Elsevier

Preventive Medicine

Volume 54, Issues 3–4, March–April 2012, Pages 212-218
Preventive Medicine

The value of social-cognitive theory to reducing preschool TV viewing: A pilot randomized trial,☆☆

https://doi.org/10.1016/j.ypmed.2012.02.004Get rights and content

Abstract

Objective

To (a) reduce the total amount of television viewing to which preschool children are exposed; and (b) shift the balance of exposure away from commercial television toward educational content.

Method

Randomized controlled clinical trial. Data collected in 2007; analyzed 2008–2011. Participants were 67 English-speaking families in Seattle with a preschool-aged child exposed to more than 90 min of television viewing on average per day. A case manager for each group used in-person conferences, monthly newsletters, and e-mail contact to motivate behavior change around child television viewing (intervention) or child safety (control).

Results

Compared to those in the control group, families randomized to the intervention group experienced a significant reduction by 37 minutes/day in total viewing time (95% CI: 5.6–68.7), including a marginally significant reduction by 29 minutes/day in viewing of commercial content (95% CI: − 4.6–63). Compared to those in the control group, those in the intervention group experienced a positive change in outcome expectations. There were no significant changes in self-efficacy or volitional control. An advance in stage-of-change was marginally significant.

Conclusions

Targeting commercial TV viewing may prove a successful behavioral intervention to achieve public health goals in this population.

Highlights

► The intervention clearly communicated the adverse effects of harmful TV content. ► Overall TV time was reduced by 39 min/day, mostly in commercial content. ► The intervention was appreciated and judged not burdensome by parents.

Introduction

Obesity continues to be a major public health concern for America's children, with obesity rates for preschool children tripling in the last 30 years, and quadrupling for children ages 6–11 years (Institute of Medicine, 2006). One important component of the increase in obesity among children is extensive television viewing, which begins in earnest at about 9 months of age (Zimmerman, et al., 2007). Early television viewing has been associated with a number of other adverse consequences for child health and development (Christakis and Zimmerman, 2006a, Christakis and Zimmerman, 2006b). Because few children adhere to the American Academy of Pediatrics guidelines on early childhood TV viewing (Council on Communications and Media, 2011), it is clear that modifying young children's TV habits is a public health goal of the highest priority.

Several protocols have been developed to reduce children's or adolescents' television viewing time and have demonstrated effectiveness in randomized trials (Dennison et al., 2004, Epstein et al., 2008, Goldfield et al., 2006, Gortmaker et al., 1999, Ni Mhurchu et al., 2009, Robinson, 1999, Salmon et al., 2008). One intervention for example, implemented an educational campaign series focusing on children ages 2–5 years and included various activities for children such as arts and crafts and interactive, age-appropriate brainstorming sessions to motivate children to consider other fun alternatives to television viewing (Dennison, et al., 2004).

However, not all children's television programming is alike. Most commercial programming includes a heavy dose of food advertising, most of which is for low-nutritional-quality foods, including carbonated beverages, candy, and sugary cereals (McGinnis et al., 2006, Strasburger, 2011). By contrast, many educational shows now include substantial pro-nutritional content as well as content designed to promote physical activity (Christakis and Zimmerman, 2006a, Christakis and Zimmerman, 2006b, Weber and Singer, 2004).

One recent study found that only commercial television viewing – not educational or DVD viewing – is related to obesity among young children (Zimmerman and Bell, 2010). A consensus is emerging that television's relationship to obesity operates in no small part through the effects of advertising on diet (Gortmaker, 2008). This consensus is important, for it suggests that it may be efficient to intervene only on viewing of commercial television, rather than attempting to reduce all viewing.

This issue may be especially relevant for young children, who are in the midst of establishing life-long dietary habits (Halford et al., 2007, McGinnis et al., 2006, McNeal, 1992), and for whom many high-quality educational programs exist. In effect, modifying the media diet may go a long way toward modifying the food diet. Such an approach could be at once more acceptable to parents, who often cite the need for television to act as a babysitter, (Rideout et al., 2003, Zimmerman et al., 2007); and also more potent, by selectively reducing the primary obesogenic form of viewing.

To implement this approach, two key behavior change models, social cognitive theory (SCT) and stages-of-change (or transtheoretical model) may be useful. SCT suggests that parental behavior regarding their child's media exposure is a result of the interaction between parents' beliefs – which include outcome expectations, self-efficacy beliefs, and a sense of volitional control – and the social and physical environment in which child-rearing occurs (Bandura, 2004, Baranowski, 2002). The transtheoretical model suggests that individuals can be in different stages of readiness for change including pre-contemplation, contemplation, preparation, action and maintenance (Prochaska and Norcross, 2001). Identifying a parent's stage of change may be critical to tailoring effective messages throughout the program intervention (Jordan, et al., 2006).

This study tests the hypotheses that (a) an intervention based on behavioral change constructs can reduce the total amount of television viewing young children watch; (b) shift the balance of exposure away from commercial television toward educational content; and (c) the intervention effect will operate through the mediating effect of changing outcome expectations, volitional control, self-efficacy, and stage of change.

Section snippets

Methods

Participants were recruited from a list of parents whose children had been born in or near Seattle, WA, extracted from publicly-available birth records. Shortly after the birth of a child, parents were invited to participate in a series of child development studies conducted by the University of Washington. Families from this pool were randomly selected to be contacted via telephone to participate in a study of “how best to keep children healthy and developing well through their preschool

Results

Table 1 reports demographics and the total amount and type of television viewing among intervention and control participants. Each group is representative of the Seattle area's racial/ethnic diversity and socio-economic status. For all of the families, the identified primary caregiver was the mother.

Table 2 presents the results of the regression of the effect of the intervention on behavioral change constructs. The intervention had a significant and meaningful increase in the level of outcome

Discussion

Within a population of predominantly White and relatively well-educated parents, these results suggest that it may be possible to reduce young children's television viewing by clearly communicating to parents the adverse effects of viewing on their child's health and development, and by offering them alternative types of viewing that are less deleterious to their children.

This finding complements a recent study of TV-reduction strategies among 10–11 year-old children, which involved the children

Conflict of interest

None.

Acknowledgments

This research was supported by a grant from Children's Hospital and Regional Medical Center (CHRMC), Seattle, WA. Other than providing the funding, CHRMC had no role in the study design, collection or analysis of data, or write-up. Dr. Zimmerman was the principal investigator on the project and warrants that he had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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    This article reports the results of a randomized, controlled trial. The trial is registered with www.clinicaltrials.gov. Registration number is: NCT00503074.

    ☆☆

    This study was funded by a grant from the Seattle Children's Hospital Research Institute. Each of the authors reports that he or she has no conflicts of interest and no financial disclosures.

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