Journal of Public Health | Vol. 31, No. 2, pp. 222 – 230 | doi:10.

1093/pubmed/fdp011 | Advance Access Publication 18 February 2009

Factors associated with television viewing time in toddlers

and preschoolers in Greece: the GENESIS study
Georgia Kourlaba, Katerina Kondaki, Thodoris Liarigkovinos, Yannis Manios
Department of Nutrition and Dietetics, Harokopio University of Athens, 70 El. Venizelou Avenue, 17671 Kallithea, Greece
Address correspondence to Yannis Manios. E-mail: manios@hua.gr

A B S T R AC T

Downloaded from http://jpubhealth.oxfordjournals.org/ at Florida Atlantic University on July 14, 2015

Background The aim of this work was to describe the television (TV) viewing time of preschoolers and to examine factors that may be associated
with it.

Methods A representative sample of 2374 Greek children aged 1–5 years was examined (GENESIS study). Several anthropometric, socio-
demographic and lifestyle characteristics were recorded.

Results The mean value of children’s TV viewing time was 1.32 h/day. Twenty six percent of participants spent 2 h/day in TV viewing. The
percentage of children whose TV viewing time was longer than 2 h/day was higher in children aged 3– 5 years (32.2%) than in those aged 1–2
years (11.1%). Multiple logistic regression revealed that the time parents spent viewing TV and the region of residence were significantly associated
with child’s TV viewing time among children aged 3 –5 years. Among children aged 1–2 years, the maternal educational status, the region of
residence and the maternal TV viewing time were found to be related to child’s TV viewing time.

Conclusions The current findings suggest that almost one third of Greek preschoolers exceed the limit of 2 h/day TV viewing and that parental TV
viewing time may be the most important determinant of children’s TV viewing time.

Keywords children, parental TV viewing time, socio-demographic characteristics

Introduction achieved. Several studies have been conducted for this

purpose.16 – 23 The vast majority of these studies have been
Childhood overweight and obesity has increased markedly
carried out among school-aged children and adolescents.
over the past two decades and it has become a major public
Parental TV viewing time,16 – 18 the number of TV sets in the
health problem in most industrialized countries as well as in
household,22,23 the existence of TV in child’s bedroom,22,23
countries in economic transition.1 – 5 Several epidemiologic
the frequency of the family watching TV together,16 eating
and intervention studies have suggested that television (TV)
meals in front of the TV16,22 as well as the existence of par-
viewing time is one of the most important factors that may
ental rules16 – 18 have been proposed as the most important
be associated with overweight and obesity in preschoolers,
factors associated with children’s TV viewing time.
school-aged children and adolescents.6 – 9 Moreover, investi-
Limited data are available regarding the time preschoolers
gators have also shown that excessive TV viewing time is
spend watching TV and the factors that influence this time
linked to violent or aggressive behaviors and several psycho-
in this age-group.24 Moreover, to the best of our knowledge,
somatic symptoms (i.e. attention-deficit/hyperactivity
there is no information concerning Greek children’s TV
disorder-associated behaviors).10 – 14 For all these reasons,
viewing time. Therefore, the main objectives of the present
the American Academy of Pediatrics (AAP) has proposed
work were to describe the length of time that preschoolers
the limit of no more than 2 h/day exposure of children to
TV and video.15
Taking into account all those mentioned earlier, it is clear
Georgia Kourlaba, Biostatistician-Research Assistant
that specific measures should be taken so that the adverse
Katerina Kondaki, Public Health Nutritionist-Research Assistant
effects of excessive children’s TV viewing time on their life to
Thodoris Liarigkovinos, Public Health Nutritionist-Research Assistant
be prevented. However, the factors affecting children’s TV
Yannis Manios, Assistant Professor in Nutritional Assessment, Health Promotion and
viewing time should be identified so that this goal to be Counseling

222 # The Author 2009, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.

