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ARTICLE |
a Annenberg Public Policy Center, Philadelphia, Pennsylvania
b RTI International, Washington, District of Columbia
c Centers for Disease Control and Prevention, Atlanta, Georgia
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ABSTRACT |
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 TOP ABSTRACT METHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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2 hours per day with screen media, because excessive viewing has been linked to a plethora of physical, academic, and behavioral problems. The primary goal of this study was to qualitatively explore how a recommendation to limit television viewing might be received and responded to by a diverse sample of parents and their school-age children. METHODS. The study collected background data about media use, gathered a household media inventory, and conducted in-depth individual and small group interviews with 180 parents and children ages 6 to 13 years old.
RESULTS. Most of the children reported spending 
3 hours per day watching television. The average home in this sample had 4 television sets; nearly two thirds had a television in the child's bedroom, and nearly half had a television set in the kitchen or dining room. Although virtually all of the parents reported having guidelines for children's television viewing, few had rules restricting the time children spend watching television. Data from this exploratory study suggest several potential barriers to implementing a 2-hour limit, including: parents' need to use television as a safe and affordable distraction, parents' own heavy television viewing patterns, the role that television plays in the family's day-to-day routine, and a belief that children should spend their weekend leisure time as they wish. Interviews revealed that for many of these families there is a lack of concern that television viewing is a problem for their child, and there remains confusion about the boundaries of the recommendation of the American Academy of Pediatrics.
CONCLUSIONS. Parents in this study expressed interest in taking steps toward reducing children's television time but also uncertainty about how to go about doing so. Results suggest possible strategies to reduce the amount of time children spend in front of the screen.
Key Words: children • media • television
Abbreviations: AAP—American Academy of Pediatrics
Children's television viewing has been of concern to parents, educators, and health care providers for almost as long as the medium itself has been in existence.1 Although most studies have focused on children's exposure to potentially deleterious content, such as violence,2 sex,3 or food advertising,4,5 research suggests that the amount of time children spend in front of the screen is an important predictor of cognitive, behavioral, and physical outcomes in children, including school performance,6,7 bullying,8 attention,9 and weight status.10–13 Accordingly, the American Academy of Pediatrics (AAP) currently suggests that "pediatricians recommend to parents that they limit children's total media time (with entertainment media) to no more than 1 to 2 hours of quality programming per day and to remove television sets from children's bedrooms."14
Recent studies indicate that children spend well over 3 hours a day watching television,15–17 suggesting that, for many families, a 2-hour limit would bring dramatic changes to how children spend their time in the home. We conducted the present study to better understand the individual, familial, and sociocultural forces that shape children's television viewing in the home to identify possible simple and incremental approaches that pediatricians and others can suggest to help reduce children's television-viewing time. We explored children's and parents' reactions both to limiting television time in general and to potential television reduction strategies that empirical studies suggest may be useful in reducing television time.18–21
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METHODS |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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Participants
A total of 180 children and 1 of their parents or guardians participated in this research. We included 60 parent-child pairs from each of the following 3 age groups: 6 to 7, 9 to 10, and 12 to 13 years. These ages were selected to reflect developmental stages that shape children's interests, abilities, and decision-making autonomy.22 Half of the children were girls. Most of the parent participants were mothers (77%), 21% were fathers, and the remainders were grandparents or other caregivers. The race/ethnicity of participants, as self-identified by parents, was black (34%), white, (36%), Hispanic (26%), or other or mixed heritage (4%).
Data Collection
Parents and children filled out a household media inventory about the number and location of media in the house and completed a background form about children's time spent with television, computers and video games. Parents also completed questions about their socioeconomic background and their own television use.
Parents and older children then participated separately in small group discussions (average of 3 participants) led by trained moderators. Open-ended, small group interviews, rather than individual interviews or larger focus groups, were chosen to allow for a richer and more exploratory conversation. Children aged 6 to 7 years participated in 1-on-1 interviews, because a pilot test found that group discussions created distractions for younger children.
In both the children's and parents' groups, participants were asked about the child's typical day, use of media on weekdays and weekends, media rules, and the benefits and costs of television viewing. We also explored reactions to a 2-hour-a-day limit on television time and to the following strategies: eliminating "background" television, turning off the television during meals, not allowing a television in the child's bedroom, and limiting viewing after school. Discussions lasted 90 minutes for parents, 60 minutes for children, and 30 minutes for interviews with 6- to 7-year-olds. All of the discussions and interviews were audio taped.
