584 - High Family and Neighborhood Resilience are Associated with Less Screen Time in Children Ages 6-17 Years

Reducing screen time supports many aspects of child health, including healthy development, mood, and weight gain. Potential multi-level intervention targets to support reduced screen time include family resilience and neighborhood resilience. These are hypothesized to be part of upstream pathways that may mitigate the effects of social trauma on health behaviors, like excess screen time, especially among populations at highest risk.

Objective:

To evaluate associations between family resilience and neighborhood resilience with a child’s average daily recreational screen time.

Design/Methods:

We analyzed repeated, cross-sectional data from the 2016-2020 National Survey of Children’s Health (NSCH) reported by parents of children ages 6-17 years. Resilience was measured using two separate scales for family and neighborhood. Each item had 4-point Likert responses that were averaged to create resilience scores from 0-3 (higher values corresponding to higher resilience). Average daily recreational screen time ranged from “< 1 hour” to “4+ hours.” Proportional odds regression models evaluated associations between each resilience domain and screen time, controlling for sociodemographics. We tested for an interaction with adverse childhood experiences (ACEs), hypothesizing that resilience may condition on social trauma.

Results: Out of a weighted population of 238,351,351 children, parent-identified child race was 67% white, 14% Black, and 19% other. Median (IQR) resilience scores were 2.50 (1.00) for family and 2.40 (0.80) for neighborhood. Median (IQR) daily screen time was 3 (2) hours with 36% at 4+ hours/day. For children with both high family and neighborhood resilience, the predicted probability (95% CI) of having < 1 hour of daily screentime was 0.18 (0.17, 0.19); for those with high family and low neighborhood resilience 0.12 (0.11, 0.14); for those with high neighborhood and low family resilience 0.11 (0.10, 0.12); and for those with both low family and neighborhood resilience 0.07 (0.07, 0.08). The interaction with ACEs was statistically significant (p=0.002) (Table 1).

Conclusion(s): In a large, nationally representative dataset of U.S. children aged 6-17 years, high family and high neighborhood resilience were associated with an 11% absolute higher probability of complying with 1-hour daily recreational screentime limits recommended by the American Academy of Pediatrics. ACEs attenuated those associations. Understanding the socio-ecological factors that impact screen time use among children may help develop interventions to interrupt the pathway between toxic stress and poor childhood health outcomes.