Association between family nurturing environment and screen exposure among preschool children aged 3–6 years in Shanghai: A cross-sectional study

BACKGROUND: Excessive or early screen exposure has been deemed associated with both immediate and long-term health impairment among preschool children. This study aimed to investigate the association between family nurturing environment and screen exposure among preschool children aged 3-6 years. MATERIALS AND METHODS: A multi-stage stratified cluster sampling method was utilized to sample the kindergarten children aged 3-6 years from a district in Shanghai, China. From April to May 2023, parents completed an online questionnaire. Children's screen exposure was defined as more than 1 hour (hr) per day of screen-based devices use, and the daily screen time was categorized into three groups: non-exposure (<1hr/ day), low exposure (1-4 hrs/ day), and high exposure (>4 hrs/ day). Univariate and multivariate cumulative logit regression models were adopted to identify the determinants of screen exposure. RESULTS: A total of 1917 preschool children were included. Of these, 1604 (83.7%) were exposed to screens for more than 1 hr per day. High, low, and non-exposure groups comprised 313 (16.3%), 1291 (67.4%), and 313 (16.3%) children, respectively. The multivariate cumulative logit model showed that parental education, monthly household income, presence of screen-based devices in the bedroom, and parental screen use in front of children were positive determinants of more severe screen exposure for preschoolers. Conversely, older age, absence of siblings, co-viewing with the child, and parental restriction of screen time were negative determinants of more severe screen exposure. CONCLUSIONS: Our findings suggest that interventions targeting parental behavior and cognitive practices may be more effective in promoting healthy screen exposure habits in preschool children.