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    Original Investigation
    Pediatrics
    February 5, 2020

    Association of Parental and Contextual Stressors With Child Screen Exposure and Child Screen Exposure Combined With Feeding

    Author Affiliations
    • 1Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
    • 2Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
    • 3Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
    • 4Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
    • 5Sick Kids Research Institute, Toronto, Ontario, Canada
    • 6Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    • 7Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
    • 8Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
    • 9Department of Pediatrics, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
    • 10Paediatric Outcomes Research Team, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
    • 11Centre for Addiction and Mental Health, Department of Psychiatry, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
    JAMA Netw Open. 2020;3(2):e1920557. doi:10.1001/jamanetworkopen.2019.20557
    Key Points español 中文 (chinese)

    Question  Are individual and contextual stressors associated with the use and duration of screen time and screen time combined with food in children aged 7 to 18 months?

    Findings  In this cross-sectional, population-based study of 1085 children, higher levels of parenting stress and lower household income were associated with increased child screen exposure, whereas higher parenting stress levels and older child age, but not income, were associated with child screen exposure. Only lower household income was associated with increased child screen exposure with feeding, whereas both lower household income and older child age were associated with child screen exposure with feeding.

    Meaning  Findings of this study suggest that individual stressors, including higher parenting stress, and contextual stressors, including lower household income, were associated with pervasive screen exposure variables in children aged 7 to 18 months.

    Abstract

    Importance  Parents may use screen exposure or screen exposure combined with feeding for infants and toddlers to alleviate their own stress.

    Objective  To evaluate the association of individual and contextual stressors with child screen exposure (CSE) and CSE combined with feeding (CSE+F) in children aged 7 to 18 months as measured by parent-reported use and variation in quantity of CSE and CSE+F.

    Design, Setting, and Participants  This cross-sectional, population-based study drew parent-child participants from TARGet Kids, a network of primary health care research settings throughout Toronto, Ontario, Canada, between November 1, 2011, and July 31, 2018. The included children were aged 7 to 18 months. Exclusion criteria were health conditions affecting growth, acute conditions, chronic conditions, severe developmental delay, and families who were unable to communicate in the English language. Data were analyzed from April 1, 2019, to July 31, 2019.

    Exposures  Parenting stress, child age, child negative affectivity, family living arrangements, and family income were assessed with parent-completed questionnaires.

    Main Outcomes and Measures  The primary outcome was CSE and the variation in CSE, which represented the amount of background and engaged use of screens (television, videos or DVDs, video games, computers, and mobile devices) in a typical week. The secondary outcome was CSE+F, which represented the frequency of breakfast, lunch, dinner, and snack consumption during screen exposure in a typical week. Both CSE and CSE+F were assessed with the parent-completed Nutrition and Health Questionnaire; Infant Behavior Questionnaire, Revised Very Short; and Parenting Stress Index, Short Form.

    Results  The final sample size was 1085 children for the analysis of CSE and 1083 children for the analysis of CSE+F. Among 914 respondents, the children’s mean (SD) age was 11.6 (2.3) months, and 478 (52.3%) were male. Among 910 respondents, 839 (92.2%) were mothers, with a mean (SD) age among 873 respondents of 34.4 (4.2) years. In a typical week, 581 of 779 children (74.6%) were reported to have any CSE, and 321 of 874 children (36.7%) had some CSE+F. Higher parenting stress levels (odds ratio [OR], 1.01; 95% CI, 1.00-1.02; P = .04) and older child age (OR, 1.43; 95% CI, 1.01-2.03; P = .04) were associated with CSE. Higher parenting stress levels (incidence rate [IR], 1.00; 95% CI, 1.00-1.01; P = .002) and lower household income (IR, 1.26; 95% CI, 1.10-1.45; P = .01) were associated with increased CSE. Older child age (OR, 1.79; 95% CI, 1.35-2.38; P < .001) and lower household income (OR, 2.54; 95% CI, 1.72-3.74; P < .001) were associated with CSE+F. Lower household income (IR, 1.21; 95% CI, 1.03-1.42; P = .02) was associated with increased CSE+F.

    Conclusions and Relevance  This study found that parenting stress, income, and child age were associated with CSE, and child age and household income were associated with CSE+F. Given these findings, interventions to improve parental coping mechanisms may decrease child screen exposure.

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