Skip to main content
Top
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

Reducing electronic media use in 2–3 year-old children: feasibility and efficacy of the Family@play pilot randomised controlled trial

Authors: Trina Hinkley, Dylan P. Cliff, Anthony D. Okely

Published in: BMC Public Health | Issue 1/2015

Login to get access

Abstract

Background

Participation in electronic media use among 2–3 year olds is high and associated with adverse health and developmental outcomes. This study sought to test the feasibility and potential efficacy of a family-based program to decrease electronic media (EM) use in 2–3-year-old children.

Methods

Family@play was a six-session pilot randomised controlled trial delivered to parents of 2–3 year-old children from August to September 2012 in a community environment in the Illawarra region of New South Wales, Australia. Development of program content was guided by Social Cognitive and Family Systems Theories. The primary outcome was children’s electronic media use. Secondary outcomes included children’s time in sitting, standing and stepping. Data collectors were blinded to group allocation. Parents completed comprehensive process evaluation measures and participated in focus group discussions following completion of the program. Regression analyses were undertaken and effect sizes calculated using principles of intention to treat.

Results

Twenty-two participants (n = 12 intervention; n = 10 control) provided complete baseline data; complete data from 16 participants (n = 6 intervention; n = 10 control) were available post-intervention. Process evaluation results were high, showing the acceptability of the program. Compared with children in the control group, there were greater decreases in total EM use among children in the intervention group (adjusted difference [95 % CI] = −31.2 mins/day [−71.0–8.6] Cohen’s d = 0.70). Differences for other outcomes were in the hypothesised direction and ranged from small for postural (sitting, standing, stepping) outcomes to moderate to large for individual electronic media (e.g. TV viewing, DVD/video viewing).

Conclusions

This is the first family-based study to engage families of 2–3 year old children outside the United States and target multiple EM behaviours. Family@play was shown to be a feasible and acceptable intervention to deliver to families of 2–3 year old children. Potential efficacy is evident from moderate to large effect sizes. A larger trial is warranted to test the efficacy of the program.

