Topic: Screen & TV Time

Brief: Incorporating Screen Time into the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Modified Value Enhanced Nutrition Assessment (VENA) in Oklahoma

Posted on October 5, 2017

The information in this brief is intended for educational use only.

This brief provides a summary of a CHOICES Learning Collaborative Partnership simulation model of incorporating opportunity for screen time counseling in Oklahoma’s WIC Program by training WIC staff to assess and offer motivational interviewing counseling to WIC participants on strategies for modifying screen time behaviors.

The Issue

Over the past three decades, more people have developed obesity.1 Now labeled an epidemic, health care costs for treating obesity-related health conditions like heart disease and diabetes were $147 billion in 2008.2 While multiple strategies are needed to reverse the epidemic, emerging prevention strategies directed at children show great promise.3 A large body of evidence shows limiting screen time like non-educational television helps kids grow up at a healthy weight. The more TV children watch, the more they overeat or eat unhealthy foods and drinks that are advertised, leading to excess weight gain. The American Academy of Pediatrics recommends children ages 2-54 get a maximum of 1 hour screen media daily, half what they currently get5; the Guide to Preventive Services recommends implementing strategies to reduce screen time to prevent childhood obesity.6

WIC provides food benefits to low-income children and is the only federal nutrition assistance program required by law to provide nutrition education to participants. In Oklahoma, 26.5% of 2-4 year olds participate in WIC; nearly 15% of these children have obesity.7 The WIC Program offers an opportunity to provide education and support for families to adopt healther screen time habits.

About the Policy and Training to Help Families Participating in WIC Reduce Screen Time

The intervention incorporates screen time counseling into required WIC certification visits through the inclusion of relevant assessment items within the existing screening assessment tools regularly used by WIC clinical staff. Oklahoma’s WIC office participates in VENA, which establishes standards for the assessment process used to determine WIC eligibility and to personalize nutrition education, referrals and food package tailoring. The intervention modeled includes training for WIC staff who provide motivational interviewing and counsel to WIC participants. The training, offered by the state Department of Health WIC Services office, would include strategies for providing participants with guidance for modifying screen time behaviors.

Comparing Costs and Outcomes

CHOICES cost-effectiveness analysis compared the costs and outcomes of integrating screen time questions and counseling into the standard OK WIC practices over 10 years with costs and outcomes associated with not implementing this initiative. The approach assumes all WIC clinics in Oklahoma would integrate screen time questions into VENA and provide counseling to those families who select it as a target.

Implementing screen time counseling in WIC is an investment in the future.
By the end of 2025:
Chart summarizing the conclusions and implications of the brief

Conclusions and Implications

Every child deserves a healthy start in life. This includes ensuring all kids have opportunities to be healthy. A state-level initiative to provide screen time counseling to families participating in WIC could prevent 660 cases of childhood obesity in Oklahoma in 2025 and ensure healthy screen time habits for over 149,000 children.

For every $1 spent on implementing this screen time strategy, $20.90 would be saved in health care costs.The results reinforce the importance of investing in prevention efforts, relative to other treatment interventions, to reduce the prevalence of obesity. Shortchanging prevention efforts can lead to costlier and complicated treatment options in the future, whereas introducing small changes to young children can help them develop healthy habits for life.

Evidence is growing about how to help children achieve a healthy weight. Programs to reduce screen time are laying the foundation for a healthier future by helping families create environments that nurture healthy habits. Leaders at the federal, state, and local level should use the best available evidence to determine which evidence-based programs and policies hold the most promise to help children grow up at a healthy weight.