spend watching TV in Greece and to investigate the factors
that may influence preschoolers’ TV viewing time.
Methods
Sampling
The design and rationale of the ‘Growth, Exercise and
Nutrition Epidemiological Study in preSchoolers’
(GENESIS study) study have been published previously.25
In brief, 2518 children, aged 1 – 5 years were recruited in the
study, between April 2003 and July 2004 (response rate
75%). These children were enrolled from a representative
sample of randomly selected public and private nurseries as
well as day-care centers within municipalities in five counties
of Greece (Attica and Thessalonica because they cover the
largest part of Greek population (almost 60%) and the rest
three because they were convenient counties). All nurseries
invited to participate responded positively and then they
took part in the study. Among the total number of nursery
schools studied (n ¼ 115), 63 were in Attica, 10 were in
Thessalonica, 12 were in Halkidiki, 22 were in
Aitoloakarnania and 8 were in Helia. The sampling of the
nurseries was random, multistage and stratified by the total
population of children, according to data provided by the
National Statistical Service of Greece (Census 1999). The
selected counties are widely scattered over the Greek domin-
ion while their overall local population comprises about
70% of the total Greek population (Census 1999). After
adjusting for parental age and educational level of the popu-
lation agreed to participate in the study, no significant differ-
ences between the overall population characteristics and the
study sample within counties, according to data provided by
the National Statistical Service of Greece (Census of 1999)
were observed. Thus, the final sample is representative of
70% of the Greek population with proportions of 8.7, 21.1,
38.8 and 31.4% (in the current study) for children aged 12 –
23, 25 –35, 36 –47 and 48 –60 months, respectively. Both a
letter explaining the aims of the current study and a consent
form were distributed to each parent having a child in these
nurseries. Parents agreed to participate in the study had to
sign the consent form and provide their contact details.
Complete data became available for 2374 children. The par-
ticipation rate in each nursery varied from 54 to 95% (mean
participation rate: almost 78% and median participation rate:
almost 66%), reaching the highest rates in rural areas ( par-
ticipation rate . 84% in all rural areas) and the lowest in
urban areas. Moreover, it should be mentioned that the pro-
portion of children attending day-care centers varies
between 85% and 95% depending on age group while no
T EL E V I SI O N V IE WI N G 223
differences are observed for these proportions between
urban and rural residencies. Approval to conduct the study
was granted by the Ethical Committee of Harokopio
University of Athens and by all municipalities invited to par-
ticipate in the study.
TV viewing assessment
Children’s TV viewing time was assessed by parental report
on their children’s TV/video viewing time during a usual
weekday and a usual weekend. In particular, two questions
(i.e. How many hours your child watches TV/video on a
usual weekday and how many hours your child watches TV/
Downloaded from http://jpubhealth.oxfordjournals.org/ at Florida Atlantic University on July 14, 2015
video on a usual weekend) were used in order to assess chil-
dren’s TV viewing time. Children of this age usually spend
6 –8 h/day at daycare and there is no opportunity for TV
viewing during that time. The mean daily TV viewing time
was calculated using the following equation: daily TV
hours ¼ ((weekday TV hours  5) þ weekend TV hours)/7.
Thereinafter, on the basis of the recommendations of the
AAP regarding children’s TV viewing time (i.e. less than
2 h/day), the participants were divided into two groups as
follows: children watching TV less than 2 h/day and those
watching TV  2 h/day.15 It should be noted that this limit
has been proposed only for children aged 2 years and older,
and AAP recommends that TV viewing should be discour-
aged for children younger than 2 years of age. However, this
cut-off point was also used for children aged 1 –2 years so
that the current findings to be comparable with those
declared from other works. Moreover, parents were asked to
report the time they spent watching TV on a usual weekday
and on a usual weekend. Using the aforementioned
equation, parental mean TV viewing time was also calcu-
lated, separately for participating mothers and fathers.
Physical activity assessment
Using a valid, structured questionnaire, information regard-
ing children’s physical activity was obtained by parents
during scheduled interviews at the nurseries (heart rate
monitoring was used to validate this questionnaire).26
Parents were asked to provide information regarding their
child’s participation in outdoor organized or non-organized
physical activities during a typical week. Then, a research
team member was recording this information on this proxy
questionnaire. Emphasis was placed on light to vigorous
physical activities (LVPAs) with intensity higher than four
metabolic equivalents. More information on the type of
activities comprising LVPAs is presented elsewhere.25
Preschoolers were divided into those having a LVPA  3 h/
week and those having LVPA , 3 h/week.
224 J O U RN A L O F P U B L I C H E A LTH