Trial registration

Australian New Zealand Clinical Trials Registry (ACTRN12612000470​897).
Literature
1.
go back to reference American Academy of Pediatrics Committee on Public Education. Children, adolescents, and television. Pediatrics. 2001;107:423–6.CrossRef American Academy of Pediatrics Committee on Public Education. Children, adolescents, and television. Pediatrics. 2001;107:423–6.CrossRef
2.
go back to reference Reilly JJ. Physical activity, sedentary behaviour and energy balance in the preschool child: opportunities for early obesity prevention. Proc Nutr Soc. 2008;67:317–25.CrossRefPubMed Reilly JJ. Physical activity, sedentary behaviour and energy balance in the preschool child: opportunities for early obesity prevention. Proc Nutr Soc. 2008;67:317–25.CrossRefPubMed
3.
go back to reference Mistry KM, Minkovitz CS, Strobino DM, Borzekowski DLG. Children’s television exposure and behavioural and social outcomes at 5.5 years: Does timing of exposure matter? Pediatrics. 2007;120:762–9.CrossRefPubMed Mistry KM, Minkovitz CS, Strobino DM, Borzekowski DLG. Children’s television exposure and behavioural and social outcomes at 5.5 years: Does timing of exposure matter? Pediatrics. 2007;120:762–9.CrossRefPubMed
4.
go back to reference Anderson DR, Pempek TA. Television and very young children. Am Behav Sci. 2005;48:505–22.CrossRef Anderson DR, Pempek TA. Television and very young children. Am Behav Sci. 2005;48:505–22.CrossRef
5.
go back to reference Lobo YB, Winsler A. The effects of a creative dance and movement program on the social competence of Head Start preschoolers. Soc Dev. 2006;15:501–19.CrossRef Lobo YB, Winsler A. The effects of a creative dance and movement program on the social competence of Head Start preschoolers. Soc Dev. 2006;15:501–19.CrossRef
6.
go back to reference Tremblay MS, Leblanc AG, Carson V, Choquette L, Connor Gorber S, Dillman C, et al. Canadian sedentary behaviour guidelines for the early years (aged 0–4 years). Appl Physiol Nutr Metab. 2012;37:370–80.CrossRefPubMed Tremblay MS, Leblanc AG, Carson V, Choquette L, Connor Gorber S, Dillman C, et al. Canadian sedentary behaviour guidelines for the early years (aged 0–4 years). Appl Physiol Nutr Metab. 2012;37:370–80.CrossRefPubMed
8.
go back to reference Dennison BA, Erb TA, Jenkins PL. Television viewing and television in bedroom associated with overweight risk among low-income preschool children. Pediatrics. 2002;109:1028–35.CrossRefPubMed Dennison BA, Erb TA, Jenkins PL. Television viewing and television in bedroom associated with overweight risk among low-income preschool children. Pediatrics. 2002;109:1028–35.CrossRefPubMed
9.
go back to reference Australian Bureau of Statistics, Physical Activity 2011–2012. Australian health survey: physical activity 2011–2012. In: Book Australian Health Survey. City: Australian: Bureau of Statistics; 2013. Australian Bureau of Statistics, Physical Activity 2011–2012. Australian health survey: physical activity 2011–2012. In: Book Australian Health Survey. City: Australian: Bureau of Statistics; 2013.
10.
go back to reference Hinkley T, Salmon J, Okely AD, Crawford D, Hesketh K. Preschoolers’ physical activity, screen time, and compliance with recommendations. Med Sci Sports Exerc. 2012;44:458–65.CrossRefPubMed Hinkley T, Salmon J, Okely AD, Crawford D, Hesketh K. Preschoolers’ physical activity, screen time, and compliance with recommendations. Med Sci Sports Exerc. 2012;44:458–65.CrossRefPubMed
11.
go back to reference Beets MW, Bornstein D, Dowda M, Pate RR. Compliance with national guidelines for physical activity in U.S. preschoolers: measurement and interpretation. Pediatrics. 2011;127:658–64.CrossRefPubMedPubMedCentral Beets MW, Bornstein D, Dowda M, Pate RR. Compliance with national guidelines for physical activity in U.S. preschoolers: measurement and interpretation. Pediatrics. 2011;127:658–64.CrossRefPubMedPubMedCentral
12.
go back to reference Cardon G, De Bourdeaudhuij I. Are preschool children active enough? Objectively measured physical activity levels. Res Q Exerc Sport. 2008;79:326–32.CrossRefPubMed Cardon G, De Bourdeaudhuij I. Are preschool children active enough? Objectively measured physical activity levels. Res Q Exerc Sport. 2008;79:326–32.CrossRefPubMed
13.
go back to reference Network SBR. Standardized use of the terms “sedentary” and “sedentary behaviours”. Appl Physiol Nutr Metab. 2012;37:540–2.CrossRef Network SBR. Standardized use of the terms “sedentary” and “sedentary behaviours”. Appl Physiol Nutr Metab. 2012;37:540–2.CrossRef
14.
