Extended Abstract
Introduction
The use of digital devices, both actively and interactively (such as computers and tablets) and passively and non-interactively (such as television), is increasing among children. Excessive use of digital devices, which can have significant impacts on children’s cognitive, social, emotional, and health-related behaviors, including nutrition, physical activity, and sleep, has become widespread among children.
Screen time is recognized as a sedentary activity, meaning that the individual is not physically active and expends minimal energy during the screen time.
Obese or overweight children spend more than 2 hours per day engaged in screen-based activities compared to children with a normal weight. Given children’s increased access to the Internet and computer games, media use has risen by at least one hour, and this duration has further increased with the use of social media. The parental television screen time is closely correlated with their children’s screen time.
Physical inactivity is another growing health concern among children. Physically active children have better metabolic status, lower body fat and body mass index (BMI), and higher cognitive function compared to inactive children. Due to changes in lifestyle and nutrition, children residing in developing countries, including Iran, have a higher likelihood of developing non-communicable diseases, such as obesity and cardiovascular diseases. This study was conducted to evaluate the correlation among screen time, sleep quality, and overweight in preschool children.
Methods
This descriptive-analytical study was conducted on 100 preschool children (46 boys and 54 girls) aged 3 to 6 years and their parents in the city of Qazvin, Iran using a census method during 2019-2020.
The inclusion criteria included preschool children aged 3 to 6 years, possessing general health, and parental consent for participation in the study. The non-inclusion criterion was the presence of chronic diseases affecting the children’s sleep or weight status. Additionally, the exclusion criteria included unwillingness of parents or children to continue participation and incomplete completion of questionnaire information related to screen time, sleep quality, and weight.
Data were collected using interviews and the Factors Associated with Screen Time in Iranian Children and Adolescents Questionnaire (Mozafarian et al., 2017), the validity and reliability of which have been confirmed.
The variables under study were recorded in a checklist, encompassing family socioeconomic variables (child’s age and gender, household monthly income, family size, parental age, occupational level, and education level), children’s health variables (breastfeeding duration, sleep duration, physical activity, unhealthy eating habits, height, weight, and BMI of the child), and lifestyle variables, including parental screen time duration, eating while watching screens, parental restrictions on television use, age of television and other digital device screen time, television in the child’s bedroom, background television being on in the home, and the purpose of screen time (for entertainment and for learning). The questionnaire comprised 48 questions and was completed through face-to-face interviews with the mother or primary caregiver.
Screen time duration for the television, computer, tablet, gaming, and mobile phone was calculated in minutes per day. Screen time activity was categorized into two groups: Less than two hours per day and two hours or more per day. Parents were asked to report the child’s mean daily physical activity at kindergarten (or preschool center) and at home, as well as any outdoor sports activities (if applicable) during the past week. The sum of these hours was considered the child’s weekly physical activity level. The child’s mean daily physical activity (minutes per day) was then calculated. Similarly, the duration of the child’s sleep per 24 hours was assessed in the same manner as the daily physical activity level. Regarding unhealthy eating habits, parents were asked to report the weekly mean eating habits, such as high consumption of fast foods, overeating, or undereating as poor dietary habits.
Results
In 76% of the cases, the children were the firstborn in their families. The mean age of these children was 6 years, with an age range of 3 to 6 years. Their mean BMI was 17.77 kg/m² (16.5-19.0 kg/m²). Additionally, the fathers’ mean age was 38 years (34-41 years), and the mothers’ mean age was 35 years (32-39 years). Regarding education level, most of the mothers held a bachelor’s or master’s degree (38%), while most of the fathers held a master’s degree (40%). Regarding occupational level, most of the mothers (50%) and the fathers (41%) were employees. The children’s mean time spent on various screens was 4 hours per day (3-5 hours). This time was 2 hours for television (1-2 hours). Computer screen time was the lowest among all screen time categories. In 9% of the cases, there was a television in the child’s bedroom. Approximately, half of the parents did not adequately supervise their children’s television screen time at home. The mean screen time was 3 hours per day (2-4 hours) for mothers, and 2 hours per day (1-3 hours) for fathers, and this difference was statistically significant (P<0.01).
As children aged, their mobile phone screen time significantly increased (r=0.26, P=0.01). A statistically significant positive correlation was observed between BMI and television screen time (r=0.24, P=0.01). The mean sleep duration for children was 10 hours (9-10 hours) per day. A statistically significant decrease in children’s sleep duration was found with increasing their cumulative screen time (r=−0.21, P=0.04). The mean age at which children started watching television was 2 years (2-2 years). Furthermore, the children’s mean physical activity level was 90 minutes (60-180 minutes) per day. Although mothers had a significantly higher mean screen time compared to fathers (P<0.001), children’s television screen time exhibited a statistically significant positive correlation with their fathers’ television screen time (r=0.23, P=0.002).
Conclusion
Based on the findings of this study, the children’s mean screen time was evaluated as significantly high, demonstrating a significant association with a reduction in their sleep duration. Additionally, increased screen time may be correlated with an increase in children’s weight. Parents, particularly mothers, dedicated a greater screen time, which could influence children’s screen time behavior. The average time spent by children on various screens was 4 hours per day. For television, this time was 2 hours.
Ethical Statement
The current study was approved by the Research Ethics Committee of Qazvin University of Medical Sciences (IR.QUMS.REC.1397.372).
Funding
This article has been extracted from Kiana Aslani Mehr’s Ph.D dissertation in Medicine at Qazvin University of Medical Sciences. The current research did not receive any specific financial support from any organization in the public, commercial, or non-profit sectors.
Conflicts of Interest
No conflicts of interest.
Key Message: The mean screen time for preschool children is high. Furthermore, the mean screen time is associated with children’s decreased sleep duration and increased BMI.