Review Article

Associations of Parental Influences with Physical Activity and Screen Time among Young Children: A Systematic Review

Table 3

Association between parental influence and children’s screen time.

Author (year) country referenceStudy designSampleAge (years)Parental influence (measurement)Child PA
(measurement)
Adjusted confoundersMain findingsQuality score

Barr-
Anderson
et al. (2011)
USA
[33]
Cross-sectional431Mean age 5.8
SD 0.51
(1) Parent TV time
(2) Parent limit child’s TV
(3) Parental perception of child’s screen time
(parent self-administered questionnaire)
Child screen time
(parent self-administered questionnaire)
(1) Intervention condition
(2) Child age
(3) Parent BMI
(4) Relative socioeconomic status
(1) Parental TV viewing time was positively associated with child screen time ( = 0.37, < 0.001).
(2) Parent often or always limits child’s TV was associated with less child screen time ( = −0.38, = 0.01).
(3) Parental perception that the child spent too much time playing video games was positively associated with child screen time ( = 1.06, < 0.001).
6

Birken et al. (2011)
Canada
[34]
Cross-sectional1573(1) Parent screen time
(2) Screen time rules
(3) Meals with the TV on
(parent self-administered questionnaire)
Child screen time
(parent self-administered questionnaire)
(1) Maternal education
(2) Maternal age
(1) An increase of 1 hour of parental screen time was associated with 12 (95% CI 6–18) minutes of increase per day of child weekend screen time.
(2) Screen time rules decreased child weekend screen time by 30 (95% CI 6–54) minutes per day.
(3) Eating lunch in front of the screen was associated with 78 (95% CI 36–132) minutes of increase per day of child weekday screen time and 96 (95% CI 30–192) minutes of increase per day of child weekend-day screen time.
5

Bleakley et al. (2013)
USA
[35]
Cross-sectional465≤5(1) Parent TV time
(2) Coviewing TV with child
(3) TV time restriction
(parent self-reported online survey)
Child TV viewing time
(parent self-reported online survey)
(1) Parental well-being
(2) Media access
TV in bedroom
Number of TV sets
PC in bedroom
(3) Demographic
Child gender
Child age
Parent race
Parent education
Parent income
Parent employment
Number of children
(1) Parent TV viewing was significantly associated with child TV time ( = 0.47, < 0.05).
(2) Coviewing TV with child was positively associated with more child TV time ( = 0.16, < 0.05)
(3) Parent TV time restriction was associated with lower child TV time.
5

Campbell
et al. (2010)
Australia
[36]
Cross-sectional1401 ( = 60)
5 ( = 80)
(1) Maternal self-efficacy to promote PA to displace TV viewing
(2) Maternal self-efficacy to limit TV viewing
(parent self-administered questionnaire)
Children’s TV (TV, DVD, and video) time
(parent self-administered questionnaire)
No(1) Maternal self-efficacy to promote PA to displace TV viewing was significantly inversely associated with both groups of children’s TV time (Spearman rank order correlation −0.28 and −0.27, < 0.05 for 1-year and 5-year-old children, respectively).
(2) Maternal self-efficacy to limit TV viewing was significantly inversely associated with both groups of children’s total TV time (Spearman rank order correlation −0.38, < 0.005, and −0.31, < 0.05 = 1 for 1-year- and 5-year-old children, respectively).
(3) Mothers of 1-year-old children indicated significantly higher self-efficacy for limiting TV viewing than mothers of 5-year-old children ( < 0.005).
4

