV sets.27 Of the homes with multiple TV sets, 66% The development of the questionnaire was based on
have 1 TV set in a child’s bedroom.27 In Australia, 60% of data generated from a qualitative study,37 items used in
households have 2 or more TV sets28 and approximately a descriptive study investigating children’s leisure activi-
30% of 10 to 12 year-olds have a TV in their bedroom.17 ties17,38 as well as literature on sedentary behavior and
Furthermore, 80% of Australian 10- to 14-year-olds have socioecological constructs.32,33 Test-retest reliability was
at least 1 video/computer game and about 30% of children established by administering the survey twice, 10 days
have 3 or more electronic devices at their disposal.16,17 apart among a subsample of 143 adolescents. Intraclass
An EM-filled home is highly associated with screen time correlation coefficients (ICC) were calculated for ordinal
and body mass index (BMI) among children.17 and continuous variables,39 while Kappa values and per-
The family home is a setting where EM use, particu- cent agreement were calculated for nominal variables.40
larly TV viewing, is prevalent and forms part of families’
day-to-day leisure time.29 Previous studies have identified Electronic Media Use
a broad range of predictors of TV viewing or overall
Children were asked to report the total time per day (in
screen time among young children and adolescents,
hours or minutes) they spent in 5 EM activities on a
including gender,2,4 sociodemographics,7,17 child’s weight
typical school day (outside school hours) and a typical
status2,7,24 and adiposity,4 availability and accessibility of
weekend day: TV viewing, watching videos/DVD, using
electronic devices,13,17,30 physical activity,4,7,12,17,29 poor
a computer for fun, using a computer for homework, and
dietary intake,12,30 paternal BMI,7 lack of restriction
playing electronic games (hand-held and those that hook
over TV use,13,17 coviewing with family and friends,29,31
up to a TV set). This instrument was adapted from an
eating in front of TV,29 as well as parental and sibling TV
existing measure.41 Total duration of EM use per school
viewing habits.29,30 However, few studies have examined
day and per weekend day was computed. The test-retest
these influencing factors simultaneously.32–35 Even fewer
reliability (ICC) for total EM use was 0.78 for a typi-
have studied these influencing factors within the context
cal school day and 0.67 for a typical weekend day. The
of a school and a weekend day. It is possible that differ-
ICC’s for individual sedentary activities ranged from
ent factors may operate to influence EM on school and
0.51 to 0.76.
weekend days and such information is important for the
development of interventions. This study aimed to exam-
ine associations between individual, and home social Individual Measures
and physical electronic environment factors and EM use Participants were asked how frequently (ICC = 0.58)
among 11- to 12-year-old children. Identifying correlates and for how many hours (ICC = 0.84) they usually par-
of heavy EM use is likely to facilitate the development of ticipated in physical activity (PA) outside school hours
specific strategies to limit excessive EM use in children. (PA defined as ‘very active and out of breath or sweat’).
Participants were also asked where they usually watched
Methods TV (own bedroom, other bedroom, dining/meals room,
living/lounge/theater room: Kappa = 0.49; percent
Design agreement = 86%) and when they usually watched TV
on a typical school day (before and straight after school,
In this cross-sectional study, a self-administered question- during dinner, after dinner, late at night, Kappa = 0.41
naire and objective anthropometric measurements were to 0.72; percent agreement = 80% to 87%) and weekend
used to collect data from 11- to 12-year-olds (Grade 7). day (morning, lunchtime, afternoon, during dinner,
The data were collected between October and December after dinner, late at night: Kappa = 0.45 to 0.58; percent
2004. The study was approved by school Principals and agreement = 73% to 83%). Children were asked what
The University of Western Australia Human Research time they usually get home from school and responded
Ethics Committee. by providing the hour and minutes (ICC = 0.80). Outside
of main meals, snacking while watching TV was also
Sample Selection and Recruitment measured with a yes or no response category (Kappa =
0.76; percent agreement = 92%). Perceptions regarding
A postcode36 stratified random sample of 15 primary the amount of TV they watched (ICC = 0.60) and if a
(elementary) schools from metropolitan Perth, Western sitter (other than a family member) were usually present
Australia, were selected and all 11- to 12-year-olds (n = at home when they returned home from school (Kappa
553) at each of these school invited to participate in this = 0.56; percent agreement = 76%) were also assessed in
study. Participation was voluntary. The return of a signed the questionnaire.
informed consent form by the student and their primary Anthropometric measures were obtained by Level
carer was a requirement for participation and students 1 ISAK (International Society for the Advancement of
nominated their level of participation: questionnaire (54% Kinanthropometry) accredited technicians.42 All mea-
response rate) and/or anthropometric measurements (49% surements (height, weight, waist circumference, hip
response rate). circumference, and skinfolds) were taken using standard
Electronic Media Use Among Children 615
* t test analysis; significant differences between boys and girls, P < .05.
