Children’s Violent Television Viewing: Are Parents Monitoring? Essay Example

with their youngest child. Among children who watched television, parents reported that they spent an average of 2.6 hours per day watching television. Limitation of television violence was associated with female parents and younger children. Conclusions. There was variability in attitudes and practices regarding television violence viewing and monitoring among parents. Attitudes and practices varied on the basis of the age of the child and the gender of the parent. Pediatrics 2004;114:94 -99; media violence, television viewing, violence prevention, anticipatory guidance, parental norms.

ABBREVIATIONS

OR, odds ratio; CI, confidence interval. The American Academy of Pediatrics has encouraged child health professionals to be proactive in addressing violence prevention in child health supervision. The policy statement entitled "The Role of the Pediatrician in Youth Violence Prevention in Clinical Practice and at the Community Level" suggests that health providers have an emerging role in youth violence prevention and management.1 Anticipatory guidance on media violence exposure and encouraging media literacy are examples of this role. Effective violence prevention counseling requires an understanding of norms regarding parental attitudes and practices and the factors that influence norms. The theory of planned behavior2 evolved out of the theory of reasoned action and focuses on intentions to act as important predictors of behavior.3 Both theories emphasize that perceptions about normative behavior and attitudes about what others think are associated with intended behavior.4 Although data exist on children's media exposure, only limited data focus specifically on violent television viewing from a cross-section of families. By understanding the spectrum of parental attitudes and behavior, community-sensitive interventions for violence prevention can be developed. Viewing violent television has been associated with aggressive behavior.

According to many studies using laboratory simulations,

population-based observations, and longitudinal analysis, children who are exposed to violent television programming are more likely to be aggressive and to become involved in the juvenile justice system compared with those with less exposure.5-11 A school-based intervention to reduce television, videotape, and video game use found that compared with control subjects, children in the intervention group had statistically significant decreases in peer ratings of aggression. Public Education advocates that child health providers assess and counsel on children's media consumption and lead efforts in their community and on the legislative level to address negative health effects of television viewing.13 The purpose of this study was to accumulate normative data on the views and practices of parents regarding violent television viewing from a crosssection of families. In addition, we wished to determine whether norms varied on the basis of practice setting and sociodemographics of the family. The objective of this study was not to judge the appropriateness of certain norms and behaviors but to determine what is commonly practiced and believed to be socially acceptable.

METHODS

An anonymous self-report assisted survey was administered to a convenience sample of parents/guardians who visited child health providers in January 1999 to July 2000. Three very different settings were chosen for the survey: an urban children's hospital clinic, an urban managed care clinic, and a suburban private practice in the metropolitan Washington, DC, area. All Englishspeaking parents in the waiting room were invited to participate in the 10-minute survey, and patients in the 3 practices were recruited simultaneously. The study was approved by the Children's National Medical Center's institutional review board. The questionnaire included questions on child-rearing attitudes and practices as well as

sociodemographic information. Results presented here are part of a larger survey on child-rearing practices. Questions on television viewing were developed after review of television viewing and parental monitoring questionnaires and extensive preadministration piloting including interviews with parents on their interpretation of the questions (N 65).

The questionnaire included items regarding amount of media exposure to video games, television, and video watching; parental limitation of child's television watching; how often parents watch television with their child; and their estimation of how often they believe that their child views "fighting, guns, or other types of violence on television." Questions on television viewing and monitoring were in relation to the index subjecttheir youngest child. Predictor variables included the practice setting; age, gender, and number of children; and age, marital status, educational level, socioeconomic status, race, religiosity, and gender of parents. The main outcomes used in our analysis were parenting practices on television watching. Because these outcome variables had sparse counts for certain categories of responses, outcome variables were dichotomized into the "never" or "ever" categories.

Questions on television monitoring excluded parents who reported that their youngest child watched no television. The 2 test (or Fisher exact test when mandated by sparse data) was used to compare the distribution of categorical variables for different levels of the outcome variables. For dimensional variables, the t test was used to perform the 2-group comparisons when the data were normally distributed and the Mann-Whitney U test when assumptions of normality were not met.14 Multivariable logistic regression models were used to identify characteristics that predicted the outcomes of interest.15 Variables that were statistically significant in crude bivariate associations were included as independent variables to adjust

for the indirect effects of other variables in the regression model. Association between the characteristics and outcomes was expressed as odds ratios (ORs) obtained by the exponentiation of regression parameter estimates. Confidence intervals (CIs) of the adjusted odds ratios were computed using test-based methods. P .05 was considered to be statistically significant, and all P values were interpreted in a 2-tailed manner.