Carson and Janssen
(2012)
Canada
[37]
Cross-sectional746≤5(1) Parents’ screen time
(2) Parents’ self-efficacy in reducing children’s screen time
(3) Parent attitudes regarding children’s screen time
(4) Parents’ barriers to reduce children’s screen time
(5) Parents’ perception of typical screen time in children
(parent self-administered questionnaire)
Child screen time
(parent self-administered questionnaire)
Sequential linear regression models adjusted for
(1) Child age
(2) Siblings
(3) Education
(4) Income
(5) Family structure
(6) Parental cognitions
Multiple logistic regress models adjusted for
(7) Child age
(8) Child gender
(9) Income
(10) Parental cognitions
(11) TV in bedroom
(12) Video games in bedroom
Sequential linear regression models
(1) Parents’ screen time was positively associated with children’s screen time ( = 0.13, 95% CI 0.07 to 0.19).
(2) Parents’ self-efficacy was negatively associated with children’s screen time ( = −0.38, 95% CI −0.64 to −0.11).
(3) Parents’ attitude was positively associated with children’s screen time ( = 1.68, 95% CI 1.19 to 2.17).
(4) Parents’ barrier was positively associated with children’s screen time ( = 0.99, 95% CI 0.57 to 1.42).
(5) Parents’ perception of typical screen time in children was positively associated with children’s screen time ( = 1.16, 95% CI 0.97 to 1.35).
When separated children by 0–3 yr olds and 4-5 yr olds, parents’ screen time and self-efficacy were associated with children’s screen time for 4-5 yr olds, but not for 0–3 yr olds.
Multiple logistic regress models
(1) Parents’ screen time was associated with children’s high (top quartile) screen time (AOR 1.76, 95% CI 1.43–2.17).
(2) Parents’ self-efficacy was negatively associated with children’s high (top quartile) screen time (AOR 0.62, 95% CI 0.49–0.78).
(3) Parents’ attitude was positively associated with children’s high (top quartile) screen time (AOR 1.48, 95% CI 1.12 to 1.91).
(4) Parents’ barrier was not associated with children’s high (top quartile) screen time.
(5) Parents’ perception of typical screen time in children was positively associated with children’s high (top quartile) screen time (AOR 2.78, 95% CI 2.21 to 3.51).
6

Hinkley et al. (2013)
Australia
[38]
Clustered cross-sectional935Mean age 4.54
SD 0.70
(1) Maternal TV time
(2) Paternal TV time
(3) Parental concern about child screen time
(4) Parent prefers child to do activities older children do
(5) Parent believes the amount of TV child watches would not affect child health
(6) Parental confidence to say no to child requests to play video games
(7) Parent limits child TV view
(parent self-administered questionnaire)
Child screen time
(parent self-administered questionnaire)
(1) Child age
(2) Child quiet play time
(3) Maternal education
(4) Physical environmental variables
Boys
(1) Maternal TV time but not paternal TV time was negatively associated with boys meeting Australian/Canadian screen time recommendations (<1 hour/day) (AOR 0.90, 95% CI 0.84–0.97).
(2) Boys were more likely to meet Australian/Canadian screen time recommendations if their parents had the confidence to say no to their child’s requests to play video games (AOR 3.14, 95% CI 1.41–7.00).
(3) Parent limits child TV viewing was not significantly associated with boys meeting Australian/Canadian screen time recommendations.
Girls
(1) Maternal TV time but not paternal TV time was negatively associated with girls meeting Australian/Canadian screen time recommendations (AOR 0.87, 95% CI 0.80–0.94).
(2) Girls were less likely to meet Australian/Canadian screen time recommendations if their parents are concerned about their screen time (AOR 0.81, 95% CI 0.72–0.91).
(3) Girls were less likely to meet Australian/Canadian screen time recommendations if their parent prefers child to do activities older children do (AOR 0.36, 95% CI 0.15–0.82).
(4) Parent believes the amount of TV child watches would not affect child health was not significantly associated with girls meeting Australian/Canadian screen time recommendations.
(5) Parent limits child TV viewing was not significantly associated with girls meeting Australian/Canadian screen time recommendations.
6

