Sociodemographic, home environment and parental influences on total and device-specific screen viewing in children aged 2 years and below: an observational study

Objective: This study aimed to investigate total and device-specific screen viewing (SV) and its determinants in children aged 2 years and below. Design: Cross-sectional study conducted in February 2014. Setting: Well-child clinics in Singapore national polyclinics. Participants: Parents of children (Singapore citizens or permanent residents) aged 2 years and below were enrolled during routine clinic visits. Out of 794 eligible parent-child dyads, 725 (91.3%) provided informed consent and were included in the analysis. Main outcome measures: Device-specific information on SV and determinants was ascertained using interviewer-administered survey questionnaires. The prevalence and duration of aggregate and device-specific SV were reported. Associations with potential determinants were investigated using multiple logistic regression analysis. A p value less than 0.05 was considered statistically significant. Results: The prevalence of daily SV and SV >= 2 h/day constituted 53.5% and 16.3%, respectively. The majority of children aged 18-24 months (88.2%) engaged in daily SV. TVs and mobile devices were the most commonly used screen devices, followed by computers and video consoles. In multivariable analysis, younger child age, Chinese ethnicity and setting rules on time of SV were strongly and consistently associated with lower levels of any SV and SV >= 2 h/day. Parental knowledge of SV recommendations and less parental SV were additionally associated with lower levels of SV >= 2 h/day. The number of screen devices was not associated with children's SV. Conclusions: In contrast to recommendations, SV prevalence in children aged less than 2 years is high and appears to increase steadily across age groups. TVs and mobile devices are most frequently used. Improving parental knowledge of SV recommendations, reducing parental SV and especially the implementation of strict rules on SV time could be successful strategies to reduce SV in young children.