Anthropometric measurements
Details about the measures used for performing the afore-
mentioned measurements are presented elsewhere.25 In brief,
body weight was recorded to the nearest 10 g with the use of
a Seca digital scale and with subjects standing without shoes
in the minimum clothing possible, i.e. underwear. Recumbent
length was measured for all subjects to the nearest 0.1 cm
with a portable measuring wooden board that had a station-
ary head piece, a sliding vertical foot piece and a horizontal
back piece with a measure tape mounted on it. Further to
recumbent length, standing height was also measured to the
nearest 0.1 cm, with the use of a commercial stadiometer
(Leicester height measure). Body mass index (BMI) was cal-
culated as the ratio of weight (kg) with height squared (m2).
The Nutstat module of EpiInfo27 was used to determine chil-
dren’s age and sex-specific percentiles for weight, length and
BMI. The US Center for Disease Control (CDC) age- and
sex-specific growth charts and relative cut-off points were
used for the definition of overweight.28 Specifically, up to 24
months the weight-for-length growth chart was used to clas-
sify children .95th percentile as ‘obese’, while for children
older than 24 months, the BMI-for-age chart was used to
classify children 85th and ,95th percentile as ‘overweight’
and those 95th percentile as ‘obese’. Overall, 65.2% of
participants were normal weight, 17.2% were overweight and
the rest 17.6% were obese.
Other recorded characteristics
A structured interview was conducted with both parents, in
order to collect additional information regarding (a) parental
educational level, (b) parents’ age at birth of the child, (c)
participating preschoolers’ birth rank (i.e. first-born versus
not first-born child), (d) the existence of brothers/sisters, (e)
the region of residence (i.e. large urban/urban versus rural/
small towns), (f ) maternal employment status (i.e. employed
versus unemployed) and (g) time mother and father spent,
separately, with their child at weekdays and weekends. All
measurements were performed by the same research team
in all nurseries.
Statistical analysis
Normality of distribution was evaluated through the
Shapiro –Wilk test. Continuous variables are presented as
mean + standard deviation (SD) and categorical variables
are summarized as relative frequencies (%). Associations
between categorical variables were tested by the use of con-
tingency tables and the calculation of chi-square tests
without the correction of continuity. Because the TV viewing
time was not found to be normally distributed (P , 0.001),
the associations between this time and several other categ-
orical characteristics (i.e. parity, parents’ educational status,
the existence of brother/sisters, etc) were evaluated through
Mann –Whitney or Kruskal –Wallis test, as appropriate.
However, owing to multiple comparisons, the Bonferroni
correction was used in order to account for the increase
in Type I error. Correlations between children’s TV
viewing time and other continuous characteristics (i.e.
parents’ TV viewing time, and time that parents spent with
their children) were assessed using the Spearman correlation
coefficient.
Multiple logistic regression analysis was performed in
order to determine the independently associated factors
Downloaded from http://jpubhealth.oxfordjournals.org/ at Florida Atlantic University on July 14, 2015
with child’s TV viewing time (i.e. ,2 h/day versus  2 h/
day). Several socio-demographic characteristics (i.e. child’s
gender, parental educational status, maternal employment
status, siblings) and lifestyle characteristics of children and
their parents (i.e. child’s physical activity, parental TV
viewing time, time parents spent with their children) were
entered as independent factors. These factors were selected
either because they have been found to be significantly
associated with child’s TV viewing time in previous works
or because we hypothesized that they will be associated with
child’s TV viewing time. Moreover, because the sample of
the current work is based on a cluster design (all preschoo-
lers of nurseries enrolled in the study), this was taken into
account in multiple logistic regression analysis using the
option ‘robust cluster’.
Finally, discriminant function analysis was used in order
to determine which of the independent variables best dis-
tinguish children spending 2 h/day in front of TV from
those spending , 2 h/day. Standardized canonical discrimi-
nant function coefficients that indicate the degree of influ-
ence of the several independent factors on the dependent
variable were used for this purpose. The larger the standar-
dized coefficient the greater the contribution of the respect-
ive factor to the discrimination between groups is. In this
analysis, all factors used in the multiple logistic regression
were used as independent factors.
A probability value of 5% was considered as statistically
significant. STATA software was used for all the statistical
calculations (version 8, 2003, STATA Corp, College Station,
TX, USA).
Results
Table 1 illustrates several socio-demographic characteristics
and TV viewing time of participating children and their
parents. The mean value of child’s TV viewing time (SD)
was 1.32 (1.12) h/day, that is 1 h and 19 min per day, and
 T EL E V I SI O N V IE WI N G 225

