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Decreasing Television Viewing of Children: Guidance Document Strategies

Decreasing Television Viewing of Children: Guidance Document Strategies. Barbara Polhamus, PhD, MPH, RD Beverly Kingsley, PhD, MPH Division of Nutrition, Physical Activity and Obesity. TV Viewing in Children. Rationale for document focus

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Decreasing Television Viewing of Children: Guidance Document Strategies

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  1. Decreasing Television Viewing of Children: Guidance Document Strategies Barbara Polhamus, PhD, MPH, RD Beverly Kingsley, PhD, MPH Division of Nutrition, Physical Activity and Obesity

  2. TV Viewing in Children Rationale for document focus • Majority of evidence is related to TV viewing and children • Other forms of media are important but limited evidence • CDC recommends that communities reduce screen time in child care centers and schools • American Academy of Pediatrics recommends limiting total media time for infants and children

  3. Recommended Strategies • Child Care and School-Based Strategies Strategy 1: Establish Regulations, Legislation, Policies to Reduce TV Strategy 2: Develop and Implement Curricula to Reduce TV Viewing • Medical-Based Strategies Strategy 3: Promote Counseling by Health Care Providers Strategy 4: Promote Continuing Medical Education Curricula for Physicians • Community-Based Strategies Strategy 5: Develop and Implement Community Awareness Campaigns

  4. TV Viewing: Child Care and Schools Establish Regulations, Legislation and Policies in Child Care • No federal standards for child care • Child care provides opportunity to promote limited TV • Each one-hour increment of TV viewing per day increases intake of energy dense food 1 Miller SA, Taveras EM, Rifas-Shiman SL, Gillman MW. Int J Obes 2008:3(3):168-76.

  5. TV Viewing: Child Care and Schools Evidence of Effectiveness • Limited peer reviewed literature • NYC and DE have made regulatory changes to limit TV viewing • An evaluation of the NYC amendment is currently in progress

  6. TV Viewing: Child Care and Schools Potential Action Steps • Develop partnerships that can move forward policy change in child care • Provide training to child care providers on effects of TV viewing • Work toward state-mandated elements in child care facilities to require adoption of AAP recommendations for TV and screen time

  7. TV Viewing: Child Care and Schools Program Examples • New York City Amendment to the Health Code • Delaware Child Care Policy to Improve Children’s Health

  8. TV Viewing: Child Care and Schools Develop and Implement Curricula • Curriculum interventions can be incorporated into existing curricula or designed for families • Curricula have a broad reach

  9. TV Viewing: Child Care and Schools Program Examples • Brocodile the Crocodile (preschool curriculum) • Planet Health (middle school curriculum)

  10. TV Viewing: Child Care and Schools Evidence of Effectiveness • In child care, there has been mixed success in reducing TV viewing and BMI • In schools, some but not all curricula have shown a reduction in TV viewing time and obesity prevalence

  11. TV Viewing: Child Care and Schools Potential Action Steps • Work with the Department of Education to inform teachers about available curricula that include TV limits • Partner with organizations and businesses to fund purchase of curricula • Train child care providers and staff on available curricula

  12. TV Viewing: Medical Promote Counseling by Health Care Providers • Medical care visits provide valuable opportunity for guidance • State organizations can promote using AAP guidelines at health care visits. • Many parents not aware of AAP guidelines or of the link between TV viewing and obesity. • State policy to promote counseling (at every visit) on limiting TV could influence viewing practices.

  13. TV Viewing: Medical Evidence of Effectiveness • No peer reviewed literature on state policy to promote (physician) counseling on TV viewing • Gentile et al. 2004: Evaluation of pediatrician awareness, implementation of AAP Guidelines. Showed AAP successful in educating pediatricians (90% familiar with Guidelines) • However, only 41% of pediatricians always provided counseling to children and parents on guidelines • Although no evaluation, reasonable strategy

  14. TV Viewing: Medical Potential Action Steps • Promote dissemination of AAP Guidelines through State Medical Associations • Address system barriers to counseling: develop strategies for overcoming barriers • Develop additional training materials, tool kits and programs for physician counseling • Disseminate and teach the use of AAP Media History form

  15. TV Viewing: Medical Program Examples • Keep Me Healthy • 5-2-1-0 Approach • ME Youth Overweight Collaborative, ME AAP, ME Center for PH • KidShape Program • Comprehensive family-based pediatric weight management program • Includes diet, PA, reduction of TV time, healthy behaviors

  16. TV Viewing: Medical Promote Specific Continuing Medical Education (CME) Curricula for Physicians • State agencies/medical associations can promote increasing specific knowledge of physicians: CME on limiting TV for prevention/mitigation of overweight/obesity • States have the ability to mandate CME content • Examples: H1N1, HIV/AIDS, Child Abuse, Ethics CME • Although no currently required CME requirements on screen time/childhood obesity to evaluate, this is a potential strategy

  17. TV Viewing: Medical Evidence of Effectiveness • CME in certain topic areas is effective (at least to some degree) in increasing knowledge among physicians. • No program examples of CME requirements with specific screen time/childhood obesity component • No peer reviewed literature.

