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    Original Investigation
    November 25, 2019

    Association of Trajectory and Covariates of Children’s Screen Media Time

    Author Affiliations
    • 1Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Intramural Population Health Research, National Institutes of Health, Bethesda, Maryland
    • 2Glotech, Inc, Rockville, Maryland
    • 3Department of Environmental Health Sciences, Epidemiology and Biostatistics, University at Albany School of Public Health, Albany, New York
    • 4Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Albany, New York
    • 5Department of Pediatrics, New York University Langone, New York
    • 6Department of Environmental Medicine, New York University Langone, New York
    • 7Department of Population Health, New York University Langone, New York
    JAMA Pediatr. 2020;174(1):71-78. doi:10.1001/jamapediatrics.2019.4488
    Key Points

    Question  What are the trajectories and covariates associated with screen time among children aged 3 years and younger?

    Findings  In this cohort study of 3895 children aged 1 to 3 years with screen media time classified into trajectories of low and increasing use, higher parental educational levels and female child sex were associated with a lower risk of increasing trajectory, whereas maternal nulliparity was associated with a higher risk. Increasing trajectory status was associated with greater screen time at 8 years of age compared with the low trajectory.

    Meaning  This study suggests that screen time patterns are associated with several sociodemographic characteristics and may persist over childhood starting from a young age.


    Importance  Many children begin interacting with screen media as early as infancy. Although screen time is associated with negative developmental consequences, few longitudinal studies in the United States have examined covariates of screen time among children under 3 years of age.

    Objectives  To identify trajectories of screen time among children aged 1 to 3 years, to examine their association with screen use at 8 years of age, and to assess potential determinants of screen time.

    Design, Setting, and Participants  This prospective birth cohort study included 3895 children (3083 singletons and 812 unrelated multiples) in New York State who had screen time data available for at least 1 time point from 1 to 3 years of age; 1156 children had data at 8 years. The study spanned September 4, 2007, through June 12, 2014, in the first phase, and August 29, 2014, through November 15, 2019, in the second phase. Data analysis for the present study was conducted from September 28, 2018, to July 15, 2019.

    Main Outcomes and Measures  Maternal reports of children’s television, movie, and computer game times were summed for total daily screen time at 12, 18, 24, 30, and 36 months of age. Two screen time trajectories (low and increasing use) were classified by cluster analysis, and logistic regression was used to model risk factors for the increasing trajectory. Children exhibiting the highest 10th percentile of screen use at each point were examined, and linear mixed models were used to identify risk factors of this high exposure category.

    Results  Among the 3895 children included in the analysis (2031 boys [52.1%] and 1864 girls [47.9%]), median daily screen time increased from 30 (interquartile range, 0-60) minutes at 12 months of age to 120 (interquartile range, 75-200) minutes at 36 months of age. Of 1045 children with complete data at all 5 time points, 279 (26.7%) had an increasing screen time trajectory. Female child sex (adjusted odds ratio [aOR], 0.90; 95% CI, 0.81-0.99) and graduate school levels of paternal (aOR, 0.73; 95% CI, 0.56-0.95) and maternal (aOR, 0.60; 95% CI, 0.47-0.77) education, compared with having completed college, were associated with lower risk of increasing trajectory. Maternal nulliparity was associated with higher risk of increasing trajectory (aOR, 1.14; 95% CI, 1.00-1.30). Children with an increasing trajectory from 1 to 3 years of age had an additional 22 (95% CI, 11-33) minutes per day of screen time at 8 years of age. Covariates associated with the highest 10th percentile of screen exposure included paterman graduate school education compared with college (aOR, 0.63; 95% CI, 0.39-0.99), maternal graduate school education compared with college (aOR, 0.55; 95% CI, 0.37-0.82), maternal nulliparity (aOR, 1.98; 95% CI, 1.50-2.61), twins compared with singletons (aOR, 1.41; 95% CI, 1.05-1.91), non-Hispanic black compared with non-Hispanic white race/ethnicity (aOR, 4.77; 95% CI, 2.25-10.10), and type of care (home-based care aOR, 2.17 [95% CI, 1.38-3.41]; parental care aOR, 2.11 [95% CI, 1.41-3.15]) compared with center-based care.

    Conclusions and Relevance  These findings suggest that a range of parental and child characteristics are associated with screen time. Screen time habits appear to track from as early as infancy, emphasizing the need for earlier interventions.