Table 1 Socio-demographic characteristics and TV viewing time of this time was statistically significantly longer in children aged
children and their parents by children’s age; the GENESIS study (n ¼ 2374) 3 –5 years compared with those aged 1– 2 years (P ,
0.001). Similar results were found regarding the time that
1 –2 years old 3– 5 years old children spent on watching TV through weekdays and week-
ends (Table 1). Almost one third of the participants (26.0%)
Child’s sex spent 2 h/day and more in watching TV (i.e. 22.9% spent
Male 52.9% 51.0%
2 –4 h/day and only 3.1% spent more than 4 h/day in front
Child’s BMI status
of a TV set). The percent of children whose TV viewing
Normal weight 72.3% 62.5%
time was longer than 2 h/day was higher in children aged
Overweight 13.2% 18.7%
Obese 14.5% 18.8%
3 –5 years than in those aged 1 – 2 years (32.2 and 11.1%,
Child’s physical activity status
respectively), and no significant difference was observed
LVPA  3 h/week 13.3% 12.3% between boys and girls (P ¼ 0.470). The mean value of
Presence of sister/brother parents’ TV viewing time was almost 2 h/day for both

Downloaded from http://jpubhealth.oxfordjournals.org/ at Florida Atlantic University on July 14, 2015

Yes 62.5% 59.4% mothers and fathers. In particular, 55% of fathers and 44%
Maternal educational status of mothers spent more than 2 h/day in watching TV. In
,9 years 8.8% 33.0% addition, only 9 and 7% of fathers and mothers, respectively,
9 –12 years 30.8% 11.1% spent  4 h/day (Table 1).
.12 years 60.4% 55.9% Children’s BMI status, their physical activity status, their
Father’s educational status
maternal educational status and the region of residence were
,9 years 15.6% 16.0%
significantly associated with the time children spent in
9 –12 years 38.9% 35.9%
watching TV (Table 2). In particular, it was found that TV
.12 years 45.4% 48.1%
Region of residence
viewing time (daily, at weekdays and at weekend) was shorter
Large urban/urban 68.0% 79.9%
among normal weight children compared with ‘overweight’
Rural/small towns 32.0% 20.1% and ‘obese’ children aged 1 –2 years. Similar results were
Maternal employment status detected in children aged 3 – 5 years as concerns the TV
Unemployed 25.6% 31.8% viewing time at weekends and on a daily basis. Moreover,
Employed 74.4% 68.2% the TV viewing time was statistically significantly longer only
Child’s TV viewing timea among the children aged 3 – 5 years with low physical
Weekly (h/day) 0.77 + 0.91 1.55 + 1.12 activity (LVPA , 3 h/day) and those lived in large urban or
Weekdays (h/day) 0.74 + 0.95 1.49 + 1.13 urban regions compared with their counterparts. Finally, the
Weekend (h/weekend) 1.56 + 1.95 3.43 + 2.76
TV viewing time was shorter in children whose maternal
Mother’s TV viewing timea
educational status was high (.12 years) compared with
Weekly (h/day) 1.97 + 1.13 1.97 + 1.19
those whose maternal educational status was moderate (9 –
Weekdays (h/day) 2.06 + 1.34 2.03 + 1.35
Weekend (h/weekend) 3.46 + 2.11 3.61 + 2.40
12 years) or low (,9 years). On the other hand, no signifi-
Father’s TV viewing timea
cant association was detected in the TV viewing time
Weekly (h/day) 2.16 + 1.28 2.19 + 1.32 between children with and without siblings, between those
Weekdays (h/day) 2.16 + 1.49 2.18 + 1.43 whose mothers were unemployed and employed and
Weekend (h/weekend) 4.29 + 2.55 4.44 + 3.00 between those who were the first child and those who were
Time mother spend with her childa not (Table 2). Bivariate analyses revealed a significant small
Weekly (h/day) 6.68 + 3.04 6.33 + 3.33 positive association between children’s TV viewing and
Weekdays (h/day) 6.55 + 3.59 6.06 + 3.75 parents’ TV viewing time (Table 3) in both the age groups
Weekend (h/weekend) 13.88 + 7.25 13.89 + 8.03 of children. In addition, a slight inverse correlation was
Time father spend with his childa
detected between the time mothers reported to spend with
Weekly (h/day) 2.98 + 1.79 2.81 + 1.76
their children and children’s TV viewing time (the corre-
Weekdays (h/day) 2.57 + 1.83 2.32 + 1.77
lation coefficient r ranged between 20.076 and 20.147).
Weekend (h/weekend) 7.59 + 5.63 7.72 + 6.07
Table 4 presents the results from the multiple logistic
LVPA, light to vigorous physical activity; BMI, body mass index. aData are
regression for children aged 1 –2 years and those aged 3 –5
presented as mean + SD.
years, separately. Time that mothers and fathers spent in
226 J O U RN A L O F P U B L I C H E A LTH

Table 2 Children’s TV viewing time according to several characteristics for children aged  2 years and those aged 3– 5 years, separately: the GENESIS
study

1– 2 years old 3– 5 years old

TV viewing TV viewing TV viewing weekend TV viewing TV viewing TV viewing weekend

weekly (h/day) weekday (h/day) (h/weekend) weekly (h/day) weekday (h/day) (h/weekend)

Child’s sex
Male 0.79 + 0.91 0.80 + 0.96 1.58 + 1.92 1.59 + 1.17 1.52 + 1.17 3.53 + 2.89
Female 0.74 + 0.90 0.72 + 0.94 1.54 + 1.99 1.51 + 1.06 1.45 + 1.08 3.32 + 2.60
Child’s BMI status
Normal weight 0.73 + 0.88 0.73 + 0.91 1.45 + 1.88 1.52 + 1.09 1.47 + 1.12 3.30 + 2.59

Downloaded from http://jpubhealth.oxfordjournals.org/ at Florida Atlantic University on July 14, 2015

Overweight 0.97 + 1.02 0.95 + 1.09 1.99 + 2.46 1.48 + 1.06 1.41 + 1.04 3.30 + 2.72
Obese 0.85 + 0.99 0.85 + 1.06 1.71 + 1.88 1.66 + 1.16 1.57 + 1.14 3.77+ 2.96
Child’s physical activity status
LVPA , 3 h/week 0.75 + 0.88 0.74 + 0.90 1.58 + 1.96 1.59 + 1.13* 1.51 + 1.13* 3.55 + 2.81*
LVPA  3 h/week 0.85 + 1.09 0.91 + 1.22 1.43 + 1.94 1.31 + 0.99 1.33 + 1.09 2.54 + 2.15
Presence of sister/brother
Yes 0.83 + 1.00 0.83 + 1.05 1.65 + 2.15 1.54 + 1.05 1.50 + 1.08 3.24 + 2.53
No 0.73 + 0.85 0.73 + 0.90 1.52 + 1.85 1.56 + 1.16 1.49 + 1.15 3.52 + 2.87
Maternal educational status
,9 years 0.99 + 0.92 1.06 + 1.03 1.58 + 1.71 1.59 + 1.25 1.57 + 1.27 3.29 + 2.94
9– 12 years 0.83 + 0.92 0.85 + 1.08 1.58 + 1.84 1.70 + 1.23 1.65 + 1.22 3.66 + 3.07
.12 years 0.70 + 0.86* 0.67 + 0.87 1.52 + 2.04 1.45 + 1.02 1.38 + 1.05 3.28 + 2.54
Father’s educational status
,9 years 0.88 + 1.00 0.96 + 0.74 1.37 + 1.63 1.48 + 1.09 1.52 + 1.17 2.93 + 2.54
9– 12 years 0.75 + 0.94 0.96 + 1.12 1.53 + 2.02 1.58 + 1.16 1.49 + 1.11 3.46 + 2.81
.12 years 0.74 + 0.86 0.72 + 0.87 1.62 + 2.01 1.54 + 1.12 1.46 + 1.12 3.52 + 2.79
Region of residence
Large urban/urban 0.79 + 0.91 0.75 + 0.90 1.77 + 2.14* 1.62 + 1.14* 1.53 + 1.14* 3.73 + 2.89*
Rural/small towns 0.72 + 0.90 0.79 + 1.04 1.14 + 1.42 1.31 + 0.99 1.35 + 1.08 2.41 + 1.96
Maternal employment status
Unemployed 0.80 + 0.94 0.85 + 1.05 1.39 + 1.70 1.57 + 1.11 1.56 + 1.12 3.22 + 2.68
Employed 0.76 + 0.90 0.74 + 0.92 1.61 + 2.01 1.54 + 1.12 1.47 + 1.13 3.49 + 2.78

