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Abstract
Background: Childhood obesity affects millions of children in the United States; the estimated prevalence of obesity among two to five year olds has doubled between 1980 and 2008. The American Academy of Pediatrics (AAP) and many agencies of the United States Department of Health and Human Services identify screen time as an important risk factor for childhood obesity. Screen time is commonly defined as time spent watching TV, videotapes, or DVDs, playing video or computer games, surfing the Internet, and anything else that requires watching a screen. Child care environments and the policies that impact those environments are a prime area for obesity prevention efforts including screen time reduction because a large proportion of children spend time in these settings.
Objectives: This study aims to 1) describe child care providers' screen time knowledge, provider advocacy with families around screen time issues, and child care facility screen time practices 2) examine whether factors such as child care facility type (home-based versus center-based) and years of child care experience are associated with knowledge, provider advocacy for screen time recommendations with families, and facility practices regarding screen time issues 3) investigate associations between screen time policies in child care facilities and child care provider knowledge, provider advocacy, and facility practices regarding screen time issues.
Methods: Training questions from a Washington State Training and Registry System (STARS) screen time training module called Media Aware Child Care were used to collect information regarding child care provider screen time knowledge, provider advocacy for screen time recommendations with families, facility screen time practices, type of child care program provider works at (home-based or center-based facility), and whether the facility possesses a screen time policy. Knowledge, advocacy, and facility practices scores were calculated for each participant based on their answers to training questions. Two-sample t tests were used to compare knowledge, advocacy, and facility practices scores by facility type, years of child care experience and presence of screen time policy.
Results: Participants in this study were somewhat knowledgeable about screen time viewing statistics, adverse effects of screen time, and national screen recommendations. They reported feeling strongly towards educating family members about screen time issues. One-third of all participants reported they did not have or use TV in their child care facility. Center-based providers were more likely to report that their facility did not have/use TV compared to home-based providers (p < .001). Average knowledge scores were significantly higher for providers that worked at home-based facilities versus center-based facilities (P = 0.003). Years of child care experience was not a determinant of provider screen time knowledge, provider advocacy, and facility practices. In settings where a TV was used, child care providers who worked at child care facilities with an established screen time policy reported more positive screen time behaviors than providers who worked at facilities that did not have a screen time policy (P < 0.001).
Conclusion: This study supports the recommendation for child care facilities to develop screen time policies. Home-based facilities should specifically be targeted for intervention because of the high rates of screen time viewing. More efforts are needed to educate all child care providers about screen time issues and promote site-based screen time policy implementation.
