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Behavioral Correlates of Television Viewing in Primary School Children Evaluated by the Child Behavior Checklist
Elif Özmert, MD, PhD;
Müge Toyran, MD;
Kadriye Yurdakök, MD
Arch Pediatr Adolesc Med. 2002;156:910-914.
ABSTRACT
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Background Television is a source from which children gain information about life
and experience different types of behavior. The Child Behavior Checklist (CBCL)
has not been used thoroughly to evaluate the behavioral effects of television
viewing on children.
Objective To examine the competency and problem behavior correlates of television
viewing in school-aged children using the CBCL.
Design Cross-sectional survey.
Setting Two randomly selected grade schools, one from a high-income district
and the other from a low-income district.
Participants Students in grades 2 and 3 and their parents.
Main Outcome Measures A questionnaire on children's time spent watching television and engaging
in other daily activities and the CBCL were sent to the parents of 888 second-
and third-grade students.
Results Results of the questionnaire reported that the overall mean ±
SD daily television viewing time was 2.5 ± 1.3 hours. Overall television
viewing time had a negative correlation with social and school achievement
(r = -0.17, P<.001
and r = 0.11, P = .03, respectively)
subscale scores. Withdrawn (r = 0.11, P = .004), social problem (r = 0.14, P = .001), thought problem (r
= 0.11, P = .03), attention problem (r = 0.20, P<.001), delinquent behavior
(r = 0.12, P<.001), aggressive
behavior (r = 0.22, P<.001),
and externalization (r = 0.19, P<.001) subscales and total problem (r
= 0.15, P<.001) scores were positively correlated
with time spent watching television. Stepwise logistic regression analysis
revealed that the only significant variables associated with a risk of watching
television for more than 2 hours were age, gender, social subscale, and attention
problem subscale scores of the CBCL.
Conclusion As evaluated by the CBCL, television viewing time is positively associated
with social problems, delinquent behavior, aggressive behavior, externalization,
and total problem scores. Older age, male gender, and decreasing social subscale
and increasing attention problem subscale scores on the CBCL increases the
risk of watching television for more than 2 hours.
INTRODUCTION
CHILDREN LEARN about life, exercise problem solving skills, and develop
their own character by watching and experiencing the world around them. It
has been stated that the average child or adolescent in United States watches
an average of 3 hours of television per day,1
and by the time he or she reaches 70 years of age, he or she will have spent
the equivalent of 7 to 10 years watching television.2
Television gives children a distorted image of the world, as children
have difficulty in discriminating reality from fantasy on television.3 The results of the cultivation effect of television4 on children are widely studied, but the effects of
television on human beings are too complicated to study thoroughly and then
to specify cause-effect relationships.
Violence is the most widely studied subject in the field of pediatrics,
and 2 recent meta-analyses5-6
investigating the relationship between violence viewed on television and aggressive
behavior in children concluded that exposure to portrayals of violence on
television was associated consistently with children's aggressive behavior.
Other studies have blamed television for causing conduct disorder, symptoms
of psychological trauma, social skill difficulties,7-8
anorexia nervosa,9-10 nutritional
changes, dieting and obesity,11 and substance
use and abuse,12-13 and for negatively
affecting sexuality12 and body concept and
self-image.14 The effect of television on school
performance is also widely studied; there are reports of positive and negative
effects.15-17
Social status and intelligence quotient seem to play important roles,18 as does the content of the programs viewed.19-20
The Parent Report form of the Child Behavior Checklist (CBCL) is widely
used to assess behavioral problems and social competency of children aged
4 through 16 years. It has strong psychometric properties.21
To our knowledge, the CBCL has not been used thoroughly to examine the effects
of television viewing on child behavior. This study was performed to examine
the competency and problem behavior correlates of television viewing using
the CBCL in school-aged children.
PARTICIPANTS, MATERIALS, AND METHODS
The study was performed between March 2000 and June 2000 in Ankara,
Turkey. Two primary schools were selected randomly: one from a low socioeconomic
status (SES) district and the other from a high SES district. Subjects were
in the second and third grades, 472 from a low SES, and 414 from a high SES
district. The study was approved by Hacettepe University Institute of Child
Health (Ankara). After giving informed oral consent, parents were asked to
fill out a questionnaire and the CBCL. The questionnaire contained questions
about the parent's and the child's television viewing habits, including the
time the child spent watching television vs engaging in other daily activities.
