Early Literacy Research Library (ELRL) - Article

Real-World Usage of Educational Media Does Not Promote Parent–Child Cognitive Stimulation Activities

Choi, J.H., Mendelsohn, A.L., Weisleder, A., Cates, C., Canfield, C., Seery, A., Dreyer, B.P., Tomopoulos, S. (2018) Real-World Usage of Educational Media Does Not Promote Parent–Child Cognitive Stimulation Activities. Academic Pediatrics, 18(2), 172-178.,

Access: FREE/Open Access

Publication year


study description

Secondary analysis of the control group of a longitudinal cohort.

core topic(s)

Early Literacy

Population Characteristics

Poverty/Low-Income , Pregnancy/Postpartum , Urban

Exposures, Outcomes, Other

Child Development (general) , Language and Literacy Development , Mental Health , Parent-Child Relationships/Interactions , Technology and Digital/Screen-Based Media


To determine whether educational media as actually used by low-income families promote parent–child cognitive stimulation activities.


Educational media.

outcomes evaluated

Cognitive stimulation.


Enrollment of consecutive eligible mother–infant dyads in the BELLE Project was performed in the postpartum unit of Bellevue Hospital Center, New York City an urban public hospital serving a predominantly Latino and low-income population from November 2005 to October 2008.


We performed secondary analysis of the control group of a longitudinal cohort of mother–infant dyads enrolled postpartum in an urban public hospital. Educational media exposure (via a 24-hour recall diary) and parent–child activities that may promote cognitive stimulation in the home (using StimQ) were assessed at 6, 14, 24, and 36 months.

sample size

n=149 (mother-child dyads)


Measure of Educational Media Exposure: we assessed electronic media exposure in the home at 6, 14, 24, and 36 months of age with a 24-hour recall diary based on an interview with the mother.


Measure of Home Cognitive Stimulation: StimQ-I, StimQ-T, and StimQ-P assessing:

    • Parental Verbal Responsivity (PVR) assesses parent–child verbal interactions such as talking while feeding and making sounds together.
    • Parental Involvement in Developmental Advance (PIDA) assesses parent teaching activities such as naming body parts, stacking blocks, or basic arithmetic.
    • Reading (READ) assesses the number and diversity of books read to the child, frequency of reading activities, and associated interactions.
    • Availability of Learning Materials (ALM) assesses the degree to which the parent plays with the child using toys and other learning materials in the home.

Measure of Child Language (control variable): Preschool Language Scale-4 (PLS-4) and at 36 months using the Clinical Evaluation of Language Fundamentals—Preschool-2 (CELF-Preschool-2).


Measure of Maternal Depression (control variable): maternal depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9) at 6 and 14 months and the Center for Epidemiologic Studies Depression Scale (CES-D) at 24 and 36 month.


Data from 149 mother–child dyads, 93.3% Latino, were analyzed. Mean (standard deviation) educational media exposure at 6, 14, 24, and 36 months was, respectively, 25 (40), 42 (58), 39 (49), and 39 (50) minutes per day. In multilevel model analyses, prior educational media exposure had small positive relationship with subsequent total StimQ scores (b ¼ 0.11, P ¼ .03) but was nonsignificant (b ¼ 0.08, P ¼ .09) after adjusting for confounders (child: age, gender, birth order, noneducational media exposure, language; mother age, ethnicity, marital status, country of origin, language, depressive symptoms). Educational media did predict small increases in verbal interactions and toy provision (adjusted models, respectively: b ¼ 0.13, P ¼ .02; b ¼ 0.11; P ¼ .03). In contrast, more consistent relationships were seen for models of the relationship between prior StimQ (total, verbal interactions and teaching; adjusted models, respectively: b ¼ 0.20, P ¼.002; b ¼ 0.15, P ¼.006; b ¼ 0.20, P ¼.001) and predicted subsequent educational media.


Educational media as used by this sample of low-income families does not promote cognitive stimulation activities important for early child development or activities such as reading and teaching.


First, we classified programming as educational with industry standards and consumer media Web sites, which are based on Federal Communications Commission regulations but are not related to any objective or scientific assessment of educational value. Furthermore, only some educational programming is specifically designed to enhance parent– child interactions, and such programming was not the focus of our study. Second, this study preceded the extensive use of new types of interactive media in the context of emerging digital platforms and applications, which has rapidly evolved over the past 5 years. While these findings apply to television and video programming that was watched in formats that included mobile devices such as tablets and smartphones, these results do not apply to interactive media such as games and apps. Third, media exposure data were collected with 24-hour diaries, which are subject to recall bias. Finally, we enrolled subjects from a low-income, predominantly Hispanic/Latino immigrant population. Children from Hispanic families are exposed to more television than white families, and exposure is higher in lower-income families and families with lower education levels.37 Within Hispanic families, children with Spanish-speaking mothers watch less television compared to children with English-speaking mothers.38 Therefore, our study may not be generalizable to populations with higher acculturation.