… 2) 2. 0 (1-3) 1. 0 (.
8-2) 1. 0 (1-2) 1. 0 (1-2) (N 21) (N 20) (N 32) (N 66) (N 47) Watch videos 2. 7 (3. 9) 2.
0 (3. 2) 2. 4 (3. 6) 2.
0 (3. 2) 1. 5 (1. 3) 1.
3 (1-2) 1. 0 (1-2) 1. 0 (1-2) 1. 0 (1-2) 1.
0 (1-2) (N 54) (N 77) (N 48) (N 61) (N 43) Watch television (not counting videos) 3. 0 (3. 0) 2. 5 (2. 9) 3.
0 (3. 0) 2. 5 (2. 5) 1. 8 (1. 0) 2.
0 (1-4) 2. 0 (1-3) 2. 0 (1-4) 2. 0 (1-3) 2. 0 (1-2) (N 118) (N 122) (N 68) (N 115) (N 84) Responses of parents whose children watch television. 96 CHILDREN’S VIOLENT that rigorous study and evidence are lacking.
22 Given this, the 5 hours per week of video game play is of concern, although we did not ask about the specific content of video game play. The American Academy of Pediatrics policy statements on media violence 8, 23 report that the link between media violence and real-life violence is “undeniable and un contestable.” This link is thought to be mediated through 1) facilitating aggressive and antisocial behavior, 2) desensitizing viewers to future violence, and 3) increasing viewers’ perceptions that they are living in a mean and dangerous world. Strasburger and Donnerstein 24 reported that there 1000 studies link media violence to real-life violence, yet we found that only 53% of parents whose children in our sample watch television always limit their child’s television watching of violent content. There are some data suggesting that viewing media sexual content negatively affects teen sexual behavior or attitudes, but the relationship is less clear.
25 However, more parents (81%) reported usually or always limiting viewing of sexual content on television compared with limiting violent television (75%). Other studies have shown that some parents believe that media can have positive effects and could help in educating young people about sex and violence. 26, 27 Few other studies have queried parents on monitoring of television specifically for violent or sexual content. In one of the most comprehensive studies of children and media exposure, the Kaiser Family Foundation Report, general family rules regarding television were assessed. They found that among children 8 years and older, 61% said that there were no rules about television watching. 18 In another study, 42% of sixth and seventh graders reported that their parents set no limits on the television viewing.
28 Importantly, surveys of children suggest even lower rates of television monitoring than what parents report. It was interesting that the majority of parents limit violent television viewing but acknowledge that their children still view television violence at least weekly. Reasons for monitoring failure were not queried in this study but may include inadequate monitoring mechanisms or warnings regarding violent content of shows and commercials, viewing outside the home (eg, friend or relative’s home, school, childcare), televisions in children’s bedrooms, resignation by parents to the ubiquitous nature of media violence, lack of concern about the potential negative impact of violent television exposure, and competing demands for parents’ attention. Additional investigation is warranted. Studies have found that approximately one quarter of children under age 2, one third of preschool- and elementary-age children, and more than half of older children have television sets in their bedrooms, 18, 23, 29, 30 making monitoring of television viewing difficult. Moreover, in a study of children aged 4 to 10, almost 20% of parents frequently disagreed with their child about bedtime television.
31 Co-viewing has been another suggested monitoring strategy and potential opportunity for parents to teach media literacy. We found that 45% of parents reported usually or always watching television with their child, which is consistent with other studies finding that fewer than half of parents report co viewing. 32, 33 Media diary reporting of television viewing in the Kaiser study found that those older than 7 years almost never watch television with their parents and even among younger children (2-7 years), 81% of the time when children are watching television, their parents were doing something else. 18 Supporting parents in the difficult task of monitoring media exposure is needed to increase parent self-efficacy. It is likely that child health providers may face social desirability bias in parent reporting of their child’s television watching. To avoid putting parents on the defensive, some have advocated that child health providers educate on sensitive topics such as television viewing or gun ownership without directly asking questions of families about their practice.