** t test analysis; significant differences between boys and girls, P < .01.
Table 2 Factors Associated With Level of Electronic Media Use on a School and Weekend Day; Table
Shows Mean for Quantitative Factors and Percent for Categorical Factors
Type of electronic media (EM) users
School day Weekend day
Light user Heavy user Light user Heavy user
Factors an = 155% an = 143% P an = 155% an = 143% P
Individual
Gender
Boy 44.5 54.5 0.08 39.4 60.1 0.00**
Girl 55.5 45.5 60.6 39.9
Socio-Economic Status (SES)+
Low SES 16.8 44.1 0.00** 23.9 36.4 0.05
Middle SES 29.0 28.7 30.3 27.3
High SES 54.2 27.3 45.8 36.4
Frequency of PA outside school hours
≤1 time per week 11.0 22.4 0.00** 14.2 18.9 0.15
2–3 times per week 31.0 37.1 31.0 37.1
4–6 times per week 40.0 23.8 38.1 25.9
Everyday 18.1 16.8 16.8 18.2
Duration of PA outside school hours
≤1 hour per week 12.3 23.1 0.13 16.1 18.9 0.51
2 hours per week 16.8 14.7 13.5 18.2
3 hours per week 14.8 16.8 18.7 12.6
4 hours per week 15.5 12.6 13.5 14.7
5 or more hours per week 40.6 32.9 38.1 35.7
616 (continued)
Table 2 (continued)
Type of electronic media (EM) users
School day Weekend day
Light user Heavy user Light user Heavy user
Factors an = 155% an = 143% P an = 155% an = 143% P
Where child usually watches TV
Own bedroom 7.1 16.1 0.01* 8.4 14.7 0.08
Elsewhere in the house 92.9 83.9 91.6 85.3
Time (pm) when child gets home from school 3.52 3.35 0.01* - - -
Sitter/carer (other than a family member) present
at home when child gets home from school
Yes 0.6 7.0 0.00** - - -
No 99.4 93.0 - - -
Period of the day when child usually watches TV
on a school day
Before school 37.1 62.9 0.00** - - -
After school 40.2 59.8 0.00** - - -
During dinner 42.2 57.8 0.00** - - -
After dinner 51.1 48.9 0.55 - - -
Late at night 34.2 65.8 0.00** - - -
Period of the day when child usually watches TV
on a weekend day
Morning - - - 50.3 49.7 0.48
Midday - - - 30.4 69.6 0.00**
During dinner - - - 46.0 54.0 0.07
After dinner - - - 39.8 60.2 0.00**
Late at night - - - 48.2 51.8 0.00**
Snacking while watching TV (outside of main meals)
Yes 67.1 79.7 0.01* 67.1 79.7 0.01*
No 32.9 20.3 32.9 20.3
Child’s perception about their quantity of TV viewing
Right amount 57.0 43.0 0.00** 55.1 44.9 0.04*
BMI 19.11 20.09 0.00** 19.41 19.77 0.33
Waist circumference (cm) 63.90 65.84 0.01* 64.69 64.99 0.70
Hip circumference (cm) 80.70 82.21 0.18 81.94 80.85 0.33
Skinfold score# (mm) 49.01 54.17 0.04* 52.02 50.90 0.66
Social
TV coviewing with mom
Sometimes 65.5 53.6 0.04* 56.3 45.2 0.06
Often 34.5 46.4 43.7 54.8
TV coviewing with dad
Sometimes 65.2 62.8 0.67 67.6 60.3 0.21
Often 34.8 37.2 32.4 39.7
TV coviewing with brother/s^
Sometimes 41.7 45.0 0.63 46.0 40.2 0.39
Often 58.3 55.0 54.0 59.8
TV coviewing with sister/sXXX
Sometimes 49.4 53.3 0.60 50.6 52.3 0.82
Often 50.6 46.7 49.4 47.7
Child (only) usually watches TV
during a main meal
Breakfast 32.7 67.3 0.00** 40.2 59.8 0.00**
Lunch - - - 33.3 66.7 0.00**
Dinner 45.2 54.8 0.02* 50.0 50.0 0.37
(continued)
617
Table 2 (continued)
Type of electronic media (EM) users
School day Weekend day
Light user Heavy user Light user Heavy user
Factors an = 155% an = 143% P an = 155% an = 143% P
Family usually watches TV during a main meal
Breakfast 27.9 72.1 0.00** 36.1 63.9 0.00**
Lunch 38.2 61.8 0.01** 42.6 57.4 0.08
Dinner 45.6 54.4 0.00** 48.5 51.5 0.15
Household rules about EM use
