Abstract
Objective
Excessive video game playing has several health implications on children. In this study, we evaluate the factors related to video game use in school-aged children.
Material and Methods
This cross-sectional descriptive study included 160 children aged 6–8 years who applied to outpatient clinics at the Department of Pediatrics at Başkent University Hospital. Each parent completed a structured questionnaire including demographic information, video game use, average daily screen time, and parental habits and concerns about their children’s screen use.
Results
The mean age of first video game use was (mean±SD) 2.8±1.1 years. The minimum age for playing video games was 1 year. Male children spent more time playing video games. Both parental age and maternal education level were higher in the group of video gamers compared with non-gamers (p<0.05). Average time spent playing video games was 2.7±1.6 hours/day. The group of video gamers had a considerably younger age for starting watching television and higher rates for other video gamers at home than non-gamers (p=0.036 and p<0001, respectively). The group of video gamers had significantly higher rates for having a computer, tablet, and game console at home compared with non-gamers (p<0.05).
Conclusions
Our study indicates a statistically significant relationship between the age of starting watching television, gender of child, parent’s age, maternal education, and the categories of video gaming habits. Developing strategies toward avoiding early screen exposure in children should be taken into consideration, because it is directly related to video gaming habits in children.
Keywords: Children, screen use, video gaming, video use
What is already known on this topic?
Video games are popular among children as a form of entertainment. The amount of time spent on playing video games has increased rapidly in the last decades.
What this study adds on this topic?
In this study, we found that early screen exposure and the presence of video gamers within the family were associated with an increase in the frequency of video gaming habits in childhood.
Introduction
Screen time is the amount of time spent watching television or movies, playing video games, and using computers, smartphones, and tablets (1). Although television and video games were the most common devices used, smart phones and tablets are gaining widespread use among children nowadays. Previous studies reported both negative and positive effects of excessive screen use on children’s health and development (2). Recent studies reported significant association between screen use and cognitive development outcomes, such as short-term memory skills, academic achievement, and language development in young children (3, 4). Increased screen use before the age of 5 years is a potential risk factor for aggression and attention problems during early elementary school and one of the causes of obesity among children (5, 6). Studies showed a positive association between screen use and sleep problems, musculoskeletal pain, hyperactivity, and internalizing problems. In contrast, screen use was negatively associated with social support (7, 8).
The popularity of video games among children as a form of entertainment and the amount of time spent playing video games has increased rapidly. Technological advancements, urbanization, and insufficient playground areas are the main reasons for the shift from traditional game activities toward digital games (9). With the enormous growth of the video games industry and video gaming, concerns regarding potentially problematic gaming behaviors have arisen. Pathological video gaming has been associated with numerous academic, social, psychological, and physiological problems, including shortened sleep duration, reduced sleep quality, increased attention problems, diminished academic performance, increased caloric intake, and obesity (10). Increased playing of video games has also impacted children’s development by reducing the quality of interactions between parents and children (11).
Despite the increase in playing video games among young children, very limited research has been carried out to identify factors associated with video gaming in school-aged children. The mechanisms behind the development of early problematic gaming habits among vulnerable children are still unknown while children at risk remain unidentified. Herein, we evaluate the frequency and patterns of screen use and video gaming and associated risk factors in school-aged Turkish children. To our knowledge, this is the first study to address the starting age for video gaming in elementary school-aged children in Turkey.
Material and Methods
Study subjects
This cross-sectional descriptive study included 160 children aged 6–8 years who applied to outpatient clinics of the Department of Pediatrics at Başkent University Hospital from February 2018 through September 2018. The study was conducted according to the Declaration of Helsinki. Informed written consent was obtained from the parents. The study was approved by local ethics committee of Başkent University Institutional Review Board (Project no: KA19/407).
Study design
Each parent completed a structured questionnaire developed by the researchers to collect demographic information and screen and video gaming habits of the children and their families. The questionnaire included questions regarding demographic information (age, gender, parental level of education, number of children, and age of children); video game use; average daily screen use of children; and parental attitudes, beliefs, opinions, and concerns regarding the use of screens among their children. Children with neurological problems or disabilities were excluded from this study.