Data are presented as mean + SD. *P-value , 0.05 within each child’s age group. P-value , 0.05 for the comparison with the other two categories. LVPA,
light to vigorous physical activity; BMI, body mass index. Bonferroni correction was used in order to account for the increase in Type I error due to multiple
significance comparisons.

front of a TV set and the region of residence seems to influ-
ence significantly the TV viewing time of children aged 3 –5
years. On the other hand, the maternal educational status,
the region of residence and the maternal TV viewing time
were found to be significantly associated with the TV
viewing time of children aged 1 –2 years. In the total
sample, it was found that child’s age, maternal educational
status, parental TV viewing time and region of residence
were significantly associated with children’s TV viewing time
(data does not presented in detail). Moreover, stratified
analysis by region of residence was performed in order to
assess a possible selection bias that may have been caused
by the low response rate in urban regions. The results were
similar with those mentioned earlier.
Finally, the discriminant function analysis revealed that
among children aged 3 – 5 years, the three most important
factors that best distinguished children who spent 2 h/day
watching TV from those who spent ,2 h/day were
mother’s TV viewing time (b ¼ 0.670), father’s TV viewing
time (b ¼ 0.411) and the region of residence (b ¼ 20.325).
Among children aged 1 –2 years, the three most important
factors were the maternal educational status (b ¼ 1.107), the
region of residence (b ¼ 0.469) and maternal TV viewing
time (b ¼ 20.443). In the total sample, the most to
 T EL E V I SI O N V IE WI N G 227

Table 3 Correlation between children’s TV viewing time and parents’ characteristics: the GENESIS study

1 –2 years old 3–5 years old

TV viewing TV viewing TV viewing weekend TV viewing TV viewing TV viewing weekend

weekly (h/day) weekday (h/day) (h/weekend) weekly (h/day) weekday (h/day) (h/weekend)

TV viewing time of
mother
Weekly (h/day) 0.127* 0.132* 0.105* 0.273* 0.251* 0.244*
Weekdays (h/day) 0.085 0.105* 0.052 0.233* 0.232* 0.189*
Weekend (h/weekend) 0.202* 0.184* 0.210* 0.295* 0.244* 0.300*
TV viewing time of father
Weekly (h/day) 0.181* 0.193* 0.166* 0.200* 0.196* 0.173*

Downloaded from http://jpubhealth.oxfordjournals.org/ at Florida Atlantic University on July 14, 2015

Weekdays (h/day) 0.173* 0.196* 0.142* 0.170* 0.182* 0.131*
Weekend (h/weekend) 0.148* 0.130* 0.176* 0.212* 0.174* 0.222*
Time mother spend with
her child
Total (h/day) 20.072 20.039 20.093 20.051 0.006 20.106*
Weekdays (h/day) 20.089 20.039 – 20.074* 0.005 –
Weekend (h/weekend) 20.022 – 0.002 20.001 – 20.004
Time father spend with
his child
Total (h/day) 0.052 0.052 0.045 0.001 0.011 20.007
Weekdays (h/day) 0.048 0.058 – 20.006 0.028 –
Weekend (h/weekend) 0.070 – 0.087 0.022 – 0.050

Data are presented as Spearman correlation coefficients. *P-value , 0.05.

