# Exercise as it relates to Disease/Screen time vs active play in young children
## What is the background to this research?

Physical activity verses screen time in young children is an emerging public health issue in the western world today. With the constant innovation and improvement of technology and social media, young children of today’s world are spending more time on digital devices than ever before.
The high rates of childhood obesity highlight the emphasis needed to monitor population trends in children’s physical activity and screen time. The purpose of this report was to gather information and data of young children to assess the proportional ratio of their physical activity and screen time in their day to day life and describe the associations relating to their gender, age, weight, race and religion.

## Where is the research from?

This research article was conducted in the United States of America, nation-wide, by three experienced personnel, recognised for their expertise in this field. The article was written by Sarah E Anderson, Christine D Economos and Aviva Must.
* Sarah Anderson is affiliated with the Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio, USA. Anderson is an associate professor where her research focuses on the understandings of psychological influences on children’s growth and development in relation to obesity.
* Christine E Economos is currently associated with the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA. Economos is the Chair of the Division of Nutrition Interventions, Communication, and Behaviour Change.
* Aviva Must, is also affiliated with the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA. She is also a part of the Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston, Massachusetts. These three authors have written a research article that can relate to current 21st century society, world-wide. All three have expertise in the field and share similar interests and passion in nutritional studies and behaviours in young children.

## What kind of research was this?

The study undertaken in this article was a Cross sectional study. Cross sectional studies are an observational study strategy. Articles which obtain cross sectional studies investigate the measures and exposes the outcome in the study participants. In cross sectional studies the participants must be selected based on the inclusion and exclusion of the criteria set. In this case, children were selected who had high levels of active play, or high levels of screen time or both. Furthermore, cross sectional studies are seen to be a good type of analysis, as they are clear, and allow the researchers to examine large numbers of variables.
Although cross sectional studies may be a good method to use, recall bias may be easily shown. However in this article, no bias was shown by the authors.

## What did the research involve?

A cross sectional study was completed after analysing the data that was collected in the National Health and Nutrition Examination Surveys, which assess the health and nutritional status of adults and children in the United States.
A study of 2964 children aged 4 to 11 was undertaken. The outcomes were based on the data from weekly times that the child had participated in hard physical activity (resulting in sweat or heavy breathing), daily hours the child spent watching TV or playing on a device and the combination of children who participated in little physical activity yet a high level of screen time.
Below are different types of methods used throughout the study:
* Complex survey designs were accounted for within this assessment in report proportions and 95% confidence intervals.
* Wald Chi-square tested the difference between the proportions. Chi-Square tests are most commonly used to evaluate tests of independence when analysing two simultaneous variables.
* Multivariate logistic regressions were used to recognise the aspects associated with low physical activity and high screen time.

#### Findings:

* Low physical active play = ≤6 times per week.
* High screen time = > 2 hours per day.

## What were the basic results?

From the study, we gathered that many young American children were reported to have physical activity and screen time behaviours that are inconsistent with the recommendations from the healthy paediatric development. Children who are approaching adolescence, girls, and non-Hispanic blacks are most likely to have low levels of active play and high screen time.
Of the many American children tested between the ages of 4 and 11, 37.3% had low to little levels of physical activity. However, 65% had high levels of screen time, and 26.3% prohibited both of these activities. Furthermore, the characteristics of children who attained low active play, yet high screen time were; older aged, female, non-Hispanic and possessed a BMI in the 95th percent of the Centres for Disease Control (CDC) growth charts. Additionally, the frequency of obesity among 4-5-year old’s and 6-8-year-old children was around 15% and was 20% among the 9-11-year-old children. From these results we can conclude that the number of times per week the children participated in active play (resulting in breath exertion or sweat), ranged from a minimum of 0 to a maximum of 77 times per week. We can gather from these outcomes, that half of the children analysed, aged 4 to 11 years used a form of technology for 30 minutes or less per day. 10% percent of children used technology for 2 hours or more per day, and the top 5% used technology for 3 or more hours per day.
To conclude, it is evident from the above information that young children are spending too much time on computers/devices per day, opposed to active play.

## What conclusions can we take from this research?

In today’s society it is imperative to ensure that young children are getting the right balance of active play and minimising their screen time. With the growing popularity and ease of access to online and digital based technology and platforms, it is important to establish strategies and routines within the family unit to avoid too much inactivity in children’s lifestyles. Furthermore, findings from this study indicate that when excessive amounts of screen time are combined with low levels of physical activity, it makes us think about how the younger children of our society are spending their time, and the impact this may have on their physical development and mental health.
This article conveys a message to society, that children between 4 and 11 years of age to participate in more physical activity and to be less inactive. In doing this, it will allow children to transition into their teen years with a balance of technology and health and well-being.
In conclusion, it is important that parents are educated, and understand the middle ground for social media, and social interactions.

## Practical advice

This cross-sectional study has been successful and informative on how screen time has an effect on young children’s lives and future health. This article may have given more of a broad scale to viewers if the ages of the participants were older. As the children get older and develop into teenagers, more time is spent on screens, computers and social media – resulting in less active play and physical activity. By expanding the ages of participants, it would result in more data, and would have an effect on a larger popularity.

## Further information/resources

These following research articles co inside and relate heavily to the article of ‘Active play and screen time in US children aged 4 to 11 years in relation to sociodemographic and weight status characteristics.’
* Too much screen time and too little outside play is holding back kids
* Prevention of Paediatric Overweight and Obestiy
* Active Healthy Living: Prevention of Childhood Obesity Through Increased Physical Activity.
* Relationship of Physical Activity and Television Watching With Body Weight and Level of Fatness Among Children Results From the Third National Health and Nutrition Examination Survey.

## References

* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Anderson S, Ecomonos C, Must A. Active play and screen time in US children aged 4 to 11 years in relation to sociodemographic and weight status characteristics: a nationally representative cross-sectional analysis [Internet]. BMC. 2018 [cited 18 September 2018]. Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-8-366
* ↑ Sarah E. Anderson, PhD | College of Public Health | The Ohio State University [Internet]. Cph.osu.edu. 2018 [cited 18 September 2018]. Available from: https://cph.osu.edu/people/sanderson
* ↑ Christina Economos | Friedman School of Nutrition Science and Policy [Internet]. Nutrition.tufts.edu. 2018 [cited 18 September 2018]. Available from: https://nutrition.tufts.edu/profile/faculty/christina-economos
* ↑ Design I. Aviva Must, PhD | Tufts University School of Medicine [Internet]. Medicine.tufts.edu. 2018 [cited 18 September 2018]. Available from: http://medicine.tufts.edu/Education/Academic-Departments/Clinical-Departments/Public-Health-and-Community-Medicine/Faculty/Resident%20Faculty/Must-Aviva
* ↑ Singh Setia M. Methodology Series Module 3: Cross-sectional Studies [Internet]. NCBI. 2016 [cited 18 September 2018]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4885177/
* ↑ Cross Sectional Study - an overview | ScienceDirect Topics [Internet]. Sciencedirect.com. 2018 [cited 18 September 2018]. Available from: https://www.sciencedirect.com/topics/medicine-and-dentistry/cross-sectional-study
* ↑ NHANES - National Health and Nutrition Examination Survey Homepage [Internet]. Cdc.gov. 2018 [cited 18 September 2018]. Available from: https://www.cdc.gov/nchs/nhanes/index.htm
* ↑ Using Chi-Square Statistic in Research - Statistics Solutions [Internet]. Statistics Solutions. 2018 [cited 18 September 2018]. Available from: http://www.statisticssolutions.com/using-chi-square-statistic-in-research/