Statistical analysis
To ensure that the 80% confidence interval estimate of the proportion of children video gaming is within 5% of the true proportion, a sample of size 165 is needed (OpenEpi).
Statistical analysis was performed using the Statistical Package for the Social Sciences (IBM SPSS Corp.; Armonk, NY, USA) 21.0 package program. The distributions of the continuous variables were evaluated by the Shapiro Wilk test and histograms. Starting age for screen use was skewed, and Mann-Whitney U test was applied to compare differences in groups. Other parameters were normally distributed, and groups were compared with Student’s t-test. Differences in proportions were analyzed with chi-square test. Values of p<0.05 were considered statistically significant.
Results
This study included 160 children aged 6–8 years. The mean ages of children, mothers, and fathers were found as 6.9±0.8 years (55% of children are males), 36.2±5.1 years, and 38.7±5.6 years, respectively.
Overall, 58.1% of children (n=93) had started video gaming. Sociodemographic characteristics of children according to video game use are shown in Table 1. When the gender of children was analyzed, male children were more frequent in the video gamers group than the non-gamers group (67.7% and 37.3%, respectively; p<0.001). The maternal and paternal ages were higher in the video gamers group than the non-gamers group (p=0.002 and p=0.023, respectively). Maternal occupation, paternal education, birth order, number of children, household size, and family type did not differ between groups (Table 1). We found a statistically significant relationship between maternal education and video game use (p<0.005) in this study.
Table 1.
Sociodemographic characteristics of children according to video game use
| Characteristics | Overall | Video gamers | Non-gamers | p |
|---|---|---|---|---|
| N | 160 | 93 | 67 | |
| Gender, malea | 55.0 | 67.7 | 37.3 | <0.001c |
| Age, yearsb | 7.0±0.8 | 7.1±0.7 | 7.0±0.8 | 0.305 |
| Maternal age, yearsb | 36.2±5.1 | 37.3±5.3 | 34.6±5.2 | 0.002c |
| Paternal age, yearsb | 38.7±5.6 | 39.5±5.6 | 37.5±5.4 | 0.023d |
| Maternal occupation, workinga | 60.6 | 64.5 | 55.2 | 0.235 |
| Maternal education > high schoola | 58.8 | 65.6 | 49.3 | 0.038d |
| Paternal education > high schoola | 65.0 | 71.0 | 56.7 | 0.062 |
| Birth order: first childa | 41.3 | 39.8 | 43.3 | 0.657 |
| Number of children ≥ 3a | 18.1 | 18.3 | 17.9 | 0.952 |
| Household size ≥ 5 membersa | 25.0 | 22.6 | 28.4 | 0.405 |
| Family type, nucleara | 83.1 | 86.0 | 79.1 | 0.249 |
Results shown in percentages. Chi-square test applied to compare the differences between groups.
Results shown as mean±SD; Student’s t-test applied to compare the differences between groups.
p<0.01.
p<0.05.
Screen use characteristics according to video game are shown in Table 2. The earliest exposure to screens for the first time was at the age of 5 months in this study. A total of 65% (n=104) of children had a history of screen use before the age of 1 year. Overall, 36.3% (n=58) of children spent ≥2 hours/day on screen. The mean television viewing age of video gamers was significantly lower than the non-gamers group (p=0.036). The mean age of first video game use was 2.8±1.1 years. Overall, 14.0% of children started playing video games as early as 1 year old. Of video gamers, 30.1% (n=28) spent ≥2 hours/day on video gaming.
Table 2.