least important factors were child’s age (b ¼ 0.629), mother’s
TV viewing time (b ¼ 0.467), father’s TV viewing time
(b ¼ 0.351), the region of residence (b ¼ 20.309) and
mother’s educational status (b ¼ 20.274).
Discussion
Main findings of this study
In this work, the time that preschoolers spend watching TV
and the factors associated with children’s TV viewing time
were examined. The mean daily TV viewing time was
46.2 min/day for children aged 1 – 2 years and 1.5 h/day for
children aged 3– 5 years. Moreover, taking into account that
AAP recommends the limit of no more than 2 h/day for
children’s TV viewing time, we found that 26% of the par-
ticipants exceeded this limit. However, this percentage was
higher among children aged 3 –5 years (32%) compared
with children aged 1 –2 years (11%).
Moreover, the current findings indicate that parental TV
viewing time was significantly and positively associated with
children’s TV viewing time in both age groups of children.
In particular, the maternal TV viewing time was the first
most important factor for the discrimination of children
spending 2 h/day from those spending ,2 h/day in front
of screen among children aged 3 –5 years and the third
most important factor for children aged 1 – 2 years (i.e. the
first and second most important factors were the maternal
educational status and the region of residence).
Finally, the findings of the current work indicate that chil-
dren living in urban or in large urban regions are more likely
to exceed the limit of 2 h/day for watching TV. This may be
because children living in these regions spend more time
inside house and consequently they have more time available
to watch TV. Moreover, children whose mothers are
highly educated are less likely to spend 2 h/day in front of
a TV set compared with children whose mothers are
low-educated.
What is already known on this topic
and what this study adds
Several similar studies have been conducted in school-aged
children and adolescents. The results of the current work
are consistent with those of others. For instance, Solgul
Yalcin et al. reported that the mean of daily TV viewing time
228 J O U RN A L O F P U B L I C H E A LTH

Table 4 Independently associated factors with children’s TV viewing time (,2 h/day versus  2 h/day)

1 –2 years old 3– 5 years old

Odds ratio 95% CI P-value Odds ratio 95% CI P-value

Gender
Male Reference group – – Reference group – –
Female 1.16 0.60– 2.11 0.645 0.79 0.55 –1.09 0.155
Physical activity status
LVPA , 3 h/week Reference group – – Reference group – –
LVPA  3 h/week 1.92 0.94– 3.96 0.080 0.83 0.56 –1.32 0.315
Presence of sister/brother
No Reference group – – Reference group – –

Downloaded from http://jpubhealth.oxfordjournals.org/ at Florida Atlantic University on July 14, 2015

Yes 0.77 0.38– 1.34 0.302 1.22 0.95 –1.71 0.345
Maternal employment status
Unemployed Reference group – – Reference group – –
Employed 1.68 0.73– 3.86 0.219 1.35 0.93 –1.96 0.113
Time mother spent with her child 1.03 0.91– 1.21 0.480 0.99 0.94 –1.03 0.631
Time father spent with his child 0.96 0.79– 1.07 0.295 0.96 0.89 –1.06 0.634
Region of residence
Large urban/urban Reference group – – Reference group – –
Rural/small town 0.48 0.22– 0.99 0.050 0.57 0.40 –0.78 0.008
Mother’s educational status
,9 years Reference group – – Reference group – –
9– 12 years 0.49 0.18– 1.28 0.144 0.92 0.54 –1.57 0.773
.12 years 0.26 0.09– 0.74 0.012 0.64 0.36 –1.13 0.124
Father’s educational status
,9 years Reference group – – Reference group – –
9– 12 years 1.46 0.63– 3.36 0.375 0.99 0.59 –1.54 0.855
.12 years 1.13 0.54– 2.35 0.739 1.03 0.70 –1.42 0.733
Mother’s TV viewing time (h/day) 1.24 0.94– 1.79 0.091 1.38 1.25 –1.57 ,0.001
Father’s TV viewing time (h/day) 1.16 0.95– 1.47 0.135 1.24 1.15 –1.42 ,0.001

Results from multiple logistic regression analysis: the GENESIS study.

among 187 children from Ankara, aged 3 –6 years was 2 h
and 11 min per day.24 Another study was conducted in
order to develop and evaluate an intervention to reduce TV
viewing by preschool children during 2004 in rural upstate
New York. In this work, it was found that children watched
TV almost 1 h and 42 min per day before the intervention.
Moreover, 33% of children included in the intervention
group and 45% of participants in control group spent at
least 2 h/day in front of TV.29 Finally, the results of a large
cross-sectional study conducted among Australian children
aged between 4 and 12 years showed that preschoolers
watched TV 1 h and 42 min per day.21
In addition, in agreement with the current findings, the
results of the unique previous study conducted in preschoo-
lers24 showed that parental TV viewing time was positively
and significantly associated with children’s TV viewing time.
Similar results have been reported in studies conducted
among school-aged children and adolescents.16,17,20 This
relationship between children’s and parents’ TV viewing time
may imply that parental behaviors create an environment that
can promote similar behaviors in their children. This hypoth-
esis may be confirmed by the fact that previous studies have
reported associations between parental and children beha-
viors, such as physical activity and dietary habits.30 – 34
Therefore, although several studies have investigated
potential factors that may influence children’s TV viewing
time in adolescents and school-aged children, to the best of
our knowledge, only one previous study—much smaller
than the current study—has investigated the factors influen-
cing preschoolers’ TV viewing time.24 As a result, this study
extends the findings of the previous works in a younger age
group (i.e. preschoolers).