  18. TV Viewing: Medical Potential Action Steps • In partnership with state or national medical associations, include information about strategies to limit television and other screen time in CME curricula.   • Develop additional training materials, tool kits and programs for physicians • Disseminate/teach the use of AAP Media History form

  19. TV Viewing: Medical Program Examples • No program examples of state health departments requiring/promoting CME courses which address importance of limiting TV/screen time BUT very possible • Development of CME courses for physicians and other health care providers would be advantageous.

  20. TV Viewing: Community Develop and Implement Community Awareness Campaigns • Community campaigns valuable method to promote healthy behaviors; can create awareness about the importance of limiting TV viewing in the home • Opportunity to create awareness of specific issues using multiple media formats • Evidence that media campaigns can affect health behaviors of youth [VERB – national, multicultural social marketing campaign to promote PA in children]

  21. TV Viewing: Community Evidence of Effectiveness • VERB campaign evaluation - effectiveness in increasing physical activity and positive attitudes about physical activity in children • TV Turnoff Week– example of community campaign but not formally evaluated • No peer reviewed literature evaluating specific community campaign to reduce TV viewing; mixed results on other studies on effectiveness of community campaigns

  22. TV Viewing: Community Potential Action Steps • Form coalitions that include faith based organizations, neighborhood groups, libraries to develop and implement or participate in community campaigns. • Identify physical and social environments that encourage/enable safe and enjoyable physical activity as alternatives to TV viewing. • Plan a community wide event to heighten awareness of excess TV viewing and impact of television viewing on overweight and obesity; link this effort to other activities for children.

  23. TV Viewing: Community Program Examples • Nickelodeon Network Turn off the TV and Go Outside Network stopped broadcasting for 3 hrs one Saturday and urged children to go out/play. Reached 1.5 M viewers • Communities promote TV turn off week New Hampshire Dept of Health [Health Promotion in Motion]

  24. TV Viewing in Children Summary • Currently, evidence is limited for policy and environmental approaches to reduce TV viewing • The majority of strategies presented are emerging

  25. Acknowledgements • Dr. Bettylou Sherry, DNPAO • Dr. Deborah Galuska, DNPAO • Dr. Sarah Lee, DASH • Dr. Bill Dietz, DNPAO The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

  26. Four State Level Data Sources for TV Viewing/Screen Time Data Bettylou Sherry, PhD, RD Obesity Prevention and Control Branch DNPAO/NCCDPHP/CDC March, 2010

  27. Pediatric Nutrition Surveillance System Annual • Children viewing < 2 hours of television/day - includes videotapes and DVDs (2-5 years)

  28. National Survey of Children’s Health 2007, 2011 - Every 4 years • Hours of TV viewing time, video games (0-18 years) • TV in child's bedroom (6-17 years) • Family rules on TV programs watched (6-17 years) • Average weekday computer use (not schoolwork) (6-17 years)

  29. School Health Profiles2010 - Biannual • School-based curricula to reduce TV/screen time

  30. Youth Risk Behavior Surveillance System (YRBSS)2009 - Biannual • TV: number of hours on average school day • Video games/computer for non-school purpose: number of hours on average school day

  31. National Resource Center for Health and Safety in Child Care(Public access database) • Policies to limit TV viewing at child care facilities • Limit defined as AAP guidelines • <2 hrs per day for children 2-18 yrs • No TV time for children <2 yrs

  32. School Based Intervention Helps Reduce TV Watching Among Middle School Students Solomon Mezgebu Massachusetts Department of Public Health Solomon Mezgebu , Massachsuetts Department of Public Health

  33. 5-2-1 Go! • Planet Health classroom curriculum, focused on individual behavior and • School wide initiative focused on policy and system changes to • $2500 grant/school (two years) Solomon Mezgebu , Massachsuetts Department of Public Health

  34. The 5-2-1 Goals • 5- Consume 5-9 servings of fruits and vegetables a day • 2- Reduce screen time to no more than 2 hours a day • 1- Participate in at least 1 hour of physical activity each day Solomon Mezgebu , Massachsuetts Department of Public Health

