title: [Multi-center study on the effects of television viewing on sleep quality among children under 4 years of age in China].
abstract: OBJECTIVE
  To explore the current television viewing situation among children less than 4 years of age in our country and investigate effects of television viewing on sleep quality.
  
  
  METHODS
  According to the"Hospital of Province-City-County"sampling technical route, a total of 1 046 full term healthy children at the age of 4-48 months were sampled by stratified cluster random sampling method from 8 provinces in China from 2012-2013. The information of television viewing and family and personal information was investigated by Shanghai Children's Medical Center Socio-demographic Questionnaire. Brief Infant Sleep Questionnaire (BISQ) and Brief Child Sleep Questionnaire (BCSQ) were employed to assess the sleep behaviors of children 0-3 years old and over 3 years old respectively.The effects of television viewing on sleep quality were analyzed by multiple linear regression analysis.
  
  
  RESULTS
  The children's average age was (20±13) months, with boys accounted for 53.3% (558/1 046). The percentage of children who viewed television was 70.3% (735/1 046). Moreover, 58.7% (408/695) of infants and young children under the age of 2 viewed TV per day, and 19.9% (70/351) of 2 years and older infants and young children viewed television ≥2 hours per day. With the increase of age, the percentage of children who viewed television time gradually increased (P<0.001). Child sex, geographic area, paternal education, and family structure were not associated with television viewing time among children aged 4-48 months. However, the presence of a bedroom TV(χ(2)=13.682, P=0.001) and maternal employment (χ(2)=15.053, P=0.005) were commonly correlated with long screen-watching time among children. After adjusting for age, gender, mother' education level, and working state, it was revealed by multiple linear regression analysis that television viewing was not only positively correlated with later bedtime (t=5.49, P<0.001) and shorter night sleep duration (t=-3.49, P=0.001) but also significantly associated with longer sleep onset latency (t=2.63, P=0.009).
  
  
  CONCLUSIONS
  The percentage of children under 4 years of age who viewed television is very high in our country, and many infants under 6 months of age exposed to TV environment. Bedroom TV and mother full-time job were associated with higher proportion of children viewing TV. In early childhood, television viewing was positively correlated with later bedtime, shorter sleep duration and longer sleep onset latency. There is a need for parents and pediatricians to pay more attention to the behavior of children viewing TV and improve sleep quality.
authors.affiliation: Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Ministry of Education Shanghai Key Laboratory of Children's Environmental Health, Shanghai 200127, China.
authors.forename: Shumei
authors.initials: S
authors.lastname: Dong
authors.affiliation: Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Ministry of Education Shanghai Key Laboratory of Children's Environmental Health, Shanghai 200127, China.
authors.forename: Yuanjin
authors.initials: Y
authors.lastname: Song
authors.affiliation: Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Ministry of Education Shanghai Key Laboratory of Children's Environmental Health, Shanghai 200127, China.
authors.forename: Yanrui
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Ministry of Education Shanghai Key Laboratory of Children's Environmental Health, Shanghai 200127, China.
authors.forename: Wanqi
authors.initials: W
authors.lastname: Sun
authors.affiliation: Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Ministry of Education Shanghai Key Laboratory of Children's Environmental Health, Shanghai 200127, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Ministry of Education Shanghai Key Laboratory of Children's Environmental Health, Shanghai 200127, China; Email: fanjiang@shsmu.edu.cn.
authors.forename: Fan
authors.initials: F
authors.lastname: Jiang
mesh_terms: D002675:Child, Preschool; D002681:China; D005190:Family; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010290:Parents; D012890:Sleep; D011795:Surveys and Questionnaires; D013690:Television; D013997:Time Factors