The American Academy of Pediatrics recommends 1 to 2 hours of television
watching per day, while it has been reported that an average child watches
3 hours per day.1 Taking these into consideration,
children were separated into 3 groups according to the time they spent watching
television as reported in the questionnaires: children watching 2 hours or
less constituted the low television watching group (group 1), children watching
2 to 4 hours constituted the medium television watching group (group 2), and
children watching more than 4 hours constituted the high television watching
group (group 3). To evaluate the reliability of the parent-reported television
viewing time in the questionnaires, a subgroup was selected. Ten percent of
the children from each SES (n = 90) were selected randomly and the parents
were asked to fill out a diary for 7 days. The diary was divided into hourly
periods and parents recorded the activities of their child for each period.
The correlation between the diary- and questionnaire-reported television viewing
time was evaluated.
The CBCL consists of competency and problem scores. The competency scores
of the CBCL are school achievement, social, and activity scores. From these
3 scales, a total competency score is obtained. The problem scores within
the checklist are somatic complaint, withdrawn, anxious/depressed, social
problem, thought problem, attention problem, delinquent behavior, aggressive
behavior, and sex problem. Scores from all of these problem scales constitute
the total problem score. In addition, 2 broadly based scales labeled internalizing
(consisting of anxious and withdrawn scores) and externalizing (consisting
of delinquent behavior and aggressive behavior) are available. The test was
adapted for Turkish children.22 All of the
competency and problem scores were calculated and used. Raw scores were used
for CBCL analysis. The physical health effects of television viewing in these
children were also evaluated and reported elsewhere.23
The data were analyzed by the t test, Pearson
correlation test, partial correlation test, and 1-way analysis of variance.
As the data did not fulfill the criteria for normal distribution, stepwise
logistic regression was performed. The outcome variable was defined as time
spent watching television. Children watching television for 2 hours or less
constituted the control group and those watching more constituted the risk
group. This cutoff value was also in accordance with the current recommendations
of television watching hours.1 The tests were
performed using SPSS version 9.0 (SPSS Inc, Chicago, Ill).
RESULTS
Parents of 689 second- and third-grade students (78% of parents), 368
from a low and 321 from a high SES district, answered the questionnaires.
Of the students, 346 were girls and 343 were boys. The mean ± SD age
of the students was 7.95 ± 0.77 years.
The mean ± SD daily viewing time according to the questionnaires
was 2.1 ± 1.2 hours during the weekdays, 3.4 ± 2.1 hours during
the weekends, and 2.5 ± 1.3 hours overall. Television viewing time
did not differ by SES, although gender seemed to have some effect (Table 1).
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Table 1. Television Viewing Time of Children According to Socioeconomic
Status (SES) and Gender
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Diaries were filled out by 84 parents, 37 from the high and 47 from
the low SES district. Among these children, 39 were boys and 45 were girls.
The SES and gender distribution of this subgroup was similar to the whole
group (P>.05). The overall daily mean ± SD
television viewing time reported from diaries was 2.5 ± 1.2 hours.
There was a moderate but significant correlation between the television viewing
time reported by the questionnaire and that reported by the diary (r = 0.6, P<.001).
The mean raw CBCL scores according to the time spent watching television
are presented in Table 2. Group
3 had higher scores than group 1 for withdrawn, social problem, thought problem,
attention problem, delinquent behavior, aggressive behavior, and externalization
subscales and for total problem scale, and had lower social subscale scores.
Group 3 scores were also higher than group 2 for social problem, aggressive
behavior, and externalization subscale score. Group 2 had scores higher than
group 1 for attention problem, aggressive behavior, sex problem, externalization
subscales, and total problem scores, and had lower scores for social and school
achievement subscales.
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Table 2. Child Behavior Checklist Scores of Children Grouped According
to Daily Television Viewing Hours*
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Overall television viewing time was negatively correlated with social
and school achievement subscale scores (r = -0.17, P<.001 and r = 0.11, P = .03, respectively). Scores for withdrawn (r = 0.11, P = .004), social problem (r = 0.14, P = .001), thought problem
(r = 0.11, P = .03), attention
problem (r = 0.20, P<.001),
delinquent behavior (r = 0.12, P<.001), aggressive behavior (r = 0.22, P<.001), and externalization (r
= 0.19, P<.001) subscales and total problem scale
(r = 0.15, P<.001) were
positively correlated with the time spent watching television. Although these
correlations were significant statistically, they were of low grade.
When controlled for gender and SES, the correlation between television
viewing time and social problem (r = 0.36, P = .02), delinquent behavior (r
= 0.43. P = .005), and aggressive behavior (r = 0.43, P = .005) scores did
not only persist but also became stronger. The correlation between television
viewing time and externalization scores (r = 0.18, P<.001) and total problem (r
= 0.15, P<.001) scores persisted at a lower strength.