No TV before school only 69.4 30.6 0.00** - - -
No TV after school only 66.7 33.3 0.00** - - -
No TV before homework (hw) 61.5 38.5 0.00** 54.6 45.4 0.42
No late night TV 68.5 31.5 0.00** 53.7 46.3 0.66
Time limit on portable e-games 77.4 22.6 0.00** 64.2 35.8 0.00**
Time limit on TV-based e-games 61.8 38.2 0.00** 48.3 51.7 0.39
Time limit on PC use (minus hw) 66.0 34.0 0.00** 55.7 44.3 0.34
Time limit on playing PC games 69.8 30.2 0.00** 59.4 40.6 0.08
No PC or e-games before hw 60.0 40.0 0.00** 51.1 48.9 0.49
Frequency dad plays e-games
Never 84.7 69.0 0.00** 85.3 68.7 0.00**
Often‡ 15.3 31.0 14.7 31.3
Frequency mom plays e-games
Never 88.2 86.8 0.73 90.0 85.0 0.24
Often‡ 11.8 13.2 10.0 15.0
Frequency sister/sXXX plays e-games
Never 55.9 35.9 0.01** 52.9 38.2 0.07
Often‡ 44.1 64.1 47.1 61.8
Frequency brother/s^ plays e-games
Never 63.6 50.6 0.07 59.1 55.8 0.64
Often‡ 36.4 49.4 40.9 44.2
Physical
Number of electronic screen-based devices present
in child’s bedroom
None 38.5 0.00** 58.1 44.1 0.01**
1 21.7 22.6 20.3
2 14.7 6.5 14.7
3 or more 25.2 12.9 21.0
Internet access at home
Yes 78.3 0.00** 81.9 86.7 0.25
No 21.7 18.1 13.3
Pay TV access at home
Yes 27.3 0.42 21.3 29.4 0.10
No 72.7 78.7 70.6
Pay TV access in child’s bedroom
Yes 1.4 0.71 0.0 3.5 0.01**
No 98.6 100.0 96.5
a Type of electronic media user cut-points are based on this sample’s median for total time (mins) in EM. The cut point for a light EM user on a typical school day
is < 240.00 mins/day and a heavy EM user is > 240.01 mins. The cut-point for a light EM user on a typical weekend day is < 320.00 mins and for heavy EM user
it is >320.01 mins. * Significant differences between light and heavy EM users, P < .05. ** Significant differences between light and heavy EM users, P < .01.
+ Based on residential postcodes and classified according to SEIFA.36 # The skinfold score is a sum of 4 skinfold thickness’ (mm) taken on triceps, subscapular,
suprailiac and midabdominal body sites. ^ Only children who had a brother/s were used in this cross-tabulation. XXX Only children who had a sister/s were used
in this cross-tabulation. ‡ Collapsed category of ‘sometimes’ and ‘often’ as few response counts had less than 5 cases violating chi-square test assumption.
618
Electronic Media Use Among Children 619
620
Electronic Media Use Among Children 621
Figure 1 — Factors influencing children’s electronic-media use at home. * Variables showed a significant association with heavy
electronic media use at bivariate level (P < .05). ‡ Variables showed a significant association with heavy electronic media use at
multivariate level and adjusted for all variables significant (P < .05) in Table 2.
elsewhere.37,53,54 Frequency of physical activity (but not behaviors.55 Given that children who watched TV after
duration) was associated with EM use in the unadjusted school were more than twice as likely to be heavy EM
analysis. However, in the adjusted model physical activity users and that physical activity guidelines specifically
was no longer significant. This adds weight to the notion recommend that EM use for entertainment be limited
that sedentariness and physical activity are independent during daylight hours,15 and with the greatest range of
622 Granich et al
alternative activities (active or otherwise) is likely to be possibly due to the reinforcing nature of the behavior.