  35. Hypothesis & Indicators Hypothesis 1: Reduce the prevalence of overweight and at-risk-of-overweight among middle school students. • Measure: Improvement of weight status between baseline and follow-up. (Reduction in overweight or at risk or remaining normal) Hypothesis 2: Increase the number of students achieving the recommended level of physical activity • Measure 1: Moderate Activity=increased number of days by at least one of moderate activity from baseline to follow-up compared with no improvement or decrease. • Measures 2-4 ( similar as above: for vigorous, strength activities and walking to and from school) Hypothesis 3: Increase the percentage of students eating five servings of fruits and vegetables per day. • Measure:  increased number of servings of fruits and/or vegetables per day compared to no improvement or decrease. Hypothesis 4: The intervention will decrease the percentage of students watching more than two hours of television per day. • Measure:  increased number of days by at least one of watching less than two hours of television per day compared to no improvement or decrease. Hypothesis 5: The intervention will create nutrition and physical activity policy and/or environmental changes at schools. • Measure:  increased number of policies or environmental changes compared to no change. Solomon Mezgebu , Massachsuetts Department of Public Health

  36. Improvement in Daily Participation in PE (from baseline, at least by a day) ** P< .001 Solomon Mezgebu , Massachsuetts Department of Public Health

  37. Participation in Moderate Physical Activity (from baseline, Percent of kids who met daily recommendation for moderate PA)* ** p <.001 *** p <.001 Solomon Mezgebu , Massachsuetts Department of Public Health

  38. Findings Contd... • Hypothesis 3: Increase the percentage of students eating five servings of fruits and vegetables per day. • There was no difference between intervention and control students regarding intake of fruits and vegetables. • H 4: The intervention will decrease the percentage of students watching more than two hours of television per day. • After adjusting for age, race, number of televisions in the house, whether or not the student had a television in his/her room, and restriction on television watching, the intervention students had improved almost 50 percent more in meeting the standard of watching less than 2 hours per day on weekdays (Monday-Thursday) (O.R.1.36; CI 1.10,1.68). TGIF…? • Spent less time playing video games during the week (9.7%; p<0.001) and weekends (4.5%; p=0.071). • There was no difference in reduction of television watching between the intervention and control students during weekends. Solomon Mezgebu , Massachsuetts Department of Public Health

  39. Sedentary Behavior on Weekdays(Other than TV Watching) * P<.001 Change in % (at least 1/2hr) Solomon Mezgebu , Massachsuetts Department of Public Health

  40. Sedentary Behavior on Weekends(Other than TV Watching) ** ** p=.002 Change in % (at least 1/2hr) Solomon Mezgebu , Massachsuetts Department of Public Health

  41. TGIF… TV Time!!! p < 0.001 Solomon Mezgebu , Massachsuetts Department of Public Health

  42. Change in TV Watching Behavior > 2 Hrs/Day Solomon Mezgebu , Massachsuetts Department of Public Health

  43. Policy and Environment • H5: The intervention will create nutrition and physical activity policy and/or environmental changes at schools. • All six intervention schools made positive changes during the study period and five out of the six schools increased their composite score by about a third or more. • The seven control schools followed a less consistent trend. On average, they did not perform as well as intervention schools. • 3 schools had (-) changes (-4%, -16%, -18%) • Scores for 2 schools increased by 17% • Scores for 2 remaining schools increased on a par with Intervention schools (38% and 72%) Solomon Mezgebu , Massachsuetts Department of Public Health

  44. Summary • The 5-2-1Go! intervention was effective in increasing the amount of moderate physical activity of students and decreasing TV watching time. (Implications for ‘TV Turn-off Day’ type efforts) • The 5-2-1Go! intervention was effective in changing school policies and environments. • Similar preliminary findings from ‘Healthy Choices Initiative’ (more comprehensive, B/A School programs, 3 years, $9,000) • Admin Buy-in and On-going TA Solomon Mezgebu , Massachsuetts Department of Public Health

  45. Establish Regulations, Legislation and Policies to Reduce TV Viewing Time in Child Care Amendments to Article 47 of the New York City Health Code

  46. Article 47 • Licensed group day care centers in New York City are regulated under Article 47 of the New York City Health Code. • The New York City Board of Health enacts changes to the health code. • The amendments were adopted by the Board of Health in June 2006, and took effect in January 2007.

  47. Article 47 Amendments • Enhanced outdoor and indoor physical activities • Nutrition standards • Limits on TV viewing

  48. Physical Activity • Minimum Requirements: • 12 months and up, at least 60 minutes/day • 3 years and older, at least 30 of 60 minutes must be structured and guided • Children shall not be sedentary for more than 60 minutes consecutively, except when sleeping.

  49. Nutrition • Beverages with added sweeteners shall not be provided. • 100% juice limited to 6oz/day; shall not be offered in a bottle. • 1% or fat-free milk for children ages 2 years and older. • Water shall be made available and easily accessible throughout the day, and offered at all meals and snacks.

  50. Television Viewing • Television, video and other visual recordings: • Shall not be used with children under two years of age. • Shall be limited to not more than 60 minutes/day* of educational or movement-oriented programs for children ages 2 and older. *prorated for children in less than full-day programs

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