RESULTS

Initially, 1004 adults who accompanied children to health visits were approached for the study, and 922 surveys were completed (participation rate: 92%). The 830 (90%) respondents who were parents and had complete child data were the focus of additional analysis. Questions on television viewing were added later in the study with 677 respondents. By site, 29% were from an urban hospital setting, 43% were from an urban managed care practice, and 28% were from a suburban private practice. Sixty-seven percent were married; 84% were female. Fifty-three percent self-identified as black, 38% as white, and 5% as Hispanic. Twenty-seven percent reported a yearly household income of $25 000, 22% of $25 000 to $50 000, and 50% of $50 000. Six percent of respondents had less than a high school education, 20% had completed high school, 28% had some college, 18% had completed college, and 28% had postgraduate study. Demographic characteristics of participants in the original sample by practice site were previously published in greater detail with this sample more racially and socioeconomically balanced.16 Table 1 presents responses to questions on parenting attitudes and practice regarding television viewing. On television viewing, 25% of parents reported that their youngest child did not watch television.

With respect to television monitoring, results are presented only for children who watched

television. Among those who watched television, 53% of parents reported always limiting violent television viewing, although 73% believed that their children viewed television violence at least 1 time a week. Eighty-one percent reported usually or always limiting viewing of sexual content on television. There was a strong association between those who limit watching television violence and those who limit sexual content (P .0001). Forty-five percent of parents reported usually or always watching television with their child. Among those who limited exposure, 70% of parents reported that their youngest child still viewed television violence at least 1 time a week. Among children who watch television, parents reported that their child spent an average of 2.6 hours per day watching television with a median of 2.0 hours. Twenty-eight percent of parents stated that their youngest child played an average of 1.6 hours per day of video games (median: 1.0 hours).

Finally, 41% of children watched videos for an additional 1.7 hours per day (median: 1.0 hours). Parental monitoring of television watching was significantly more likely with young children compared with older children. With child's age, there was a progressive increase in reported violent television viewing (Table 2). Preschool children spent the most time watching television and videos and playing video games. As shown in Table 2, after preschool, there was a decrease in the number of hours per day watching television and videos but not in video game play. Multiple regression was performed to identify predictors of limitation of violent television viewing or television sexual content. Female parents (OR: 2.25; 95% CI: 1.34-3.79) and families with younger children (P .0001) were more likely to limit television violence viewing.

For restricting exposure to television sex, predictors included female parents (OR: 1.87; 95% CI: 1.11-3.14), US-born (OR: 2.86; 95% CI: 1.47-5.56), higher education level (P .0012), and black race (OR: 2.02; 95% CI: 1.17-3.47). For both models, we assessed possible interactions among significant predictors and found no effect.

Discussion

We found that parenting practices regarding media exposure and parental monitoring of their children's violent television viewing vary widely. The majority (73%) of parents acknowledged that their children do see "fighting, guns, and other violence on television." Parenting practices varied on the basis of sociodemographics of the family. Among all families in this study, the average number of hours per day reported watching television was 1.8 hours plus 0.7 hours of video viewing and 0.5 hours playing video games. Although 25% of parents stated that their youngest child did not watch television, those children who did spent an average of 2.56 hours per day watching television. These findings are consistent with other reports of 21 to 23 hours of television viewing weekly17 and Kaiser Family Foundation data reporting 2.46 hours of television per week with 17% of children watching 0 hours of television on a "typical day" and 19% watching 1 hour or less.18 Other research suggests that parents frequently underreport the number of hours that their children view television.19 Regardless, all confirm that children and adolescents have significant exposure to television. Media exposure is likely to increase in the future with the popularity of video games, introduction of new technology, and the Internet. Consequently, there is a great need to study exposure to and impact of the newer modes of media and whether media exposure truly increases

or simply shifts to other modes. Controversy over the impact of violent video games exists, with some suggesting that dangers from violent video games may be even greater than dangers of violent television5,20,21 and others stating.

Children’s violent television viewing 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 violence8,23 report that the link between media violence and real-life violence is "undeniable and uncontestable." 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 Donnerstein24 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.

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, child care), 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 coviewing. 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.

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.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.

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 over time 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 selfefficacy in 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.

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Available at: www.kff.org/entmedia/ 3378.cfm