Screen usage characteristics according to video game use
| Characteristics | Overall | Video gamers | Non-gamers | P | |
|---|---|---|---|---|---|
| N | 160 | 93 | 67 | ||
| Duration of children’ screen usea | ≥2 hours | 36.3 | 35.5 | 37.3 | 0.812 |
| Limitation of parents for children’ screen usea | Yes | 62.5 | 63.4 | 61.2 | 0.772 |
| Emotions with screen usea | Positive | 48.8 | 43.0 | 56.7 | 0.177 |
| Negative | 13.1 | 16.1 | 9.0 | ||
| Self-immersion | 38.1 | 40.9 | 34.3 | ||
| Postpone own needs during screen usea | Yes | 43.8 | 46.2 | 40.3 | 0.455 |
| Starting age for watching televisionb | Months | 13.2±8.7 (12.0) | 12.0±7.6 (10.0) | 14.8±9.8 (12.0) | 0.036c |
| Room ownershipa | Yes | 80.6 | 80.6 | 80.6 | 0.994 |
| Computer ownershipa | Yes | 86.9 | 92.5 | 79.1 | 0.013c |
| Tablet ownershipa | Yes | 80.6 | 87.1 | 71.6 | 0.015c |
| Smartphone ownershipa | Yes | 96.3 | 94.6 | 98.5 | 0.202 |
| Game console ownershipa | Yes | 29.4 | 39.8 | 14.9 | 0.001d |
| Location of video game playinga | Her/his room | 35.0 | 32.3 | 38.8 | 0.468 |
| Other rooms | 56.3 | 57.0 | 55.2 | ||
| Out of house | 8.8 | 10.8 | 6.0 | ||
| Video gamers at home | Yes | 56.9 | 76.3 | 29.9 | <0.001d |
| Video gamer sister/brother | Yes | 55.0 | 74.2 | 28.4 | <0.001d |
Results shown as percentages. Chi-square test applied to compare the differences between groups.
Results shown as mean±SD (median). Mann Whitney U test applied to compare the differences between groups.
p<0.05.
p<0.01.
Video game use of children was significantly correlated with computer, tablet, and game console ownership (p<0.005). Overall, 35% of school-aged children (n=56) were playing video games in their rooms. We found a statistically significant relationship between the presence of video gamers at home and video game use of school-aged children in this study (p<0.001).
In this study, we also investigated parents’ views on screen use limitation (Table 2). In the video gamers group, 63.4% of the parents limit their children in terms of screen use. Also, 43% of school-aged children felt positive with screen use, whereas 46.2% of children postponed their needs during screen use in the video gamers group. There were no differences in rates for the presence of limitations and postponing own needs between groups (p>0.05).
Discussion
In this study, we attempted to identify factors associated with video game use among elementary school-aged children in Turkey, where no study on video gaming habits in this population exists. We found a statistically significant relationship between starting age for watching television, parental age, maternal education, the presence of video gamers within the family, and video game use among children. It is worth noting that the age of starting video gaming in elementary school-aged children extends to early ages such as 1 year old.
Understanding the factors that influence video gaming will enhance health workers’ and parents’ efforts to reduce screen use in children and its impact on behavioral changes during early childhood (12). We found that an early starting age for watching television leads to early video game use in elementary school-aged children. We noticed early screen exposure at very early ages among participants. In a previous study, the time of video game use seems to contribute to addiction risk in video gaming (13). In another study, starting age of watching television did not affect the viewing time (14). To our knowledge, there has been no study regarding the relationship between early starting age of video gaming and addictive behaviors. Preventing early screen exposure may prevent addiction developed in later ages. Further longitudinal studies are needed on this subject.
We showed that there is a gender difference in playing video games. Male participants were found to spend more time on video gaming than females. Our results are consistent with another longitudinal study performed in elementary and secondary school-aged children in Singapore where the average video gaming time was significantly higher among boys. Furthermore, the male students were more likely to meet pathological gaming criteria (15). A study conducted on secondary school students in Turkey showed that males are more likely to be addicted in terms of video gaming (13).
Children 8 years old and younger have an average of three hours of screen use per day, primarily watching television or videos (16). Whereas 36.3% of children spent ≥2 hours/day on screen use in our study, 30.1% of children spent ≥2 hours/day on video gaming. Primary school attendance could explain the limit in video playing time of children in our study. We also found a statistically significant relationship between the presence of video gamers in the family or video gamer sister or brother at home and video game use of school-aged children.