Others have suggested asking only about televisions in bedrooms. The evidence linking media exposure and negative outcomes should be reinforced. Clear guidelines should be communicated, including American Academy of Pediatrics recommendations to make thoughtful media choices, limit all media use to no more than 1 to 2 hours per day, co-view television with their children, teach media literacy to be more critical media consumers, remove televisions from children’s bedrooms, and monitor all media exposure. 8 Emphasis should be placed on the need for monitoring and involvement through school-age and adolescent years. Other studies have found that rules about television viewing and lack of bedroom television were associated with younger children and families from higher socioeconomic groups. 18 We found that television monitoring reported by parents clearly decreased with increasing age of the child.
Limitation of violent television viewing was associated with younger children and female parent but was not associated with socioeconomic status in regression models. Other factors such as practice setting, gender and number of children, age, marital status, educational level, race, or religiosity of parents were not found to be important predictors of television violence monitoring. Limiting exposure to television violence was more common among mothers, who accounted for the majority of survey participants. Gender differences in attitudes and practice were clear on this issue and have been found in other violence prevention issues such as firearm ownership and safety. 34, 35 and toy gun play.
16 Interventions to address these issues need to target fathers as well as mothers. Because mothers more commonly are present at child health supervision visits, interventions need to extend beyond the visit to reach fathers. Strategies may include involving more fathers in child health supervision visits, reaching fathers through mothers who attend visits, or reaching families outside traditional child health supervision visits. Several important limitations of this study must be considered. Data may not be generalizable to other populations, including other regions of the country.
ARTICLES 97 Although we attempted to recruit a cross-section of families from 3 sites, we surveyed convenience samples of parents in 1 geographic area. However, demographics of participants in the survey were similar to demographics of the practice populations. Second, the sample included parents who brought their child to a health visit. We cannot be certain that the participating parent was the primary parent for the child. In addition, only a relatively small fraction of fathers brought their children in for care, and we cannot be certain that their attitudes or practices reflect those of all fathers of children in our study sites. Third, there may have been some variability in how parents interpreted “violent content” or “sexual content” in the survey, although we did ask about child exposure to “fighting, guns, or other types of violence on television.” Before administration, the study instrument underwent extensive pretesting and had face validity.
Finally, this study involved parent self-report data. Families were assured that their responses would not be shared with their health care providers. Nonetheless, it was likely that there existed social desirability bias in parent reports, and we do not know the effectiveness of their monitoring. Despite these potential limitations, we were able to survey a relatively large, diverse sample of parents and had a high participation rate. This study is a first step in understanding norms. Monitoring of parental practices and child media exposure overtime is needed.
Also needed are studies that use new methods to measure media exposure without reliance on parent or child report. The issue of violent media exposure is not a new issue. American children and adolescents spend more time engaged in media activities than any other activity other than sleeping. 18 One study has found that exposure to violence, parental monitoring, and television viewing habits were independently associated with children’s self-reported violent behavior.
36 It is recommended that child health professionals discuss parental monitoring and television viewing in anticipatory guidance with evidence that this guidance can affect parenting behavior. 37 Currently, residency programs lack media education, suggesting a need for curriculum development. 38 Previous research has found that 33% of the variability in pediatrician counseling on violent television viewing was explained by 3 factors: 1) provider perception of the importance of this topic, 2) their counseling, and 3) their belief that they could influence child health on this issue. 39 Education of health providers must emphasize the importance of this issue, teach counseling skills, and present evidence on the effectiveness of counseling in decreasing television viewing and aggression. ACKNOWLEDGMENTS We thank Ellie Hamburger, MD, Kalpa Prasad, MD, Erin Stewart, MD, and Meredith Messenger, MD, for support of this project.
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Such attention to detail means that Christopher is anxious in new places, because he has to catalogue everything-resulting in a situation like a computer overload, with a crashing of functions. New places can make him groan.” Thistlethwaite J. Review of Haddon M. The Curious Incident of the Dog in the Night-Time.
BMJ. 2003; 327: 815 Submitted by Student ARTICLES 99.