available during this time period, the after-school period Role modeling and reinforcement of EM use by other
is likely to be important. Focusing intervention efforts to family members were not significant in the final multivari-
reduce children’s EM use during this period of the school ate model. This is inconsistent with previous studies29,30,34
day may therefore be opportune. that have found role modeling and/or behavioral rein-
Despite school days posing a constraint on children’s forcement by family members (ie, parents and siblings)
leisure time, this study found a distinct pattern of EM use in general to be correlates of screen-related sedentary
where on a school day, heavy EM users were character- behavior, so this is worthy of further exploration.
ized by watching TV after school and also late into the In this study, BMI was the only index of adiposity
night. The presence of electronic devices in the bedroom significantly associated with heavy EM use in the mul-
appeared to be a consistent correlate of heavy screen-time tivariate model (for school day). This finding provides
use during a school day. Together these factors demon- additional support for the need to intervene to reduce
strate that encouraging parents to either remove or avoid the amount of time children spend using EM for enter-
placing TVs and other electronic devices in children’s tainment given that overweight children are likely to
bedrooms, and providing alternative opportunities to remain overweight as they age,56,57 and the significant
screen-based activities, particularly after school, may health implications associated with overweight during
by important. Removing EM equipment from children’s youth5,25,45,58,59 and later in life.7,60 Compared with other
bedrooms may also reduce the likelihood of watching TV studies investigating correlates of EM use in youth3,29,35
late into the night and may allow parents to have more this study examined the widest range of anthropomet-
control over their children’s EM use. In support of this, ric measures (BMI, waist and hip circumference, and
rules restricting children’s TV viewing late into the night skinfold score) with EM use. Although, no relationship
and placing time limits on personal computer games were between TV viewing and most of the body fatness indices
independently associated with lower likelihood of school apart from BMI was found (data not shown), the signifi-
day heavy EM use. This highlights that parental guidance cant relationship between BMI and EM is consistent with
and enforcement of rules is likely to be an important part other studies3,6 and supports the notion that TV viewing
of efforts to reduce children’s EM use. Previous research alone may not be an ideal single marker of sedentariness.3
has also found associations between home rules, EM use, The high screen time found by this study is also
and children’s screen-based behavior.13,17,34,38,61 House- alarming but notably, this study is one of few17,20,21 that
hold rules, however, were not associated with EM use has comprehensively included a range of different screen-
on the weekend in the multivariate model in this study. based activities. This study measured 5 distinct types of
This may be because rules are less likely to be enforced sedentary screen-based activities (ie, TV only, Video/
by parents on weekends, which may be viewed as more DVD, computer use for fun, electronic games) including
leisurely and as ‘time-out.’ This assumption is supported computer use for homework as part of the overall EM use
by the greater amount of EM use reported by participants prevalence estimate. Therefore, it is plausible that this
on a weekend day compared with a school day. While may accounted for the difference in time spent with EM
introducing household rules regarding EM use is impor- compared with other studies18,47–49 as it captured greater
tant, upholding such rules in these circumstances may range of electronic mediums that children engage with
be challenging. Therefore, a consistent enforcement of and thus higher amount of screen time.
rules may be necessary for the sustainability of home Limitations of this study included the cross-sectional
EM use rules. study design (which limits inferences about causality) and
A similar pattern of TV viewing during meal times the reliance on self-report measures that had generally
was observed by school (breakfast) and weekend (lunch) not been validated (which may result in bias). It is also
days among heavy EM users. This presents as another plausible that the general high level of EM use reported
opportunity for parents to reduce their children’s screen- in this study may have been overestimated by some
based behavior. Watching TV during meals has been children and it is possible that the truncation of extreme
linked with overweight and obesity.29,50 Although TV values at the 95th percentile to reduce their influence
viewing during meals may be a secondary task, it may in the bivariate and multivariate analysis may not have
contribute to high overall EM use by leading to extended fully accommodated this over-reporting bias. In addition,
viewing before and after meals. Meal time viewing may quarter of the sample had missing data for variables of
also encourage viewing at other times since TV and interest, necessitating the imputation of missing values so
what type of program is on TV can often be a point of as to minimize the impact of missing data in the overall
distractibility.62 Encouraging parents to remove TV as a analyses. This has been accommodated using a simple
focal point during meal times may be an important tool imputation method. Further, numerous statistical tests
for further reducing children’s screen time. were conducted in this study which may have led to bias
Coviewing of TV with mother but not other family and false-positive errors in the bivariate analysis. How-
members (ie, father or siblings) was found to be inde- ever, this is unlikely at the final multivariate level as most
pendently associated with heavy EM use on a school day, of the variables that remained were significant at P < .01.
Electronic Media Use Among Children 623
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