Screen-viewing and the home TV environment: The European Youth Heart Study
Introduction
Screen-viewing behaviors such as television (TV) watching and playing electronic games have been associated with increased body mass among youth (Jago et al., 2005, Vandewater et al., 2004, Viner and Cole, 2005). As US research has shown that over half of youth's live in homes in which the TV is on most of the time (Rideout et al., 2005) reducing screen-viewing could be an effective means of preventing obesity. To change screen-viewing behaviors we need to identify the factors that influence screen-viewing and then manipulate those variables (Baranowski et al., 1998, Baranowski and Jago, 2005). Ecological models of behavior (Saelens et al., 2003, Sallis and Owen, 1996) suggest that child factors, home environmental factors and the behaviors of other key individuals will influence screen-viewing. In this model home environmental factors would be proximal variables likely to influence screen-viewing while parental behaviors would be more distal factors that capture the underlying home screen-viewing environment. Two proximal factors that have previously been associated with TV viewing among North American youth are the presence of a TV in a child's bedroom (Adachi-Mejia et al., 2007, Dennison et al., 2002) and the number of TVs in the home (Saelens et al., 2002).
British data shows that the majority of children's TV viewing is carried out at or near bedtime (OFCOM, 2004) suggesting that bedtime could be a more distal variable associated with screen-viewing. Prohibition of TV watching during meal times was associated with less TV viewing among primary school students (Salmon et al., 2005) and watching TV with parents was associated with higher TV viewing among adolescents (Hardy et al., 2006), suggesting that the home TV Environment could influence youth screen-viewing.
Authoritative parenting style in which a parent sets clear boundaries while being sympathetic to the child has been associated with lower levels of sedentary behavior among US adolescents (Schmitz et al., 2002). Moreover, US research has shown that 53% of 8–18 year olds report that their parents have no rules about TV viewing (Rideout et al., 2005). These findings imply that the extent to which children have autonomy over their own behavior could be associated with screen-viewing.
We do not know the extent to which proximal or distal variables are associated with youth screen-viewing. To identify potentially effective means of changing screen-viewing behaviors this paper examines the extent to which proximal (number of TVs, TV in bedroom) and distal variables (bedtime, home TV Environment and child autonomy) are related to screen-viewing. Moreover, as TV viewing varies across European countries (Samdal et al., 2007) we used a sample of participants from four European countries and examined if associations differed by country.
Section snippets
Methods
The data presented here are from the Danish, Portuguese (Madeira), Estonian and Norwegian arms of the European Youth Heart Study (EYHS). The EYHS sampling frame has been reported in detail elsewhere (Riddoch et al., 2005). Briefly, a minimum of 20 schools, stratified by socioeconomic status were recruited in each country between 1997 and 2000. Random samples of 3rd and 9th grade students were recruited in each school. Ethical approval was obtained from local ethics committees and informed
Results
Child Autonomy was significantly higher in Norway and the number of TV sets in the home was higher in Denmark (Table 2). The prevalence of overweight was highest in Portugal (20.8%). Portugal also had the highest prevalence of participants who spent more than an hour per day playing computer games (29.7%).
Logistic regression models predicting whether participant's watched 2 or more hours of TV after school are shown in Table 3. For all participants, each unit increase in Child Autonomy was
Discussion
Youth's who live in homes in which the TV plays an important role (i.e. it is on when the children get home and meals are eaten in front of the TV) are more likely to watch more than 2 h of TV after school and spend more than an hour per day playing computer games. Changing screen-viewing behaviors of the entire family is likely to be important for changing youth screen-viewing and strategies such as family turn-off weeks and family TV budgets might enhance screen-viewing interventions.
Higher
Conclusions
The data presented in this paper show that among children and adolescents from four European nations higher levels of child autonomy over their own behavior and residing in a home in which after-school TV viewing is part of the home culture is associated with an increased risk of watching more than 2 h of TV per day after school and spending more than an hour per day playing computer games. Developing strategies that engage the entire family to change these variables will likely be important
Conflict of interest statement
The authors have no conflicts of interest to declare.
Acknowledgments
This study was supported by grants from the Danish Heart Foundation, the Danish Medical Research Council, Danish Council for Sports Research, Norwegian Council of Cardiovascular Diseases and Estonian Science Foundation grant numbers 3277 and 5209. The authors thank the participants and their families who gave their time to the study, and acknowledge all members of the European Youth Heart Study Group not listed as co-authors of this paper.
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