We also showed that maternal and paternal factors such as age, education might influence the video game use of children. Parents were found to be older in school-aged children who play video game more than their peers. Older mothers and fathers may be less likely to reduce the screen access of their children than younger parents. It was reported that maternal education was one of the predicted factors for frequent viewing of educational programs among children (17). In our study, we found a statistically significant relationship between maternal education and video game use of children. Higher maternal education level increased the ratio of video game use among school-aged children, likely because of the mother’s working status, the quantity of time spent with the child, caregiving, lifestyle, and parenting style that allows children to be unsupervised, which may impact gaming behaviors and video game overuse in children.
Increased video gaming in early childhood is associated with academic, social, and long-term developmental outcomes (15) and reduced quality of interactions between parents and children (11). However, a previous study from Turkey showed that 58% of parents did not limit their children’s viewing time (18). A total of 63.4% of parents limited their children’s screen use in the video gamers group in our study. Overall, 35% of school-aged children (n=56) were playing video games in their rooms. This result is consistent with previous studies where almost one-third of children have a television in their bedroom (19). Parents need to realize that increased playing of video games can have a negative effect on their children.
Our study had some limitations because a small number of children were included in the study. We did not investigate whether the game was online or offline, active or passive, or played with multiplayer or not; the content of video games; and the device used for video gaming. Future studies may be done on a larger scale to address these topics. Finally, long-term consequences of video gaming were not addressed in this study.
The age of starting video gaming in elementary school-aged children was associated with the starting age for watching television. Parental guidance on social media is important. Educating parents on effective limitation of screen use is necessary for achieving positive parenting. Further studies are needed to determine the factors associated with video gaming on children in different countries.
Acknowledgement
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The study was approved by Baskent University Institutional Review Board.
Footnotes
Ethical Committee Approval: Ethics committee approval was received for this study from the ethics committee of Başkent University Institutional Review Board (Project no: KA19/407).
Informed Consent: Written informed consent was obtained from patients’ parents who participated in this study.
Peer-review: Externally peer-reviewed.
Author Contributions: Concept – B.A., A.O., S.S.Y.; Design – B.A., A.O., S.S.Y.; Supervision – B.A., A.O., S.S.Y.; Funding – B.A.; Materials – B.A.; Data Collection and/or Processing – B.A.; Analysis and/or Interpretation – B.A., A.O., S.S.Y.; Literature Review – B.A.; Writing – B.A.; Critical Review – A.O., S.S.Y.
Conflict of Interest: The authors have no conflicts of interest to declare.
Financial Disclosure: The authors declared that this study has received no financial support.
References
- 1.Atkin AJ, Sharp SJ, Corder K, van Sluijs EMF. Prevalence and correlates of screen time in youth: an international perspective. Am J Prev Med. 2014;47:803–7. doi: 10.1016/j.amepre.2014.07.043. [DOI] [PubMed] [Google Scholar]
- 2.Barr R, Lauricella A, Zack E, Calvert SL. Infant and early childhood exposure to adult-directed and child-directed television programming: relations with cognitive skills at age four. Merrill-Palmer Q. 2010;56:21–48. doi: 10.1353/mpq.0.0038. [DOI] [Google Scholar]
