Healthy Habits, Happy Homes: methods and baseline data of a randomized controlled trial to improve household routines for obesity prevention.

OBJECTIVE: To develop a home-based intervention for parents of 2-5 year old children to promote household routines to prevent overweight/obesity. METHODS: We recruited 121 children from health centers in Boston between 2011 and 2012 and randomized 62 to intervention and 59 to the control condition. The 6-month intervention included 1) motivational coaching at home and by phone with a health educator, 2) mailed educational materials, and 3) weekly text messages. The intervention promoted three household routines: eating meals as a family, obtaining adequate sleep, and limiting screen time. RESULTS: Of the 121 children, mean (SD) age was 4.0 (1.1) years; 52% were Hispanic, 34% Black, and 14% White/Other. Nearly 60% of the sample had annual household incomes ≤ $20,000. Approximately 64% of families reported eating together ≥ 7 times per week, however, many meals were eaten in front of a TV. Over half of the children slept less than the recommended 11h/night and 78% viewed ≥ 2 h/day of screen time. CONCLUSIONS: Household routines that increase obesity risk were prevalent among low-income families in this study. If proven to be effective, promotion of household routines related to family meals, sleep, and screen time may prevent young children from becoming overweight/obese.

The effects of background television on the toy play behavior of very young children.

This experiment tests the hypothesis that background, adult television is a disruptive influence on very young children's behavior. Fifty 12-, 24-, and 36-month-olds played with a variety of toys for 1 hr. For half of the hour, a game show played in the background on a monaural TV set. During the other half hour, the TV was off. The children looked at the TV for only a few seconds at a time and less than once per minute. Nevertheless, background TV significantly reduced toy play episode length as well as focused attention during play. Thus, background television disrupts very young children's play behavior even when they pay little overt attention to it. These findings have implications for subsequent cognitive development.

Obesity-related behaviors of US- and non-US-born parents and children in low-income households.

OBJECTIVE: To examine differences in obesity-related behaviors by parental US-born status among low-income, minority families participating in Healthy Habits, Happy Homes, an intervention trial to improve household routines for childhood obesity prevention. Evidence suggests lower obesity risk among adult immigrants, but research is inconclusive regarding the influence of having a non-US-born parent on childhood obesity. METHOD: We sampled 57 US-born and 64 non-US-born families of children aged 2 to 5.9 years living in the Boston area. At baseline, parents reported their own screen time, physical activity, diet, and sleep as well as their children's behaviors. We used linear and logistic regression to examine the association of parental US-born status with obesity-related behaviors. RESULTS: Mean (SD) body mass index z score was 0.94 (1.16), and it did not differ between the groups. After adjusting for parental education and child race/ethnicity, children of non-US-born (vs US-born) parents had later bedtimes (0.81 hours later; 95% confidence interval [CI], 0.37-1.25) and wake-up times (0.56 hours later; 95% CI, 0.16-0.95) and engaged in less active play (0.15 fewer hr/d; 95% CI, -0.28 to -0.01). Non-US-born (vs US-born) parents had less screen exposure. CONCLUSION: In this cross-section of low-income, urban families, having a parent born outside the United States was associated with a profile of risk and protective behavior; adjustment for education and race/ethnicity removed the protective associations of parental nativity with child behavior. Obesity-related differences in behaviors and home environments should be considered when designing interventions targeting low-income communities with a high proportion of non-US-born participants.

Healthy Habits, Happy Homes: randomized trial to improve household routines for obesity prevention among preschool-aged children.

IMPORTANCE: Racial/ethnic and socioeconomic disparities exist across risk factors for childhood obesity. OBJECTIVE: To examine the effectiveness of a home-based intervention to improve household routines known to be associated with childhood obesity among a sample of low-income, racial/ethnic minority families with young children. DESIGN: Randomized trial. SETTING: The intervention was delivered in the families' homes. PARTICIPANTS: The study involved 121 families with children aged 2 to 5 years who had a television (TV) in the room where he or she slept; 111 (92%) had 6-month outcome data (55 intervention and 56 control). The mean (SD) age of the children was 4.0 (1.1) years; 45% were overweight/obese. Fifty-two percent of the children were Hispanic, 34% were black, and 14% were white/other. Nearly 60% of the families had household incomes of $20,000 or less. INTERVENTIONS: The 6-month intervention promoted 4 household routines, family meals, adequate sleep, limiting TV time, and removing the TV from the child's bedroom, using (1) motivational coaching at home and by phone, (2) mailed educational materials, and (3) text messages. Control subjects were mailed materials focused on child development. MAIN OUTCOMES AND MEASURES: Change in parent report of frequency of family meals (times/wk), child sleep duration (hours/d), child weekday and weekend day TV viewing (hours/d), and the presence of a TV in the room where the child slept from baseline to 6 months. A secondary outcome was change in age- and sex-adjusted body mass index (calculated as weight in kilograms divided by height in meters squared). RESULTS: Compared with control subjects, intervention participants had increased sleep duration (0.75 hours/d; 95% CI, 0.06 to 1.44; P = .03), greater decreases in TV viewing on weekend days (-1.06 hours/d; 95% CI, -1.97 to -0.15; P = .02), and decreased body mass index (-0.40; 95% CI, -0.79 to 0.00; P = .05). No significant intervention effect was found for the presence of a TV in the room where the child slept or family meal frequency. CONCLUSIONS AND RELEVANCE: Our results suggest that promoting household routines, particularly increasing sleep duration and reducing TV viewing, may be an effective approach to reduce body mass index among low-income, racial/ethnic minority children. Longer-term studies are needed to determine maintenance of behavior change. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01565161.