Data Analysis
Data from the home media inventory and background form were analyzed using SPSS 11.5 (SPSS Inc, Chicago, IL). Audiotapes were transcribed verbatim. Speakers were tagged with an identification number that indicated site, age, gender, and race/ethnicity. Transcripts were thematically coded (according to the research questions and themes that emerged in discussions) using Atlas.ti 5.0 qualitative software (Scientific Software Development, Berlin, Germany). After demographic sorts, analysts summarized themes and, where appropriate, used Microsoft Excel (Microsoft, Redmond, WA) to assess numeric trends.
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RESULTS |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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In the background forms, parents were asked how many hours their child watches television in an average week. Children were asked a more age-appropriate question about time spent with 3 different media (television, video games, and computers) in 3 day parts (between breakfast and lunch, between lunch and dinner, between dinner and bedtime) on the previous day (see Fig 1 for results.) As has been reported by others,21 parents in this study indicated that their children watched less television per day than the children reported (parent mean: 116 minutes; child mean: 189 minutes), although this may be a reflection of the differences in the measures.
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In the discussions, nearly all of the parents in this sample reported that they had 
1 rule related to television viewing. Parents of older children reported that they had fewer television-related rules than parents of younger children (and their children's reports confirmed this). These rules clustered into 4 broad categories: content restriction, behavior contingency, time, and restricting access.
Content Restriction
The most frequently cited rules related to content. Nearly all of the parents of children in all age groups described similar concerns related to media content, particularly exposure to sexual content, violence, and foul language. Content rules were also mentioned most often by the child participants and were articulated by even those aged 6 to 7 years who said, for example, that they were allowed to watch "no grown-up shows" and "no nasty talk."
Typical rules or practices to control content exposure ranged from limiting access to only specific shows, channels, types of programs (namely, educational shows) to forbidding children from watching certain types of programs (eg, no talk shows or music videos) or channels. To enforce these rules, parents said that they programmed cable channels and remote controls to block certain program content, forbade children from changing the channel, or required children to ask permission before watching a particular type of show.
Behavior Contingency
Approximately half of the parents and children talked about children's television being used as a reward or as being contingent on completing tasks, such as household chores or homework. Similarly, some parents restricted television viewing as a punishment for tasks not done, for misbehavior, or for doing poorly in school.
Time
About half of the parents described various practices to limit when their children could watch television or how much viewing was allowed. The most common practice, particularly with younger children, was to not allow television viewing after a certain time of night. Much less frequently mentioned were rules that limited television viewing to a particular amount of time.
Rather than establishing a specific, predetermined amount of time that children are allowed to watch television, many parents said that they observed their children's behavior to determine how much is "too much." If their child watched too many programs consecutively or seemed to be "tuning out," they would tell their child "take a break."
Only about a quarter of parents had rules specifying time limits for television viewing, and these limits were more common among families with younger children. Virtually all of the limits established by these parents were for 2 hours a day. A handful of parents did not allow television watching on school days.
Restricting Access
A small number of parents and children reported access restrictions, of which the most common was a "no television in the child's bedroom" rule, although 63% of the children in the sample had a television in their bedroom. Although some parents indicated that this was a rule that had always been in place, others indicated that a television had been removed from a child's bedroom because the child had spent excessive time watching the television or because the parents felt unable to control the content that their children watched.
Reactions to the Recommendation to Limit Television Viewing
Despite the finding that the majority of children reported watching >2 hours of television the previous day, most parents in this study said they believe that the 2-hour-a-day recommendation is reasonable. The children were more likely to say 2 hours a day is too little, especially the 9- to 10-year-olds. Parents of 6- to 7-year-olds viewed the recommendation most favorably. Parents of older children were more likely to say that the recommendation is "good in theory" but were skeptical about being able to make it work. Both parents and children were more open to limits on weekdays or school nights than on weekends (when children are not used to such restrictions). Another barrier to reducing television time lies in the finding that parents in this sample often did not perceive that the need to limit television use applied to their own children. For instance, a parent of a 12- to 13-year-old said, "A lot of these kids are overweight or they are couch potatoes...But not for my kids."
The group discussions also revealed another important barrier to reducing children's television time: confusion over what the limits entail or "what counts" as screen time. In particular, parents wondered if the limit applies to weekends as well as weekdays, computers and video games, and background television. In many groups, there was a discussion that "time watching together with my children" should be exempted from the 2-hour limit because, in this sample, "together" viewing time was perceived as an important shared family activity.
