Randomized Controlled Trial of Primary Care Pediatric Parenting Programs: Effect on Reduced Media Exposure in Infants, Mediated through Enhanced Parent-Child Interaction

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Publication year

2011

study description

Randomized controlled trial.

core topic(s)

Early Relational Health , Pediatric Primary Care

Population Characteristics

Infant/Newborn , Urban

Exposures, Outcomes, Other

Building Blocks , Child Behaviors and Skills , Clinic-Based Programs and Interventions , Home Language/Literacy/Learning Environment , Parent Behaviors and Skills , Parent Knowledge, Attitudes, and Beliefs , Parent-Provider Relationships/Interactions , Programs and Interventions (other) , Technology and Digital/Screen-Based Media , Video Interaction Project

metric(s)

StimQ Cognitive Home Environment Questionnaire (StimQ)

objectives

To determine whether pediatric primary care-based programs to enhance parenting and early child development reduce media exposure and whether enhanced parenting mediates the effects.

exposure

Interventions: Video Interaction Project (VIP) OR Building Blocks (BB)

outcomes evaluated

Media exposure in the home.

setting

Urban public hospital pediatric primary care clinic.

methods

Patients were randomly assigned to 1 of 2 interventions, the Video Interaction Project (VIP) and Building Blocks (BB) interventions, or to a control group. The VIP intervention comprised 1-on-1 sessions with a child development specialist who facilitated interactions in play and shared reading through review of videotapes made of the parent and child on primary care visit days; learning materials and parenting pamphlets were also provided. The BB intervention mailed parenting materials, including age-specific newsletters suggesting activities to facilitate interactions, learning materials, and parent-completed developmental questionnaires (Ages and Stages questionnaires).

sample size

n=410 (mother-newborn dyads)

measures

Measures of Media Exposure: assessed using a 24-hour recall diary; mother asked to provide information about all electronic media (television, videos/DVDs, movies, and games) to which the infant had been exposed on the most recent typical day, including the name and duration of each program.

 

Measure of Content of Exposure: program content assessed using information obtained from industry rating systems and a consumer media Web site. Media content was categorized using a classification system developed by 2ofus: educational young child oriented, noneducational young child orientated, older child, or unknown.

 

Measure of Mediating Variable (Parent-Child Interaction): StimQ assessed parent-child interactions in the home related to provision of toys and learning materials, shared reading, teaching, and verbal responsivity.

 

results

The mean (SD) exposure at 6 months was 146.5 (125.0) min/d. Exposure to VIP was associated with reduced total duration of media exposure compared with the BB and control groups (mean [SD] min/d for VIP, 131.6 [118.7]; BB, 151.2 [116.7]; control, 155.4 [138.7]; P = .009). Enhanced parent-child interactions were found to partially mediate relations between VIP and media exposure for families with a ninth grade or higher literacy level (Sobel statistic = 2.49; P = .01).

conclusions

Pediatric primary care may represent an important venue for addressing the public health problem of media exposure in young children at a population level.

limitations

First, while the use of media diaries allowed the collection of detailed information regarding content, we must acknowledge the possibility that data collected via this assessment tool cover only 1 typical day and may underestimate quantity of media in the home.41 Second, our results apply to exposure in infants primarily from Hispanic immigrant families with low SES and may not be generalizable to children in families with more resources. Third, there was larger than expected loss to follow-up at 6 months owing to limitations in resources, which led us to prioritize later assessment points. The threat to validity resulting from loss to follow-up may have been limited, as assessed participants were equivalent across groups for all measures. However, differences between assessed and nonassessed participants, likely owing to differential accessibility, may limit generalizability. In addition, effects on media exposure were small. Additional study of the cohort, in progress, will enable us to determine whether the reduction in media found in these analyses mediates the effect of VIP on child development.