title: The impact of a healthy media use intervention on sleep in preschool children.
abstract: BACKGROUND
  Although observational studies have consistently reported an association between media use and child sleep problems, it is unclear whether the relationship is causal or if an intervention targeting healthy media use can improve sleep in preschool-aged children.
  
  
  METHODS
  We conducted a randomized controlled trial of a healthy media use intervention in families of children aged 3 to 5 years. The intervention encouraged families to replace violent or age-inappropriate media content with quality educational and prosocial content, through an initial home visit and follow-up telephone calls over 6 months. Sleep measures were derived from the Child Sleep Habits Questionnaire and were collected at 6, 12, and 18 months after baseline; repeated-measures regression analyses were used.
  
  
  RESULTS
  Among the 565 children analyzed, the most common sleep problem was delayed sleep-onset latency (38%). Children in the intervention group had significantly lower odds of "any sleep problem" at follow-up in the repeated-measures analysis (odds ratio = 0.36; 95% confidence interval: 0.16 to 0.83), with a trend toward a decrease in intervention effect over time (P = .07). Although there was no significant effect modification detected by baseline sleep or behavior problems, gender, or low-income status, there was a trend (P = .096) toward an increased effect among those with high levels of violence exposure at baseline.
  
  
  CONCLUSIONS
  The significant effects of a healthy media use intervention on child sleep problems in the context of a randomized controlled trial suggest that the previously reported relationship between media use and child sleep problems is indeed causal in nature.
authors.affiliation: Seattle Children’s Research Institute, Center for Child Health, Behavior, and Development, Seattle, Washington 98145-5005, USA. michelle.garrison@seattlechildrens.org
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Garrison
authors.forename: Dimitri A
authors.initials: DA
authors.lastname: Christakis
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D002666:Psychology, Child; D007319:Sleep Initiation and Maintenance Disorders / Q000628:therapy*; D013690:Television