References

  1. Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in Obesity Among Adults in the United States, 2005 to 2014. JAMA. 2016 Jun 7;315(21):2284-91.
  2. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual Medical Spending Attributable To Obesity: Payer-And Service-Specific Estimates. Health Affairs. 2009;28(5).
  3. Gortmaker SL, Wang YC, Long MW, Giles CM, Ward ZJ, Barrett JL, Kenney EL, Sonneville KR, Afzal AS, Resch SC, Cradock AL. Three interventions that reduce childhood obesity are projected to save more than they cost to implement. Health Aff (Millwood). 2015 Nov;34(11):1932-9.
  4. American Academy of Pediatrics. (2011). Media Use by Children Younger Than 2 Years. Pediatrics, 128(5), 1040-1045. http://pediatrics.aappublications.org/content/128/5/1040
  5. Common Sense Media. (2013). Zero to Eight: Children’s Media Use in America 2013. www.commonsensemedia.org/research/zero-to-eight-childrens-media-use-in-america-2013
  6. Buchanan, L. R. et al. (2016). Reducing Recreational Sedentary Screen Time: A Community Guide Systematic Review. Am J Prev Med, 50(3), 402-415. https://www.thecommunityguide.org/sites/default/files/publications/obesity-AJPM-evrev-behavioral_0.pdf
  7. Communication with Oklahoma State Department of Health: WIC Service. (2017).
Suggested Citation:

Bryce T, Kenney EL, Giles CM, Flax CF, Gortmaker SL, Ward ZJ, Cradock AL. Oklahoma: Incorporating Screen Time into the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Modified Value, Enhanced, Nutrition Assessment (VENA) [Issue Brief]. Oklahoma State Department of Health, Oklahoma City, OK, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; August, 2017.

The design for this brief and its graphics were developed by Molly Garrone, MA and partners at Burness.

This issue brief was developed by the Oklahoma State Department of Health through participation in the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health. This brief is intended for educational use only. Funded by The JPB Foundation. Results are those of the authors and not the funders. 

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Brief: State Regulations to Reduce Non-Educational Screen Time for Young Children in Licensed Care in Mississippi

Posted on September 21, 2017

Young kids playing in an early care setting

The information in this brief is intended for educational use only.

This brief provides a summary of the CHOICES Learning Collaborative Partnership simulation model of a potential reduction in the Mississippi (MS) state child care licensing regulations’ current limit for daily non-educational screen time in child care. The limit would decrease from 60 minutes a day to 30 minutes a week.

The Issue

Over the past three decades, more and more people have developed obesity.1 Today, nearly nine percent of 2-5 year olds have obesity.2 Now labeled as an epidemic, health care costs for treating obesity-related health conditions such as heart disease and diabetes were $147 billion in 2008.3 While multiple strategies are needed to reverse the epidemic, emerging prevention strategies directed at children show great promise for addressing the epidemic.4 A large body of evidence shows that limiting time watching non-educational television helps kids grow up at a healthy weight.

In Mississippi, approximately 35% of 2-5 year olds attend a licensed child care program, either a center or a family daycare home.5 Licensed programs can offer healthy, nurturing environments for children, and this policy can support programs in creating a healthier screen time environment.

About the Policy to Help Licensing Care Programs Reduce Screen Time

The policy to limit screen time in child care settings to 30 minutes per week is based on national policy recommendations from pediatricians and child care and public health experts.6 Requiring the policy change through licensing regulations would reach a large number of child care programs. The policy change would also help support children’s development of healthy screen use habits.

Comparing Costs and Outcomes

CHOICES cost-effectiveness analysis compared the costs and outcomes of modifying the existing MS licensing regulations regarding screen time for child care providers over 10 years with costs and outcomes associated with not modifying the regulations. The approach assumes that 55% of licensed programs would comply with the regulation change.

Implementing screen time reduction programs throughout MS child care is an investment in the future. By the end of 2025:
Graphic depicting Conclusions and Implications

Conclusions and Implications

Every child deserves a healthy start in life. This includes ensuring that all kids in child care have opportunities to be healthy, no matter where they live or where they go for child care. A state-level initiative to limit non-educational screen time in child care settings could prevent 129 cases of childhood obesity in 2025 and ensure healthier child care environments for over 94,800 children.

