Prevalence, patterns and parental perceptions of excessive screen time among children aged 2-4 years: A cross-sectional study from a rural setting of Haryana, India.

Background and objectives Excessive screen time in toddlers and preschool-aged children, defined by World Health Organization as daily screen exposure exceeding 60 min, has been extensively studied in urban settings and high-income countries. However, evidence from rural contexts remains scarce. So, the objective of this study was to estimate the prevalence of excessive screen time among children aged 2-4 yr in a rural population of North India and understand related parenting practices. Methods A community-based cross-sectional study was conducted in four villages of Haryana, India among 282 children. A pre-tested, semi-structured interview schedule was administered to parents to assess weekly screen time duration and frequency, type of content, context of exposure and parental perceptions. Factors associated with excessive screen time were analysed using Poisson regression to estimate the adjusted prevalence ratio. Results The prevalence of excessive screen time was 50.5% [95% confidence interval (CI): 44.5-56.5%]. Screen use was primarily for entertainment (71.1%) or as a parenting tool (50%). Smartphones (75.2%) and televisions (57.1%) were the most commonly used devices. Most children viewed age-appropriate content, predominantly cartoons. A majority of parents perceived screen time as harmful (92%) and had attempted to restrict it (90%). Excessive screen time was associated with earlier age of screen use (<24 months) [aPR 1.4 (1.1-1.8), P=0.004] and use of devices during meals [aPR 1.4 (1.1-1.7), P=0.015 ]. Interpretation and conclusions Excessive screen time was prevalent among half the rural children. Furthermore, this was associated with earlier exposure and mealtime screen use.