To analyze the interactions of age, gender, SES, CBCL scores, and television
watching time, stepwise logistic regression was applied, as the data did not
fit a normal distribution. The coefficient of regression results are presented
in Table 3. The sensitivity of
this model was 79.9% and the specificity was 40.3%. It was found that the
only significant variables associated with a risk of watching television for
more than 2 hours were age, gender, and social and attention problem subscale
scores of the CBCL.
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Table 3. Association Between Age, Gender, Child Behavior Checklist
Scores, and Risk of Watching Television for More Than 2 Hours*
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COMMENT
In this cross-sectional survey, the association between time spent watching
television and child behavior was examined. One of the critical points of
this study is the method of determination of television viewing time. Earlier
methodological studies have concluded that the most reliable method to determine
television-viewing time is the diary method but have stated that the questionnaire
method has a moderate and significant correlation with the diary method.24 We selected a subgroup of students and asked the
parents to fill out 7-day diaries to evaluate the reliability of the questionnaire-reported
viewing time. There was a moderate and significant correlation between diary-
and questionnaire-reported television viewing time in our study group. The
second critical point of the study is the cross-sectional design, used so
that no causal relationship between television watching time and behavioral
problem could be concluded. Only associations were demonstrated and the direction
of association may be either way. Either children with a behavioral problem
watch more television or children watching more television have a behavioral
problem or both.
For years, researchers have studied the effects of television watching,
with the effects of television violence being of primary concern. Television
violence is as prevalent in Turkish programming as in countries all over the
world.16 Although there are studies reporting
the contrary, most researchers agree that television violence causes aggressive
behavior. It is not easy to perform a study that will explain the causal relationship
between television violence and aggression, but the evidence gathered thus
far suggests that a relationship exists in some way.5-6
In our study, children in group 3, who watched the most television, were found
to have higher scores in delinquent behavior and aggressive behavior subscales
than those in group 1. The aggressive behavior subscale scores of group 2
were also higher than the scores of group 1. Further strengthening the relationship,
television viewing time was found to be correlated positively with these 2
scores. In a recent intervention study by Robinson et al,25
it was shown that decreasing exposure to television decreased aggressive behavior
in children in the third and fourth grades. In our study and in that study,
program selection was not made. Both studies show that increased television
exposure is positively associated with aggressive behavior irrespective of
the content of the programs. Apart from the content of the programs, the duration
of viewing seems to be a determinant of aggressive behavior. However, stepwise
logistic regression showed a significant association only between social subscale
and attention problem subscale scores of the CBCL and the risk of watching
television for more than 2 hours. The risk of watching television for more
than 2 hours increased by 16% for each unit decrease in social subscale score.
After stepwise regression analysis, no association was found between television
viewing and delinquent behavior and aggressive behavior subscale scores. Thus,
it was speculated that not only the prolonged television viewing but perhaps
the inactivity and social isolation while watching television may have contributed
to increased aggressive behavior scores.
Besides violence, school performance is the second most popular subject
studied with regard to the effects of watching television. There are reports
on both positive and negative effects.15, 17-18,26-28
The study performed by Williams et al27 in
Canada supports a negative effect. In that study, children living in a town
that had not yet received television transmission were found to have better
reading scores than another town that had television. It was also shown that
the difference disappeared 2 years after the introduction of television to
the first town. On the other hand, it is also suggested that just as violence
can be learned from television, so can words and other useful information;
thus, television can affect school achievement positively. In 1984, children
watching television for 1 to 2 hours were reported to have better reading
scores than children watching less, but this effect did not persist when viewing
time increased further.15 Reports from Canada
and Finland claimed that television had a positive effect on word knowledge
and general information but a negative effect on mathematics and reading.28
In our study, school achievement subscale scores of group 1 children,
who watched the least amount of television, were found to be higher than the
scores of group 2. The school achievement scores of group 3 children, who
watched the greatest amount of television, were the lowest, but the difference
was not found to be significant. This may be because of the number of children
in group 3. Furthermore, this score was found to be negatively correlated
with television viewing time.
One of the reasons a negative association between watching television
and school achievement was found may be that our study methods did not consider
the program contents viewed. Recently, it has been shown that the particular
content viewed is of great importance. Children who watch programs with educational
content receive better grades in school.19-20
There was no association between the time spent viewing television and
the time spent reading and studying that may have contributed to the low school
achievement in group 3. However, group 1 was found to have lower attention
problem scores than groups 2 and 3. Also, we found attention problem scores
to be positively associated with television viewing time. Although no association
between school achievement and television viewing time could be demonstrated
after stepwise logistic regression, the association persisted for attention
problem scores. It was found that for each unit increase in attention problem
scores, the risk of watching television for more than 2 hours increased by
13%. Attention problems may also contribute to decreased school achievement.