What’s more, this is all done at a bargain – less than $1 per child annually. For every $1.00 spent on implementing this screen time strategy, we would save $0.62 in health care costs. These results reinforce the importance of investing in prevention efforts, relative to other treatment interventions, to reduce the prevalence of obesity. Shortchanging prevention efforts can lead to more costly and complicated treatment options in the future, whereas introducing small changes to young children can help them develop healthy habits for life.

Evidence is growing about how to help children achieve a healthy weight. Programs to reduce screen time in child care are laying the foundation for a healthier future by helping child care providers create environments that nurture healthy habits. Leaders at the federal, state, and local level should use the best available evidence to determine which evidence-based programs and policies hold the most promise to help children grow up at a healthy weight.

References

  1. Flegal, K.M., Kruszon-Moran, D., Carroll, M.D., Fryar, C.D., Ogden, C.L. (2016). Trends in Obesity Among Adults in the United States, 2005 to 2014. JAMA, 315(21), 2284-91.
  2. Ogden, C. L., Carroll, M. D., Lawman, H. G., Fryar, C. D., Kruszon-Moran, D., Kit, B. K., & Flegal, K. M. (2016). Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013–2014. JAMA, 315(21), 2292-2299.
  3. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual Medical Spending Attributable To Obesity: Payer-And Service-Specific Estimates. Health Affairs. 2009;28(5).
  4. Gortmaker, S. L., Wang, Y. C., Long, M. W., Giles, C. M., Ward, Z. J., Barrett, J. L., …Cradock, A. L. (2015). Three interventions that reduce childhood obesity are projected to save more than they cost to implement. Health Affairs, 34(11), 1932–1939.
  5. Communication with Mississippi Department of Public Health Child Care Licensing Office.
  6. American Academy Of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. (2011). Caring for our children: National health and safety performance standards; Guidelines for early care and education programs. 3rd edition. Elk Grove Village, IL: American Academy of Pediatrics.
Suggested Citation:

Grant T, Wiggins C, Shelson S, Cradock AL, Gortmaker SL, Pipito A, Kenney EL, Giles CM. Mississippi: State Regulations to Reduce Non-Educational Screen Time for Young Children in Licensed Care {Issue Brief}. Mississippi State Department of Health, Jackson, MS, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; April, 2017. For more information, please visit www.choicesproject.org

The design for this brief and its graphics were developed by Molly Garrone, MA and partners at Burness.

This issue brief was developed at the Harvard T.H. Chan School of Public Health in collaboration with the Mississippi State Department of Health through participation in the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership. This brief is intended for educational use only. Funded by The JPB Foundation. Results are those of the authors and not the funders.

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Brief: Training to Reduce Non-Educational Screen Time for Young Children in Mississippi

Posted on September 21, 2017

The information in this brief is intended for educational use only.

This brief provides a summary of the CHOICES Learning Collaborative Partnership simulation model of training for Mississippi licensed child care providers to reduce young children’s non-educational screen time. Child care program staff would be offered training in the Fit5Kids program1 to support families in reducing home screen time.

The Issue

Over the past three decades, more and more people have developed obesity.2 Today, nearly nine percent of 2-5 year olds have obesity.3 Now labeled as an epidemic, health care costs for treating obesity-related health conditions such as heart disease and diabetes were $147 billion in 2008.4 While multiple strategies are needed to reverse the epidemic, emerging prevention strategies directed at children show great promise for addressing the epidemic.5 A large body of evidence shows that limiting time watching non-educational television helps kids grow up at a healthy weight.6

In Mississippi, approximately 35% of 2-5 year olds attend a licensed child care program, either a center or a family daycare home.7 Licensed programs can offer healthy, nurturing environments for children,8 and this training approach can support programs in helping families adopt healthier screen time habits at home.1

About the Policy and Training to Help Licensing Care Programs Reduce Screen Time

The voluntary training in the evidence-based Fit5Kids program involves training child care providers to incorporate lesson plans and activities about viewing too much television into the daily curriculum and also involves a parent outreach component to reduce screen time at home.1 In this model, the state Department of Health would offer regional trainings. Offering a training statewide could provide participating child care providers with new tools to help families adopt healthier habits.