Limitations of this study
There are some limitations in the current study. First and
foremost, some factors that have been proved to be signifi-
cantly associated with children’s TV viewing time (i.e. the
existence of a TV in the child’s bedroom, their siblings’ TV
viewing time, the number of TV sets in the house and par-
ental rule regarding the amount their children watch TV)
have not been recorded in the current study. Moreover, only
TV/video viewing time was recorded and not the time chil-
dren spent playing video games. However, taking into
account that very young children may not spend a lot of
time on video games, we think that this limitation may not
affect significantly the current findings. In addition, chil-
dren’s TV viewing time was obtained by parental report and
the validity of their report was not examined. However, sig-
nificant correlation has been reported between parental
reports of children’s TV viewing time and TV diaries.35
Another limitation of the current study was that the
response rate was almost 54% in urban regions. Therefore,
it is possible that the association observed between region
of residence and TV viewing time (i.e. children living in
rural regions watch less TV than those living in urban areas)
may not be an actual one. Moreover, a questionnaire, not
valid in this particular age group was used to assess the chil-
dren’s physical activity. In particular, the validation of this
questionnaire has been evaluated in 6-year-old children.
However, it would be preferable to measure physically
activity using accelerometry, since it is widely accepted that
accelerometries would provide more valid data. In addition,
although it is recommended that children should achieve at
least 60 min per day of at least moderate intensity physical
activity, only the 3% of the current population was found to
be physical active more than 7 h/week. Therefore, the arbi-
trary threshold of 3 h/week was used. Moreover, it is poss-
ible that children’s physical activity is underestimated by their
parents since children spend about 6 –8 h/day in nurseries
and parents do not know at least the non-organized physical
activity of their children during this time. These limitations
could be possible explanations for the fact that no associ-
ation was detected between child’s physical activity and TV
viewing time. Finally, as a cross-sectional study, it is not
appropriate to identify cause –effect relationships.
Conclusion
In conclusion, the findings of the current work revealed that
a substantial percentage of very young children (almost 26%)
exceed the limit of 2 h/day for TV viewing. Moreover, the
present results indicate that preschoolers’ TV viewing time is
T EL E V I SI O N V IE WI N G 229
strongly associated with parental TV viewing time and par-
ticularly with mother’s viewing time. Therefore, pediatricians
and health professionals not only should make parents aware
of the adverse effects of prolonged TV viewing on their chil-
dren’s health and development but also should help them
recognize that their TV viewing habits may influence the
time that their children spend watching TV. Further research
that investigates the potential causality of parental viewing
and children’s viewing through perspective cohort studies or
randomized controlled trials are required.
Acknowledgements
Downloaded from http://jpubhealth.oxfordjournals.org/ at Florida Atlantic University on July 14, 2015
The author thanks Evdokia Oikonomou, Vivian
Detopoulou, Anastasia Anastasiadou, Christine
Kortsalioudaki, Elina Ioannou, Margarita Bartsota, Manolis
Birbilis, Elina Dimitropoulou, Nikoleta Vidra, Theodoros
Athanasoulis, Pari Christofidou, Lilia Charila, Sofia Tzitzirika
and Christos Vassilopoulos for their contribution to the
completion of the study. The GENESIS study was sup-
ported with a Research Grant from Friesland Foods Hellas.
Conflict of interest. Y.M. works as a part-time scientific
consultant for Friesland Foods Hellas. None of the other
authors had any personal or financial conflict of interest.
The study sponsor had no interference in the study design
data collection or in writing the manuscript.
References
1 Caprio S, Genel M. Confronting the epidemic of childhood obesity.
Pediatrics 2005;115(2):494 –5.
2 Manios Y, Magkos F, Christakis G et al. Twenty-year dynamics in
adiposity and blood lipids of Greek children: regional differences in
Crete persist. Acta Paediatr 2005;94(7):859 – 65.
3 Lobstein T, Jackson-Leach R. Estimated burden of paediatric
obesity and co-morbidities in Europe. Part 2. Numbers of children
with indicators of obesity-related disease. Int J Pediatr Obes
2006;1(1):33– 41.
4 Tzotzas T, Krassas GE. Prevalence and trends of obesity in chil-
dren and adults of South Europe. Pediatr Endocrinol Rev
2004;1(Suppl. 3):448– 54.
5 Ogden CL, Carroll MD, Flegal KM. High body mass index for age
among US children and adolescents, 2003 – 2006. Jama 2008;
299(20):2401 – 5.
6 Robinson TN. Reducing children’s television viewing to prevent
obesity: a randomized controlled trial. Jama 1999;282(16):1561 – 7.
7 Gortmaker SL, Must A, Sobol AM et al. Television viewing as a