go back to reference de Rezende LFM, Lopes MR, Rey-Lopez JP, Matsudo VKR, Luiz OC. Sedentary behavior and health outcomes: an overview of systematic reviews. PLoS One. 2014;9:e105620.CrossRefPubMedPubMedCentral de Rezende LFM, Lopes MR, Rey-Lopez JP, Matsudo VKR, Luiz OC. Sedentary behavior and health outcomes: an overview of systematic reviews. PLoS One. 2014;9:e105620.CrossRefPubMedPubMedCentral
15.
go back to reference Pearson N, Biddle SJ. Sedentary behavior and dietary intake in children, adolescents, and adults. A systematic review. Am J Prev Med. 2011;41:178–88.CrossRefPubMed Pearson N, Biddle SJ. Sedentary behavior and dietary intake in children, adolescents, and adults. A systematic review. Am J Prev Med. 2011;41:178–88.CrossRefPubMed
16.
go back to reference Certain LK, Kahn RS. Prevalence, correlates, and trajectory of television viewing among infants and toddlers. Pediatrics. 2002;109:634–42.CrossRefPubMed Certain LK, Kahn RS. Prevalence, correlates, and trajectory of television viewing among infants and toddlers. Pediatrics. 2002;109:634–42.CrossRefPubMed
17.
go back to reference Jones RA, Hinkley T, Okely AD, Salmon J. Tracking physical activity and sedentary behavior in childhood: a systematic review. Am J Prev Med. 2013;44:651–8.CrossRefPubMed Jones RA, Hinkley T, Okely AD, Salmon J. Tracking physical activity and sedentary behavior in childhood: a systematic review. Am J Prev Med. 2013;44:651–8.CrossRefPubMed
18.
go back to reference Janz KF, Burns TL, Levy SM. Tracking of activity and sedentary behaviors in childhood: the Iowa Bone Development Study. Am J Prev Med. 2005;29:171–8.CrossRefPubMed Janz KF, Burns TL, Levy SM. Tracking of activity and sedentary behaviors in childhood: the Iowa Bone Development Study. Am J Prev Med. 2005;29:171–8.CrossRefPubMed
19.
go back to reference Schmidt ME, Haines J, O’Brien A, McDonald J, Price S, Sherry B, et al. Systematic review of effective strategies for reducing screen time among young children. Obesity (Silver Spring). 2012;20:1338–54.CrossRef Schmidt ME, Haines J, O’Brien A, McDonald J, Price S, Sherry B, et al. Systematic review of effective strategies for reducing screen time among young children. Obesity (Silver Spring). 2012;20:1338–54.CrossRef
20.
go back to reference Essery EV, DiMarco NM, Rich SS, Nichols DL. Mothers of preschoolers report using less pressure in child feeding situations following a newsletter intervention. J Nutr Educ Behav. 2008;40:110–5.CrossRefPubMed Essery EV, DiMarco NM, Rich SS, Nichols DL. Mothers of preschoolers report using less pressure in child feeding situations following a newsletter intervention. J Nutr Educ Behav. 2008;40:110–5.CrossRefPubMed
21.
go back to reference Vandewater EA, Rideout VJ, Wartella EA, Huang X, Lee JH, Shim M. Digital childhood: electronic media and technology use among infants, toddlers, and preschoolers. Pediatrics. 2007;119:e1006–15.CrossRefPubMed Vandewater EA, Rideout VJ, Wartella EA, Huang X, Lee JH, Shim M. Digital childhood: electronic media and technology use among infants, toddlers, and preschoolers. Pediatrics. 2007;119:e1006–15.CrossRefPubMed
22.
go back to reference Evans CA, Jordan AB, Horner J. Only two hours? : A qualitative study of the challenges parents perceive in restricting child television time. J Fam Issues. 2011;32:1223.CrossRef Evans CA, Jordan AB, Horner J. Only two hours? : A qualitative study of the challenges parents perceive in restricting child television time. J Fam Issues. 2011;32:1223.CrossRef
23.
go back to reference Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol. 2010;63:e1-37.CrossRefPubMed Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol. 2010;63:e1-37.CrossRefPubMed
24.
go back to reference Bandura A. Social foundations of thought and action: A social cognitive theory. Prentice-Hall, Inc: Englewood Cliffs, NJ; 1986. Bandura A. Social foundations of thought and action: A social cognitive theory. Prentice-Hall, Inc: Englewood Cliffs, NJ; 1986.
25.
go back to reference Tey C, Wake M, Campbell M, Hampton A, Williams J. The light time-Use diary and preschool activity patterns: exploratory study. Int J Pediatr Obesity. 2007;2:167–73.CrossRef Tey C, Wake M, Campbell M, Hampton A, Williams J. The light time-Use diary and preschool activity patterns: exploratory study. Int J Pediatr Obesity. 2007;2:167–73.CrossRef
26.
go back to reference Nunnally JC. Psychometric theory. New York: McGraw-Hill; 1978. Nunnally JC. Psychometric theory. New York: McGraw-Hill; 1978.
27.
go back to reference Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60:34–42.CrossRefPubMed Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60:34–42.CrossRefPubMed