Comparing Costs and Outcomes

CHOICES cost-effectiveness analysis compared the costs and outcomes of implementing a screen time program training over 10 years with costs and outcomes associated with not implementing the training. The approach assumes that 20% of licensed child care centers would opt to participate in the Fit5Kids program.

Implementing screen time reduction programs throughout MS child care is an investment in the future. By the end of 2025:
Graphic depicting Conclusions and Implications

Conclusions and Implications

Every child deserves a healthy start in life. This includes ensuring that all kids in child care have opportunities to be healthy, no matter where they live or where they go for child care. A state-level initiative to support child care providers in reaching out to families could prevent 243 cases of childhood obesity in Mississippi in 2025 and ensure screen time habits for 27,900 children.

For every $1 spent on implementing this screen time strategy, we would save $0.17 in health care costs. While implementing the Fit5Kids program does not pay for itself in the 10-year time frame modeled here, the results reinforce the importance of investing in prevention efforts, relative to other treatment strategies, to reduce the prevalence of obesity. Shortchanging prevention efforts can lead to more costly and complicated treatment options in the future, whereas introducing small changes to young children can help them develop healthy habits for life.

Evidence is growing about how to help children achieve a healthy weight. Programs to reduce screen time in child care are laying the foundation for a healthier future by helping child care providers create environments that nurture healthy habits. Leaders at the federal, state, and local level should use the best available evidence to determine which evidence-based programs and policies hold the most promise to help children grow up at a healthy weight.

References

  1. Mendoza, J.A., Baranowski, T., Jaramillo, S., Fesinmeyer, M.D., Haaland, W., Thompson, D., Nicklas, T.A. (2016). Fit 5 Kids TV Reduction Program for Latino Preschoolers: A Cluster Randomized Controlled Trial. Am J Prev Med, 50(5), 584-92.
  2. Flegal, K.M., Kruszon-Moran, D., Carroll, M.D., Fryar, C.D., Ogden, C.L. (2016). Trends in Obesity Among Adults in the United States, 2005 to 2014. JAMA, 315(21), 2284-91.
  3. Ogden, C. L., Carroll, M. D., Lawman, H. G., Fryar, C. D., Kruszon-Moran, D., Kit, B. K., & Flegal, K. M. (2016). Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013–2014. JAMA, 315(21), 2292-2299.
  4. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual Medical Spending Attributable To Obesity: Payer-And Service-Specific Estimates. Health Affairs. 2009;28(5).
  5. Gortmaker, S. L., Wang, Y. C., Long, M. W., Giles, C. M., Ward, Z. J., Barrett, J. L., …Cradock, A. L. (2015). Three interventions that reduce childhood obesity are projected to save more than they cost to implement. Health Affairs, 34(11), 1932–1939.
  6. Community Preventive Services Task Force. (2016). Reducing Children’s Recreational Sedentary Screen Time: Recommendation of the Community Preventive Services Task Force. Am J Prev Med, 50(3), 416-8.
  7. Communication with Mississippi Department of Public Health Child Care Licensing Office.
  8. American Academy Of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. (2011). Caring for our children: National health and safety performance standards; Guidelines for early care and education programs. 3rd edition. Elk Grove Village, IL: American Academy of Pediatrics.
Suggested Citation:

Grant T, Wiggins C, Shelson S, Cradock AL, Gortmaker SL, Pipito A, Kenney EL, Giles CM. Mississippi: Training to Reduce Non-Educational Screen Time for Young Children {Issue Brief}. Mississippi State Department of Health, Jackson, MS, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; April, 2017. For more information, please visit www.choicesproject.org

The design for this brief and its graphics were developed by Molly Garrone, MA and partners at Burness.

This issue brief was developed at the Harvard T.H. Chan School of Public Health in collaboration with the Mississippi State Department of Health through participation in the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership. This brief is intended for educational use only. Funded by The JPB Foundation. Results are those of the authors and not the funders.

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