However, as pointed out earlier, such a cross-sectional survey is not suitable
for determining a cause-effect relationship (children with attention problems
may be watching television more), and to our knowledge, there is no study
in the literature that reports a direct relationship between television viewing
and attention problems. We believe this association should be evaluated further.
It has been revealed that television affects the development of gender
identity in the child and, unfortunately, stereotyped and distorted images
of females and males and their relationships are most often depicted. In the
television world, men are more often portrayed in positions of employment,
have higher-status positions than women, and are autonomous, powerful, and
violent. Women are underrepresented; they are young, have less personal power,
and are usually portrayed in domestic locations. Working women are less likely
to be married, and if married, they are less likely to be successfully married.29-30 Sexual relationships develop rapidly,
the risk of pregnancy is rarely considered, and adolescence is portrayed as
a constant state of sexual crisis.31-32
In our study, although a correlation could not be detected between television
viewing time and the sex problem subscale scores of the CBCL, group 1 had
the lowest and group 3 the highest scores (group 2 was in between). Only the
difference between groups 1 and 2 was significant. Keeping in mind that our
study group was composed of students in grades 2 and 3, this association may
become more manifest during adolescence.
The stepwise logistic regression also revealed a positive association
between age and the risk of watching television for more than 2 hours. It
was found that for each 1-year increase in age, the risk of watching television
for more than 2 hours increased by 33% in this age group (7-10 years) of children.
Stepwise analysis also found a significant association between gender and
watching television. Male gender increased the risk of watching television
for more than 2 hours by 1.6 times. In the literature, there are different
results for the association between gender and watching television.33-34
Data from the CBCL also showed a positive association between scores
on thought problem, withdrawn, and social problem subscales and television
viewing time. Withdrawn and social problem scores of group 3 were higher than
those of group 1, and social problem scores of group 3 were higher than those
of groups 1 and 2. When controlled for SES and gender, the association between
television viewing time and scores on withdrawn and thought problem subscales
disappeared, but the association with social problem subscale scores became
stronger. Still, none of these were found to be associated with television
viewing time in stepwise logistic regression.
Moller-Nehring et al,8 examining patients
between 1989 and 1994, reported that spending more time watching television
is related to the appearance of conduct disorders. Singer et al,7
studying 2245 third through eighth-grade students, claimed that showing signs
of psychological trauma can be related to watching television. The results
of our study and others are not enough to blame television for causing conduct
disorder or other psychological problems, but they are serious enough to consider
television watching as a risk factor for behavioral problems and to suggest
that physicians consider their patients' television viewing habits.35 The association between watching television and behavioral
problems may be in either direction. Children with behavioral problems may
watch television longer or prolonged television watching may cause behavioral
problems. In either direction, it deserves further consideration. Prolonged
television watching may be considered to be one of the new symptoms of this
era of technology, and it deserves more attention and evaluation in every
aspect. Families should be advised to restrict the television viewing hours
of their children and to encourage them to participate in active peer relationships.
| What This Study Adds
The relationship between television watching and aggressive behavior,
nutritional disorders, school achievement, sexual problems, and social problems
has been studied using different methods. In this study, the behavioral association
of television viewing was evaluated using the CBCL without considering the
content of the programs. Television watching time was found to be positively
associated with social problem, delinquent behavior, and aggressive behavior
subscale scores of the CBCL. Stepwise logistic regression revealed a significant
association of male gender, older age, decreasing social subscale, and increasing
attention problem subscale scores of the CBCL with the risk of watching television
for more than 2 hours per day. It was concluded that irrespective of the program
content, television viewing time was positively associated with problem behavior
scores and negatively associated with competence scores of the CBCL.
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AUTHOR INFORMATION
Accepted for publication May 9, 2002.
Corresponding author and reprints: Elif Özmert, MD, PhD, Hacettepe
University Faculty of Medicine, Department of Pediatrics, Social Pediatrics
Unit, 06100, Ankara, Turkey (e-mail: eozmert{at}superonline.com).
From the Faculty of Medicine, Department of Pediatrics, Social Pediatrics
Unit (Dr Özmert) and Department of Social Pediatrics, Institute of Child
Health (Dr Yurdakök), Hacettepe University, Ankara, and Faculty of Medicine,
Department of Pediatrics, Gaziosmanpasa University, Tokat (Dr Toyran), Turkey.
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