UNSPECIFIED (2014) Early childhood electronic media use as a predictor of poorer well-being? : a prospective cohort study. JAMA Pediatrics, 168 (5). pp. 485-492. ISSN 2168-6211
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Abstract
Importance Identifying associations between preschool-aged children’s electronic media use and their later well-being is essential to supporting positive long-term outcomes. Objective To investigate possible dose-response associations of young children’s electronic media use with their later well-being. Design, Setting, and Participants The IDEFICS (Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants) study is a prospective cohort study with an intervention component. Data were collected at baseline from September 1, 2007, through June 30, 2008, and at follow-up from September 1, 2009, through May 31, 2010, in 8 European countries participating in the IDEFICS study. This investigation is based on 3604 children aged 2 to 6 years who participated in the longitudinal component of the IDEFICS study only and not in the intervention. Exposure Early childhood electronic media use. Main Outcomes and Measures The following 6 indicators of well-being from 2 validated instruments were used as outcomes at follow-up: Peer problems and Emotional problems subscales from the Strengths and Difficulties Questionnaire and Emotional well-being, Self-esteem, Family functioning, and Social networks subscales from the KINDLR (Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents–Revised Version). Each scale was dichotomized to identify those children at risk for poorer outcomes. Indicators of electronic media use (weekday and weekend television and electronic game [e-game]/computer use) from baseline were used as predictors. Results Associations varied between boys and girls; however, associations suggested that increased levels of electronic media use predicted poorer well-being outcomes. Television viewing on weekdays or weekends was more consistently associated with poorer outcomes than e-game/computer use. Across associations, the likelihood of adverse outcomes in children ranged from a 1.2- to 2.0-fold increase for emotional problems and poorer family functioning for each additional hour of television viewing or e-game/computer use depending on the outcome examined. Conclusions and Relevance Higher levels of early childhood electronic media use are associated with children being at risk for poorer outcomes with some indicators of well-being. Further research is required to identify potential mechanisms. Adverse health outcomes of sedentary behavior, which is characterized by a low energy expenditure while in a sitting or reclining posture,1 are increasingly acknowledged in children and adolescents.2- 4 A growing body of evidence suggests that sedentary behaviors may be detrimental even at a very young age.5 Electronic media use incorporating television viewing and use of computers and electronic games (e-games) is one type of sedentary behavior. Evidence suggests that electronic media use (mainly in the form of television viewing, which is the most widely studied electronic media behavior) may be particularly detrimental to health outcomes during childhood and into adulthood.2,6 Psychological and social well-being (hereinafter referred to as well-being) as a potential outcome of young children’s contemporary lifestyle behaviors, particularly electronic media use, is not well investigated. A clear definition of well-being in the health behavior literature that reflects the multidimensional nature of this concept is lacking.7 Nonetheless, well-being can be reasonably conceptualized as constituting positive and adverse psychological and social attributes and behaviors, such as emotional symptoms, prosocial behavior, self-control, and externalizing problems. Poorer levels of well-being during early childhood are associated with later outcomes, such as depression and hostile and aggressive behavior.8- 10 Conversely, good levels of well-being during early childhood may support positive behavioral, social, and academic outcomes during later childhood.11,12 Some evidence suggests that higher levels of electronic media use may be detrimental to well-being during early childhood.5 However, the evidence supporting these associations is extremely limited and largely inconclusive. A particular dearth of information on dose-response associations of electronic media use with well-being exists,5 and this information is necessary to inform targets for interventions, public health programs, and policy. Longitudinal studies are needed to identify such associations from early childhood to later childhood. The aim of this study was to investigate possible dose-response associations of young children’s electronic media use with their well-being 2 years later.