Throughout the interviews, we asked about the benefits and costs parents perceived in imposing (or considering the possibility of imposing) time limits on children's viewing. The main themes and illustrative quotes are in Table 1.
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One major obstacle to limiting television viewing is the appeal of the medium for both children and parents. Children in this study talked of television as "fun" and "relaxing," although they also described watching because they had "nothing better to do." Parent respondents said that television shows are often educational for their children, and they give parents something to talk about with their children. As noted above, parents sometimes said they valued watching television or a rented movie as a family activity with their children. In addition, parents who enjoyed watching television realized that to cut down on their children's television time, they would need to reduce their own use. Often they were reluctant to make that change.
Another concern expressed by the parents in this sample was that limiting children's television time would limit parents' ability to complete their own chores or work and require them to spend substantial time keeping their children safely occupied. Many parent respondents conceptualized the alternative to television viewing to be homework and chores, "productive" activity that might have little appeal to children. The child respondents, on the other hand, suggested many things they could do on their own (for example, play outside with friends) or with their parents (play a board game). Parents also indicated that it might be especially difficult to adhere to the 2-hour guideline when the weather is bad, limiting their ability to promote outdoor activity.
Reactions to Strategies to Limit Television Viewing
In group discussions, moderators asked parents and children about their reactions to eliminating background television, turning off the television during meals, no television in eating areas or children's bedrooms, and no television after school. Table 2 presents the 4 potential strategies and quotations that illustrate the reactions of both parents and children participating in the study. Parents were generally positive about turning off the television when no one was actively watching, with many saying they already do so, and most children accepted this idea. Parents who were resistant to the idea liked to have background television themselves or were concerned about how their child would react if it were turned off.
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Parents and children were substantially less positive about the idea of no television in the child's bedroom, and it was clear that avoiding putting a television in a child's bedroom would be much easier than removing one that was already there. Children in this sample who already had a television in their room were very resistant to this idea. The youngest children generally would accept their parents' removing their bedroom television, but substantial opposition was found among 9- to 10-year-olds and, especially, 12- to 13-year-old boys.
The study participants' reaction to the suggestion of no television after school depended on whether the child watched television at this time, with boys 6 to 7 years old showing the greatest opposition, because many of their favorite shows are on at that time. However, this idea generally was acceptable to children who felt that they had other alternatives. It was less acceptable to parents who said that their child needs time with television to unwind after school.
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DISCUSSION |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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2 hours per day of television, health care providers may feel more efficacious in recommending very specific steps to be taken in the home. In examining the major themes identified, we found the Transtheoretical or Stages of Change Model useful for conceptualizing television reduction interventions.32,33 The model posits that, when changing behavior, people move through a series of stages: precontemplation (not considering change and unaware), contemplation (intending to change but not committed), preparation (intending to change in the near future and taking small steps toward action), action (short-term behavior change), and maintenance (behavior change for >6 months), and that effective messages should be tailored to people's current stage of change.33
The findings from this study suggest that most parents were largely at the stage of precontemplation with regard to limiting their child's television time. Although parents agreed with a 2-hour limit in principle, many felt it did not apply to their child (unless he or she was doing poorly in school or had behavioral problems), and they perceived numerous barriers to implementing the recommendations. To move people from precontemplation to contemplation, messages should appeal to benefits that parents already value and address barriers by making behavior change easier, for example, by suggesting ways to make small adjustments or encouraging incremental changes.32 This suggests that interventions must recognize that family television practices and rules (such as those restricting content) may be firmly entrenched and that parents may not fully understand the AAP guidelines and the reasoning behind the guidelines enough to contemplate change.
Our data suggest several strategies that pediatricians could provide as starting points for precontemplator parents to become more aware of their children's watching and for contemplators to address some of the barriers to action.
Pay Attention to How Much Time Children Spend Using All Screen Media
The children in this sample, like nationally representative samples,15–18 reported spending 5 hours a day looking at a television, computer, or video game screen. Parents in this sample, however, reported that their children watched significantly less television than the children themselves reported and acknowledged the difficulty of monitoring media time. They also had questions about what "counted" as media use (eg, coviewing and background television). Thus, health practitioners should encourage monitoring of all of the entertainment media that children use, as the AAP guidelines suggest.