28.
go back to reference Janssen X, Cliff DP, Reilly JJ, Hinkley T, Jones RA, Batterham M, et al. Validation and calibration of the activPAL™ for estimating METs and physical activity in 4-6 year olds. J Sci Med Sport. 2014;17(6):602–06. Janssen X, Cliff DP, Reilly JJ, Hinkley T, Jones RA, Batterham M, et al. Validation and calibration of the activPAL™ for estimating METs and physical activity in 4-6 year olds. J Sci Med Sport. 2014;17(6):602–06.
29.
go back to reference Janssen X, Cliff DP, Reilly JJ, Hinkley T, Jones RA, Batterham M, et al. Validation of activPAL Defined Sedentary Time and Breaks in Sedentary Time in 4–6-Year-Olds. Pediatr Exerc Sci. 2014;26:110–7.CrossRefPubMed Janssen X, Cliff DP, Reilly JJ, Hinkley T, Jones RA, Batterham M, et al. Validation of activPAL Defined Sedentary Time and Breaks in Sedentary Time in 4–6-Year-Olds. Pediatr Exerc Sci. 2014;26:110–7.CrossRefPubMed
30.
go back to reference Davies G, Reilly JJ, McGowan AJ, Dall PM, Granat MH, Paton JY. Validity, practical utility, and reliability of the activPAL in preschool children. Med Sci Sports Exerc. 2012;44:761–8.CrossRefPubMed Davies G, Reilly JJ, McGowan AJ, Dall PM, Granat MH, Paton JY. Validity, practical utility, and reliability of the activPAL in preschool children. Med Sci Sports Exerc. 2012;44:761–8.CrossRefPubMed
31.
go back to reference Finney JW, Mitchell RE, Cronkite RC, Moos RH. Methodological issues in estimating main and interactive effects: examples from coping/social support and stress field. J Health Soc Behav. 1984;25:85–98.CrossRefPubMed Finney JW, Mitchell RE, Cronkite RC, Moos RH. Methodological issues in estimating main and interactive effects: examples from coping/social support and stress field. J Health Soc Behav. 1984;25:85–98.CrossRefPubMed
32.
go back to reference Rogosa D. Comparing nonparallel regression lines. Psychol Bull. 1980;88:307–21.CrossRef Rogosa D. Comparing nonparallel regression lines. Psychol Bull. 1980;88:307–21.CrossRef
33.
go back to reference Aiken LS, West SG. Multiple regression: testing and interpreting interactions. Newbury Park, California: Sage Publications; 1991. Aiken LS, West SG. Multiple regression: testing and interpreting interactions. Newbury Park, California: Sage Publications; 1991.
34.
go back to reference Kraemer HC, Blasey CM. Centring in regression analyses: a strategy to prevent errors in statistical inference. Int J Methods Psychiatr Res. 2004;13:141–51.CrossRefPubMed Kraemer HC, Blasey CM. Centring in regression analyses: a strategy to prevent errors in statistical inference. Int J Methods Psychiatr Res. 2004;13:141–51.CrossRefPubMed
35.
go back to reference Robinson TN, Matheson DM, Kraemer HC, Wilson DM, Obarzanek E, Thompson NS, et al. A randomized controlled trial of culturally tailored dance and reducing screen time to prevent weight gain in Low-income African American girls: Stanford GEMS. Arch Pediatr Adolesc Med. 2010;164:995–1004.CrossRefPubMedPubMedCentral Robinson TN, Matheson DM, Kraemer HC, Wilson DM, Obarzanek E, Thompson NS, et al. A randomized controlled trial of culturally tailored dance and reducing screen time to prevent weight gain in Low-income African American girls: Stanford GEMS. Arch Pediatr Adolesc Med. 2010;164:995–1004.CrossRefPubMedPubMedCentral
36.
go back to reference Robinson TN, Borzekowski DLG. Effects of the SMART classroom curriculum to reduce child and family screen time. J Commun. 2006;56:1–26.CrossRef Robinson TN, Borzekowski DLG. Effects of the SMART classroom curriculum to reduce child and family screen time. J Commun. 2006;56:1–26.CrossRef
37.
go back to reference Cohen D. Statistical power analysis for the behavioral sciences. 2nd ed. Lawrence Earlbaum Associates: Hillsdale, NJ; 1988. Cohen D. Statistical power analysis for the behavioral sciences. 2nd ed. Lawrence Earlbaum Associates: Hillsdale, NJ; 1988.
38.
go back to reference Robinson TN. Reducing children’s television viewing to prevent obesity: a randomized controlled trial. JAMA. 1999;282:1561–7.CrossRefPubMed Robinson TN. Reducing children’s television viewing to prevent obesity: a randomized controlled trial. JAMA. 1999;282:1561–7.CrossRefPubMed
39.
go back to reference Christakis DA. Interactive media use at younger than the age of 2 years: Time to rethink the american academy of pediatrics guideline? JAMA Pediatrics. 2014;168(5):399–400. Christakis DA. Interactive media use at younger than the age of 2 years: Time to rethink the american academy of pediatrics guideline? JAMA Pediatrics. 2014;168(5):399–400.
40.