- 3.Tomopoulos S, Dreyer BP, Berkule S, Fierman AH, Brockmeyer C, Mendelsohn AL. Infant media exposure and toddler development. Arch Pediatr Adolesc Med. 2010;164:1105–11. doi: 10.1001/archpediatrics.2010.235. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Pagani LS, Fitzpatrick C, Barnett TA, Dubow E. Prospective associations between early childhood television exposure and academic, psychosocial, and physical well-being by middle childhood. Arch Pediatr Adolesc Med. 2010;164:425–31. doi: 10.1001/archpediatrics.2010.50. [DOI] [PubMed] [Google Scholar]
- 5.Zimmerman FJ, Glew G, Christakis DA, Katon W. Early cognitive stimulation, emotional support, and television watching as predictors of subsequent bullying among grade-school children. Arch Pediatr Adolesc Med. 2005;159:384–8. doi: 10.1001/archpedi.159.4.384. [DOI] [PubMed] [Google Scholar]
- 6.Wake M, Hesketh K, Waters E. Television, computer use and body mass index in Australian primary school children. J Paediatr Child Health. 2003;39:130–4. doi: 10.1046/j.1440-1754.2003.00104.x. [DOI] [PubMed] [Google Scholar]
- 7.Carson V, Hunter S, Kuzik N, et al. Systematic review of the relationships between sedentary behaviour and health indicators in school-aged children and youth: an update. Appl Phys Nutr Metab. 2016;41:S240–65. doi: 10.1139/apnm-2015-0630. [DOI] [PubMed] [Google Scholar]
- 8.Tremblay M, LeBlanc AG, Kho M, et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth. Int J Behav Nutr Phys Act. 2011;8:98. doi: 10.1186/1479-5868-8-98. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Anderson CA, Bushman BJ, Bartholow BD, et al. Screen violence and youth behavior. Pediatrics. 2017;140:S142–7. doi: 10.1542/peds.2016-1758T. [DOI] [PubMed] [Google Scholar]
- 10.Turel O, Romashkin A, Morrison KM. A model linking video gaming, sleep quality, sweet drinks consumption and obesity among children and youth. Clin Obes. 2017;7:191–8. doi: 10.1111/cob.12191. [DOI] [PubMed] [Google Scholar]
- 11.Tanimura M, Okuma K, Kyoshima K. Television viewing, reduced parental utterance, and delayed speech development in infants and young children. Arch Pediatr Adolesc Med. 2007;161:618–9. doi: 10.1001/archpedi.161.6.618-b. [DOI] [PubMed] [Google Scholar]
- 12.Nogueıra M, Farıa H, Vıtorıno A, Sılva FG, Neto AS. Addictive Video Game Use: An Emerging Pediatric Problem? Acta Med Port. 2019;32:183–8. doi: 10.20344/amp.10985. [DOI] [PubMed] [Google Scholar]
- 13.Oflu A, Yalcin SS. Video game use among secondary school students and associated factors. Arch Argent Pediatr. 2019;117:e584–91. doi: 10.5546/aap.2019.eng.e584. [DOI] [PubMed] [Google Scholar]
- 14.Yalcın SS, Tugrul B, Nacar N, Tuncer M, Yurdakök K. Factors that affect television viewing time in preschool and primary school children. Pediatrics International. 2002;44:622–7. doi: 10.1046/j.1442-200X.2002.01648.x. [DOI] [PubMed] [Google Scholar]
- 15.Gentile DA, Choo H, Liau A, Sim T, et al. Pathological video game use among youths: a two-year longitudinal study. Pediatrics. 2011;127:e319–29. doi: 10.1542/peds.2010-1353. [DOI] [PubMed] [Google Scholar]
- 16.Wartella E, Rideout V, Lauricella AR, et al. Parenting in the age of digital technology. Chicago: Northwestern University Press; 2014. [Google Scholar]
- 17.Huston AC, Wright JC, Marquis J, Green SB. How young children spend their time: television and other activities. Dev Psychol. 1999;35:912–25. doi: 10.1037/0012-1649.35.4.912. [DOI] [PubMed] [Google Scholar]
- 18.Batmaz V, Aksoy A. Family and Television in Turkey. Prime Minister Research Institution of Turkish Republic. Panajans Communication and Study; Ankara: 1995. (in Turkish) [Google Scholar]
- 19.Rideout VJ, Hamel E. The Media Family: Electronic Media in the Lives of Infants, Toddlers, Preschoolers, and Their Parents. Menlo Park, CA: Kaiser Family Foundation; 2006. [Google Scholar]