Prevalence of Preschoolers Meeting vs Exceeding Screen Time Guidelines

Global debates among researchers, clinicians, policy makers, and parents on the benefits vs consequences of children’s screen time exposure are ubiquitous. Research suggests that excessive screen time is likely consequential for early child development and health.^1,2 Accordingly, the World Health Organization and various pediatric societies have issued guidelines on screen time, suggesting that preschoolers receive no more than 1 hour of high-quality programming daily.³ To inform policy and educational initiatives, the objectives of this study were 2-fold: (1) determine the prevalence of children ages 2 and 3 years meeting vs exceeding screen time guidelines and (2) determine the strongest individual and family-level factors associated with failing to meet these guidelines.

Longitudinal data from the All Our Families study were used and collected from 2011 to 2014. Sample characteristics can be found in Table 1 and elsewhere.¹ This study was approved by the University of Calgary Conjoint Health research ethics board. Written informed consent was obtained. Consistent with previous research, we tested the most commonly examined factors associated with screen time usage in young children, including number of children in the home, the year of data collection, child sex, single vs dual parent household, family income, child sleep and physical activity, childcare arrangements, and maternal screen time use. See Table 1 for the variable operationalization.

Descriptive analyses as to meeting vs exceeding guidelines were conducted using SPSS, version 25 (IBM). At ages 2 and 3 years, 1595 and 1994 children were available for analyses, respectively. To examine factors associated with exceeding screen time guidelines, logistic regressions were performed in MPlus, version 8.0 using full information maximum likelihood. Odds ratios (ORs) and 95% confidence intervals are presented. Statistical significance was set at P < .05.

Most children did not meet screen time guidelines at ages 2 years (1266 [79.4%]) or 3 years (1889 [94.7%]). As detailed in Table 2, at age 2 years, factors that were significantly associated with exceeding the screen time guidelines were maternal screen time (OR, 2.75; 95% CI, 1.64-4.61), being cared for at home vs in day care (OR, 1.67; 95% CI, 1.30-2.19), and the year of data collection (OR, 1.33; 95% CI, 1.09-1.62). At age 3 years, only maternal screen time was significant (OR, 3.02; 95% CI, 1.10-8.27).

Study findings indicate that most preschoolers are not meeting screen time guidelines.³ The outcome most consistently associated with exceeding guidelines was maternal screen time use, which remained significant after accounting for all other factors at both ages. At age 2 years, additional factors were the year of data collection, likely because of the rapid rise and accessibility of digital platforms, and, consistent with previous research, being cared for at home (vs day care) where screens may be more accessible. Fewer associations at age 3 vs 2 years could be attributed to the small number of preschoolers meeting the guidelines at age 3 years (105 [5%]).

Findings from the current study have significant implications for health initiatives and educational campaigns aiming to reduce screen time exposure in preschool-aged children. To do so effectively, it will be important to consider the family media ecology.⁴ In high screen-viewing families, it may be difficult for parents to implement screen time guidelines without a supportive approach. Accordingly, it will be important to work together with families to devise family media plans that can be effectively implemented.⁵ This includes promoting opportunities for joint media engagement; deciding when, where, and how often screens are used; and reinforcing the need for sleep, physical activity, and device-free interactions to be prioritized to optimize child development. It is also incumbent on those in policy and practice to continue to advocate for increased transparency and regulations in media platforms and designs.⁶ The limitations of this study include the use of maternal self-report and the lack of information on how screen time was used (eg, solitary or coviewed). Initiatives to track screen time using diary methods could be adopted in future research to address these limitations.

Corresponding Author: Sheri Madigan, PhD, Department of Psychology, University of Calgary, 2500 University Ave, Calgary, AB T2N 1N4, Canada (sheri.madigan@ucalgary.ca).

Published Online: November 25, 2019. doi:10.1001/jamapediatrics.2019.4495

Author Contributions: Drs Madigan and Racine had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Madigan.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Madigan, Racine.

Critical revision of the manuscript for important intellectual content: Racine, Tough.

Statistical analysis: Madigan, Racine.

Obtained funding: Tough.

Administrative, technical, or material support: Tough.

Supervision: Madigan, Tough.

Conflict of Interest Disclosures: None reported.

Funding/Support: The All Our Families study was supported by Alberta Innovates Health Solutions Interdisciplinary Team grant 200700595 (principal investigator, Dr Tough). Research support was provided to Dr Madigan by the Alberta Children’s Hospital Foundation and the Canada Research Chairs program. Dr Racine was supported by a Postdoctoral Trainee Award from the Alberta Children’s Hospital Research Institute, the Cumming School of Medicine, and the Social Sciences and Humanities Research Council. Dr Tough was supported through an Alberta Innovates Health Solutions Health Scholar award.

Role of the Funder/Sponsor:The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: The authors acknowledge the All Our Families research team and thank the compensated participants who took part in the study.