title: Sociodemographic, home environment and parental influences on total and device-specific screen viewing in children aged 2 years and below: an observational study.
abstract: OBJECTIVE
  This study aimed to investigate total and device-specific screen viewing (SV) and its determinants in children aged 2 years and below.
  
  
  METHODS
  Cross-sectional study conducted in February 2014.
  
  
  METHODS
  Well-child clinics in Singapore national polyclinics.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore.
authors.forename: Si Ning
authors.initials: SN
authors.lastname: Goh
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore.
authors.forename: Long Hua
authors.initials: LH
authors.lastname: Teh
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore.
authors.forename: Wei Rong
authors.initials: WR
authors.lastname: Tay
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore.
authors.forename: Saradha
authors.initials: S
authors.lastname: Anantharaman
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Rob M
authors.initials: RM
authors.lastname: van Dam
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
authors.forename: Chuen Seng
authors.initials: CS
authors.lastname: Tan
authors.affiliation: National Healthcare Group Polyclinics, Singapore.
authors.forename: Hwee Ling
authors.initials: HL
authors.lastname: Chua
authors.affiliation: National Healthcare Group Polyclinics, Singapore.
authors.forename: Pey Gein
authors.initials: PG
authors.lastname: Wong
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore Institute for Social Medicine, Epidemiology and Health Economics, Charite Univeristy Medical Centre Berlin, Berlin, Germany.
authors.forename: Falk
authors.initials: F
authors.lastname: Müller-Riemenschneider
mesh_terms: D002652:Child Behavior / Q000523:psychology*; D002675:Child, Preschool; D003201:Computers / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010287:Parent-Child Relations; D016487:Parenting / Q000523:psychology*; D010290:Parents / Q000523:psychology; D057185:Sedentary Behavior; D012846:Singapore; D012931:Social Environment; D011795:Surveys and Questionnaires; D013690:Television / Q000706:statistics & numerical data*; D018910:Video Games / Q000706:statistics & numerical data*
keywords: determinants; infants; prevalence; screen devices; screen viewing; toddlers
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