go back to reference Fitzgibbon ML, Stolley MR, Schiffer LA, Braunschweig CL, Gomez SL, Van Horn L, et al. Hip-hop to health Jr. Obesity prevention effectiveness trial: Postintervention results. Obesity. 2011;19:994–1003.CrossRefPubMed Fitzgibbon ML, Stolley MR, Schiffer LA, Braunschweig CL, Gomez SL, Van Horn L, et al. Hip-hop to health Jr. Obesity prevention effectiveness trial: Postintervention results. Obesity. 2011;19:994–1003.CrossRefPubMed
41.
go back to reference Hinkley T, Salmon J, Okely AD, Crawford D, Hesketh K. Influences on preschool children’s physical activity: exploration through focus groups. Fam Community Health. 2011;34:39–50.CrossRefPubMed Hinkley T, Salmon J, Okely AD, Crawford D, Hesketh K. Influences on preschool children’s physical activity: exploration through focus groups. Fam Community Health. 2011;34:39–50.CrossRefPubMed
42.
go back to reference Epstein LH, Roemmich JN, Robinson JL, Paluch RA, Winiewicz DD, Fuerch JH, et al. A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children. Arch Pediatr Adolesc Med. 2008;162:239–45.CrossRefPubMedPubMedCentral Epstein LH, Roemmich JN, Robinson JL, Paluch RA, Winiewicz DD, Fuerch JH, et al. A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children. Arch Pediatr Adolesc Med. 2008;162:239–45.CrossRefPubMedPubMedCentral
43.
go back to reference Dennison B, Russo T, Burdick P, Jenkins P. An intervention to reduce television viewing by preschool children. Arch Pediatr Adolesc Med. 2004;158:170–6.CrossRefPubMed Dennison B, Russo T, Burdick P, Jenkins P. An intervention to reduce television viewing by preschool children. Arch Pediatr Adolesc Med. 2004;158:170–6.CrossRefPubMed
44.
go back to reference Leblanc AG, Spence JC, Carson V, Connor Gorber S, Dillman C, Janssen I, et al. Systematic review of sedentary behaviour and health indicators in the early years (aged 0–4 years). Appl Physiol Nutr Metab. 2012;37:753–72.CrossRefPubMed Leblanc AG, Spence JC, Carson V, Connor Gorber S, Dillman C, Janssen I, et al. Systematic review of sedentary behaviour and health indicators in the early years (aged 0–4 years). Appl Physiol Nutr Metab. 2012;37:753–72.CrossRefPubMed
45.
go back to reference Brown H, Hume C, Pearson N, Salmon J. A systematic review of intervention effects on potential mediators of children’s physical activity. BMC Public Health. 2013;13:165.CrossRefPubMedPubMedCentral Brown H, Hume C, Pearson N, Salmon J. A systematic review of intervention effects on potential mediators of children’s physical activity. BMC Public Health. 2013;13:165.CrossRefPubMedPubMedCentral
46.
go back to reference Hinkley T, Salmon J, Okely AD, Crawford D. The correlates of preschoolers’ compliance with screen recommendations exist across multiple domains. Prev Med. 2013;57:212–9.CrossRefPubMed Hinkley T, Salmon J, Okely AD, Crawford D. The correlates of preschoolers’ compliance with screen recommendations exist across multiple domains. Prev Med. 2013;57:212–9.CrossRefPubMed
47.
48.
go back to reference Campbell KJ, Lioret S, McNaughton SA, Crawford DA, Salmon J, Ball K, et al. A parent-focused intervention to reduce infant obesity risk behaviors: a randomized trial. Pediatrics. 2013;131:652–60.CrossRefPubMed Campbell KJ, Lioret S, McNaughton SA, Crawford DA, Salmon J, Ball K, et al. A parent-focused intervention to reduce infant obesity risk behaviors: a randomized trial. Pediatrics. 2013;131:652–60.CrossRefPubMed
49.
go back to reference van der Ploeg HP, Merom D, Chau JY, Bittman M, Trost SG, Bauman AE. Advances in population surveillance for physical activity and sedentary behavior: reliability and validity of time Use surveys. Am J Epidemiol. 2010;172:1199–206.CrossRefPubMed van der Ploeg HP, Merom D, Chau JY, Bittman M, Trost SG, Bauman AE. Advances in population surveillance for physical activity and sedentary behavior: reliability and validity of time Use surveys. Am J Epidemiol. 2010;172:1199–206.CrossRefPubMed
50.
go back to reference Stevens J, Taber DR, Murray DM, Ward DS. Advances and controversies in the design of obesity prevention trials. Obesity (Silver Spring). 2007;15:2163–70.CrossRef Stevens J, Taber DR, Murray DM, Ward DS. Advances and controversies in the design of obesity prevention trials. Obesity (Silver Spring). 2007;15:2163–70.CrossRef
Metadata
Title
Reducing electronic media use in 2–3 year-old children: feasibility and efficacy of the Family@play pilot randomised controlled trial
Authors
Trina Hinkley
Dylan P. Cliff
Anthony D. Okely
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-2126-2

Other articles of this Issue 1/2015

BMC Public Health 1/2015 Go to the issue