Systematic review of effective strategies for reducing screen time among young children.

Screen-media use among young children is highly prevalent, disproportionately high among children from lower-income families and racial/ethnic minorities, and may have adverse effects on obesity risk. Few systematic reviews have examined early intervention strategies to limit TV or total screen time; none have examined strategies to discourage parents from putting TVs in their children's bedrooms or remove TVs if they are already there. In order to identify strategies to reduce TV viewing or total screen time among children <12 years of age, we conducted a systematic review of seven electronic databases to June 2011, using the terms "intervention" and "television," "media," or "screen time." Peer-reviewed intervention studies that reported frequencies of TV viewing or screen-media use in children under age 12 were eligible for inclusion. We identified 144 studies; 47 met our inclusion criteria. Twenty-nine achieved significant reductions in TV viewing or screen-media use. Studies utilizing electronic TV monitoring devices, contingent feedback systems, and clinic-based counseling were most effective. While studies have reduced screen-media use in children, there are several research gaps, including a relative paucity of studies targeting young children (n = 13) or minorities (n = 14), limited long-term (>6 month) follow-up data (n = 5), and few (n = 4) targeting removing TVs from children's bedrooms. Attention to these issues may help increase the effectiveness of existing strategies for screen time reduction and extend them to different populations.

Television viewing in infancy and child cognition at 3 years of age in a US cohort.

OBJECTIVE: To examine the extent to which infant television viewing is associated with language and visual motor skills at 3 years of age. MEASURES: We studied 872 children who were participants in Project Viva, a prospective cohort. The design used was a longitudinal survey, and the setting was a multisite group practice in Massachusetts. At 6 months, 1 year, and 2 years, mothers reported the number of hours their children watched television in a 24-hour period, from which we derived a weighted average of daily television viewing. We used multivariable regression analyses to predict the independent associations of television viewing between birth and 2 years with Peabody Picture Vocabulary Test III and Wide-Range Assessment of Visual Motor Abilities scores at 3 years of age. RESULTS: Mean daily television viewing in infancy (birth to 2 years) was 1.2 (SD: 0.9) hours, less than has been found in other studies of this age group. Mean Peabody Picture Vocabulary Test III score at age 3 was 104.8 (SD: 14.2); mean standardized total Wide-Range Assessment of Visual Motor Abilities score at age 3 was 102.6 (SD: 11.2). After adjusting for maternal age, income, education, Peabody Picture Vocabulary Test III score, marital status, and parity, and child's age, gender, birth weight for gestational age, breastfeeding duration, race/ethnicity, primary language, and average daily sleep duration, we found that each additional hour of television viewing in infancy was not associated with Peabody Picture Vocabulary Test III or total standardized Wide-Range Assessment of Visual Motor Abilities scores at age 3. CONCLUSION: Television viewing in infancy does not seem to be associated with language or visual motor skills at 3 years of age.

Media and attention, cognition, and school achievement.

Marie Evans Schmidt and Elizabeth Vandewater review research on links between various types of electronic media and the cognitive skills of school-aged children and adolescents. One central finding of studies to date, they say, is that the content delivered by electronic media is far more influential than the media themselves. Most studies, they point out, find a small negative link between the total hours a child spends viewing TV and that child's academic achievement. But when researchers take into account characteristics of the child, such as IQ or socioeconomic status, this link typically disappears. Content appears to be crucial. Viewing educational TV is linked positively with academic achievement; viewing entertainment TV is linked negatively with achievement. When it comes to particular cognitive skills, say the authors, researchers have found that electronic media, particularly video games, can enhance visual spatial skills, such as visual tracking, mental rotation, and target localization. Gaming may also improve problem-solving skills. Researchers have yet to understand fully the issue of transfer of learning from electronic media. Studies suggest that, under some circumstances, young people are able to transfer what they learn from electronic media to other applications, but analysts are uncertain how such transfer occurs. In response to growing public concern about possible links between electronic media use and attention problems in children and adolescents, say the authors, researchers have found evidence for small positive links between heavy electronic media use and mild attention problems among young people but have found only inconsistent evidence so far for a link between attention deficit hyperactivity disorder and media use. The authors point out that although video games, interactive websites, and multimedia software programs appear to offer a variety of possible benefits for learning, there is as yet little empirical evidence to suggest that such media are more effective than other forms of instruction.