Do Not Put a Television Set in a Child's Bedroom
Children with a television in their bedroom watch more television and have fewer rules about television than children without a television in their bedroom.18,21,34 Nearly two thirds of the children in our sample had a television in their bedroom. Parents recognized that keeping televisions out of children's bedrooms was a means to control content exposure and time. Health care providers counseling parents might start by suggesting that parents never put a television set in a child's bedroom, rather than removing an existing bedroom television. In addition, because the youngest children in the sample were perceived as more amenable to parental control of media use, parents of younger children may be willing to remove a bedroom television.
Eliminate Background Television
An easy starting point for many families may be to turn the television off when it is on in the background or when it is not considered the primary activity. One recent study found a strong correlation between the prevalence of background television in the household and children's time spent viewing. In addition, they found a negative association between the use of television as "background" and children's time spent reading.35 Many families in this sample said they perceived this step as an easy change to make in the family's television practices.
Limit Television on School Days
The parents in our study were very focused on scholastic achievement, and this priority seemed to drive many of their decisions about television. A few parents restricted television use during the week to encourage homework completion and early bedtimes, and others took away television privileges when children did poorly in school. A recent study found that whereas children's heavy television viewing during the school year was correlated with obesity, children's viewing during the summer was not, suggesting that the proportion of inactivity (that is, viewing) to more physically active leisure time pursuits may be important to consider.36
Identify Nonscreen, In-Home Activities That Are Pleasurable to Children
Parents expressed difficulty in identifying nonmedia activities that were safe and affordable. In group discussions, parents also indicated concern about needing to serve as entertainers if they limited their children's television viewing. However, by restricting television viewing, parents can provide an opportunity for their children to develop their independent play skills. Parents may need to find a balance between replacing screen time with parent-child activities and independent activities. The Television Turnoff Network (www.televisionturnoff.org) offers a list of 100 alternatives to screen time that parents can suggest to their children.
Do Not Put a Television in Household Eating Areas and Do Not Connect Television Viewing With Eating of Any Sort, Including Snacks and Meals
Nearly half of the families in this study had a television set in a room designated for eating: the kitchen or the dining room. The majority of children in this sample indicated that they eat snacks and meals in front of the television, and a third of families said they regularly have the television on during mealtime. Although research is still needed to determine whether disassociating television viewing from food consumption will reduce overall television time, it does seem that viewing while eating increases the consumption of more energy-dense and less nutritious foods.36–39
The parents and children involved in this study offered a window into the meaning of television to their families and provided insight into potential strategies for reducing children's television viewing. Although our convenience sample was ethnically and geographically diverse, we are limited in our ability to generalize the findings to a broad population of parents or children. One potential bias lies in the self-selection of the sample. Parents who are more concerned about how their children spend their out-of-school time or who have a particular interest in children's television viewing may have been more interested in participating in the study. Future studies with random samples of parents and children would strengthen our understanding of how television is used and how children's viewing may be reduced across a broad population. In addition, whereas the strategies that we have laid out seem to have promise, more research in the form of randomized, controlled trials is needed to test the efficacy of these strategies. Finally, it is clear that television-viewing practices within the home are reflective of a larger dynamic of the family. Changing media behaviors may ultimately alter many elements of the family system. Although we expect television time reduction to have mainly positive consequences for children's well-being and family relationships, it is also important to recognize potential difficulties that families may need to withstand (such as bickering at mealtimes or struggling to find enjoyable alternatives), at least in the short-term.
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CONCLUSIONS |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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ACKNOWLEDGMENTS |
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We recognize the important contributions of Christina An, Amy Branner, Arlynn Filomeno, Janet Fulton, Laurence Grummer-Strawn, Jennifer Horner, Holly Massett, Lucia Rojas Smith, and Sharon Telleen.
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FOOTNOTES |
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Address correspondence to Amy B. Jordan, PhD, Annenberg Public Policy Center, 3620 Walnut St, Philadelphia, PA 19104-6220. E-mail: ajordan{at}asc.upenn.edu
The authors have indicated they have no financial relationships relevant to this article to disclose.
The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the funding agency.
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REFERENCES |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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This article has been cited by other articles:
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  A. B. Jordan and T. N. Robinson Children, Television Viewing, and Weight Status: Summary and Recommendations from an Expert Panel Meeting The ANNALS of the American Academy of Political and Social Science, January 1, 2008; 615(1): 119 - 132. [Abstract] [PDF]
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