Kourlaba
et al. (2009)
Greece
[39]
Clustered cross-sectional23741–5(1) Mother TV viewing time
(2) Father TV viewing time
(parent self-administered questionnaire)
Child TV viewing time
(parent self-administered questionnaire)
Child:
(1) Gender
(2) PA
Parent:
(3) Educational status
(4) Maternal employment
(5) Time parents spent with children
(6) Siblings
(1) In the total sample, parental TV time was significantly and positively associated with child TV time.
(2) Mother TV time was significantly associated with TV time (≥2 h/day) of children aged 3–5 years (AOR 1.38, 95% CI 1.25–1.57) but marginally associated with children aged 1-2 years (AOR 1.24, 95% CI 0.94–1.79).
(3) Father TV time was significantly associated with TV time (≥2 h/day) of children aged 3–5 years (AOR 1.24, 95% CI 1.15–1.42) but not children aged 1-2 years.
5

Rideout et al. (2006)
USA
[40]
Cross-sectional10516 months–6 yearsParent TV time
(parent self-reported telephone survey)
Children’s TV time
(parent self-reported telephone survey)
None(1) Children whose parents watched TV ≥2 hrs/day watched averaging 17 minutes more TV per day than children whose parents spend 1-2 hrs/day (74 minutes versus 57 minutes, < 0.005), and 28 minutes more TV per day than children whose parents spend <1 h/day (74 minutes versus 46 minutes, < 0.005).2

Schary et al. (2012)
USA
[41]
Cross-sectional2012–5Parenting style
(parent self-administered Child Rearing Questionnaire)
(1) Screen time
(2) Quiet play time
(parent self-administered questionnaire)
Child age
Parent BMI
(1) Compared to neglectful parenting style, authoritative parenting style was associated with less child screen time on weekend ( = −0.17, = 0.05 with adjusted model; = −0.26, = 0.002 with unadjusted model) and weekday ( = −0.21, = 0.01 with unadjusted model).
(2) Parenting style was not associated with child quiet play time.
6

Thompson et al. (2013)
USA
[42]
Longitudinal217Baseline: 3 months
Follow-up at
6, 9, 12, and 18 months
Mother TV viewing time
(parent self-administered questionnaire)
Infant TV exposure time (time spend in front of the TV)
(parent self-administered questionnaire)
(1) Child gender
(2) Visit
Mother TV viewing time was positively associated with infant TV exposure time (≥1 h/day) with AOR 1.27 (95% CI 1.12–1.44).5

Vandewater
et al. (2007)
USA
[43]
Cross-sectional10456 months–6 years(1) Parental TV time rules
(2) Parental TV program rules
(3) Parental perception TV helps
(4) Parental perception TV hurts
(5) Constant TV household (TV was on always or most of the time, even when no one was watching)
(parent self-administered questionnaire)
Child screen time
(parent self-administered questionnaire)
None(1) Parental TV time rules were not associated with child TV time.
(2) Parental TV program rules was associated with less likelihood of falling outside the AAP guidelines for 5-6-year olds (OR 0.33, 95% CI 0.12–0.90), but not for 0–2-year olds and 3-4-year olds.
(3) Parental perception TV helps was associated with greater likelihood of falling outside the AAP guidelines for 0–2-year olds and 5-6-year olds, but not for 3-4-year olds.
(4) Parental perception TV hurts was not associated with child TV time.
(5) Constant TV household was associated with greater likelihood of falling outside the AAP guidelines for 3-4-year olds, but not for 0–2-year olds and 5-6-year olds.
3

Yalçin et al. (2002)
Turkey
[44]
Cross-sectional1873–6(1) Mother TV viewing time
(2) Father TV viewing time
(parent self-administered questionnaire)
Child TV viewing time (hours/weekday)
(parent self-administered questionnaire)
None(1) The TV viewing time of children was significantly and positively correlated with that of mother and father (Pearson’s = 0.49, < 0.001, = 0.53, < 0.001)
(2) With multiple linear regression analysis the TV viewing time of mother and sibling were significant predictors of that of the child (adjusted = 0.45, < 0.001, did not provide ).
3

AOR: adjusted odds ratio. AAP: American Academy of Pediatrics.