cause of increasing obesity among children in the United States,
1986 – 1990. Arch Pediatr Adolesc Med 1996;150(4):356 –62.
230 J O U RN A L O F P U B L I C H E A LTH
8 Epstein LH, Roemmich JN, Robinson JL et al. A randomized trial
of the effects of reducing television viewing and computer use on
body mass index in young children. Arch Pediatr Adolesc Med
2008;162(3):239 – 45.
9 Mendoza JA, Zimmerman FJ, Christakis DA. Television viewing,
computer use, obesity, and adiposity in US preschool children. Int J
Behav Nutr Phys Act 2007;4:44.
10 Miller CJ, Marks DJ, Miller SR et al. Brief report: television viewing
and risk for attention problems in preschool children. J Pediatr
Psychol 2007;32(4):448– 52.
11 Landhuis CE, Poulton R, Welch D et al. Does childhood television
viewing lead to attention problems in adolescence? Results from a
prospective longitudinal study. Pediatrics 2007;120(3):532 – 7.
12 Huesmann LR, Moise-Titus J, Podolski CL et al. Longitudinal
relations between children’s exposure to TV violence and their
aggressive and violent behavior in young adulthood: 1977 – 1992.
Dev Psychol 2003;39(2):201– 21.
13 Johnson JG, Cohen P, Smailes EM et al. Television viewing and
aggressive behavior during adolescence and adulthood. Science
2002;295(5564):2468 – 71.
14 Tanaka H, Tamai H, Terashima S et al. Psychosocial factors affect-
ing psychosomatic symptoms in Japanese schoolchildren. Pediatr Int
2000;42(4):354 – 8.
15 American Academy of Pediatrics. Children, adolescents, and televi-
sion. Pediatrics 2001;107(2):423 – 6.
16 Salmon J, Timperio A, Telford A et al. Association of family
environment with children’s television viewing and with low level of
physical activity. Obes Res 2005;13(11):1939 – 51.
17 Davison KK, Francis LA, Birch LL. Links between parents’ and
girls’ television viewing behaviors: a longitudinal examination.
J Pediatr 2005;147(4):436 – 42.
18 Barradas DT, Fulton JE, Blanck HM et al. Parental influences
on youth television viewing. J Pediatr 2007;151(4):369 – 73,
73 e1-4.
19 Salmon J, Hume C, Ball K et al. Individual, social and home
environment determinants of change in children’s television
viewing: the Switch-Play intervention. J Sci Med Sport 2006;9(5):
378 – 87.
20 Hardy LL, Baur LA, Garnett SP et al. Family and home correlates
of television viewing in 12– 13 year old adolescents: the Nepean
Study. Int J Behav Nutr Phys Act 2006;3:24.
21 van Zutphen M, Bell AC, Kremer PJ et al. Association between the
family environment and television viewing in Australian children. J
Paediatr Child Health 2007;43(6):458 – 63.
22 Saelens BE, Sallis JF, Nader PR et al. Home environmental
influences on children’s television watching from early to middle
childhood. J Dev Behav Pediatr 2002;23(3):127 – 32.
23 Wiecha JL, Sobol AM, Peterson KE et al. Household television
access: associations with screen time, reading, and homework
among youth. Ambul Pediatr 2001;1(5):244 – 51.
24 Songul Yalcin S, Tugrul B, Nacar N et al. Factors that affect televi-
sion viewing time in preschool and primary schoolchildren. Pediatr
Int 2002;44(6):622 – 7.
25 Manios Y. Design and descriptive results of the ‘Growth, Exercise
and Nutrition Epidemiological Study In preSchoolers’: the
GENESIS study. BMC Public Health 2006;6:32.
26 Manios Y, Kafatos A, Markakis G. Physical activity in 6-year-old
children:validation of two proxy reports. Pediatr Exerc Sci 1998;
Downloaded from http://jpubhealth.oxfordjournals.org/ at Florida Atlantic University on July 14, 2015
10:176– 88.
27 Division of Public Health Surveillance and Informatics. Centers for
Disease Control and Prevention (CDC). EpiInfo-Database and Statistics
Software for Public Health Professionals, 2004.
28 National Center for Health Statistics and the National Center for
Chronic Disease Prevention and Health Promotion. CDC Growth
Charts, 2000.
29 Dennison BA, Russo TJ, Burdick PA et al. An intervention to
reduce television viewing by preschool children. Arch Pediatr Adolesc
Med 2004;158(2):170 – 6.
30 Wagner A, Klein-Platat C, Arveiler D et al. Parent-child physical
activity relationships in 12-year old French students do not depend on
family socioeconomic status. Diabetes Metab 2004;30(4):359–66.
31 Fisher JO, Mitchell DC, Smiciklas-Wright H et al. Meeting calcium
recommendations during middle childhood reflects mother-
daughter beverage choices and predicts bone mineral status. Am J
Clin Nutr 2004;79(4):698– 706.
32 Davison KK, Cutting TM, Birch LL. Parents’ activity-related
parenting practices predict girls’ physical activity. Med Sci Sports
Exerc 2003;35(9):1589 – 95.
33 Fisher JO, Mitchell DC, Smiciklas-Wright H et al. Parental
influences on young girls’ fruit and vegetable, micronutrient, and fat
intakes. J Am Diet Assoc 2002;102(1):58– 64.
34 Cutting TM, Fisher JO, Grimm-Thomas K et al. Like mother, like
daughter: familial patterns of overweight are mediated by mothers’
dietary disinhibition. Am J Clin Nutr 1999;69(4):608 –13.
35 Anderson DR, Field DE, Collins PA et al. Estimates of young
children’s time with television: a methodological comparison of
parent reports with time-lapse video home observation. Child Dev
1985;56(5):1345 – 57.