3.1. Community Demographic Characteristics
The study’s population consisted of 104 pre-school children (age: 2–5 years) and their parents/legal guardians, more specifically 96 mothers, 5 fathers, and 3 grandmothers (as legal guardians). The age distribution of participating parents/legal guardians was 20.2% (
n = 21) 21–30 years, 71.2% (
n = 74) 31–40 years, 5.8% (
n = 6) 41–50 years, 1% (
n = 1) 51–60 years, and 1.9% (
n = 2) in the 60+ age group. In terms of highest education level attained by mothers, 1% (
n = 1) was illiterate, 1.9% (
n = 2) primary school graduate, 4.8% (
n = 5) middle school graduate, 40.4% (
n= 42) high school graduate, 45.2% (
n = 47) university graduate, and 6.7% (
n = 7) postgraduate level. The corresponding statistics for the fathers were as follows: 1% (
n = 1) of fathers were illiterate, 3.8% (
n = 4) primary school graduate, 11.5% (
n = 12) middle school graduate, 32.7% (
n = 34) high school graduate, 42.3% (
n = 44) university graduate, and 8.7% (
n = 9) postgraduate level. In terms of gainful employment, 23.1% (
n = 24) were not employed, while 76.9% (
n = 80) of mothers worked full time jobs. All the fathers were working full time (
Supplementary Materials: Table S1).
In terms of the sex and age group of the children-participants in this study, 39.4% (n= 41) of the children were girls and 60.6% (n = 63) boys. Age-wise 5.7% (n = 6) of children were 2 years old, 21.1% (n = 22) 3 years old, 42.3% (n = 44) 4 years old, and 30.8% (n = 32) 5 years old. The mean body weight of the girl participants was 16.1 ± 2.4 kg, while the mean of weight of boys was 17.8 ± 3.0 kg. Height for girls was 101.1 ± 9 cm on average, and for boys 104.5 ± 7.5 cm. Children’s weight status was calculated based on children’s body weight and length/height. Specifically, 14.4% (n = 15) of children were found to be underweight, 61.5% (n = 64) were of normal weight, 9.6% (n = 10) were overweight, and 14.4% (n = 15) were obese. Hence, overweight and obese combined, comprised 24% of study participants.
3.2. Screen Usage by Children
Regarding the television viewing rates of the children participants 44.2% (n = 46) of the children watch TV 0–1 h/day, 36.5% (n = 38) watch 1–2 h/day, and 14.4% (n = 15) watch 2+ h/day, whereas 4.8% (n = 5) of children do not watch television. When use of tablet/smart phone rates are examined, 48.1% (n = 50) use a tablet/smart phone 0–1 h/day, 23.1 % (n = 24) use 1–2 h/day, and 7.7 % (n = 8) use 2+ h/day tablet/smart phones, while 21.2% (n = 22) of children do not use tablet/smart phones. Regarding computer rates, 7.7% (n = 8) use a computer for 0–1 h/day, 1.9% (n = 2) for 1–2 h/day, and 1% (n = 1) for 2+ h/day, whereas 89.4% (n = 93) does not use a computer.
Considering technological devices in the household, 55.8% (n = 58) of families had 1 TV, 40.4% (n = 42) had 2 TVs, and 3.8% (n = 4) had 2+ TVs in the household. In terms of computer availability, 62.5% (n = 65) of families had 1 computer, 7.7% (n = 8) had 2 computers, and 1% (n = 1) had 3+ computers, whereas 28.8% (n = 30) families do not have a computer in their household. Moreover, 53.5% (n = 56) of families had 2 tablet/smart phones, 33.7% (n = 35) had 3 tablet/smart phones, and 12.5% (n = 13) had 3+ tablet/smart phones in household.
When identifying exclusive use (practically effective ownership) by children, 15.4% (n = 16) of children had a TV in their room, whereas 84.6% (n = 88) of children did not. Additionally, 3.8% (n = 4) of children had a computer, whereas 96.2% (n = 100) of children did not. Also, 20.2% (n = 21) of children had their own tablet/smart phone, as opposed to 79.8% (n = 83) which did not.
Along with the presence of technological devices in the household, we investigated the rules governing the use of the existing devices by children. Parents whose children use these technological devices completed this section of the questionnaire. When rules for watching TV were considered, 56.6% (n = 56) of parents ensured rules about when their children can watch TV, and 62.6% (n = 62) had established rules on how long their children can watch TV. However, 43.4% (n = 43) of parents did not have any rules/conditions regulating when their children can watch TV, and 37.4% (n = 37) of parents did not have any rules about duration of TV watching for their children. When potential rules for use of tablet/smart phones by children were accounted for, 76.8% (n = 63) implemented rules about time and duration of use for tablet/smart phone by their children. However, 23.2% (n = 19) of parents did not have any rules pertinent to the use of tablet/smart phone by their children. In terms of computer use, 70% (n = 7) of parents had rules established about when their children could use the computer, and 80% (n = 8) of parents had rules about the duration of use. However, no rules were employed by 30% (n = 3) of parents on timing and 20% (n = 2) of parents on the duration of use for children’s home computer(s).
3.3. Eating Behaviors of Children Relative to Screen Use
When evaluating the eating behaviors of children, it is reported that 84.6% (
n = 88) of children always had breakfast, 8.7% (
n = 9) of children often had breakfast, 3.8% (
n = 4) of children sometimes had breakfast, 2.9% (
n = 3) of children rarely had breakfast, and there was no child reported to never have breakfast (
Table 1). In terms of number/frequency of meals per day, it was observed that 58.7% (
n = 61) of children always consumed 3 or more meals per day, 24% (
n = 25) of children consumed often, 14.4% (
n = 15) of children sometimes, and 2.9% (
n = 3) of children rarely consumed 3 or more meals in a day. When looking at the consumption of fresh fruit of children, it was seen that 51% (
n = 53) of children always consumed, 30.8% (
n = 32) consumed often, 15.4% (
n = 16) sometimes, 1.9% (
n = 2) rarely, and 1% (
n = 1) of children never consumed fresh fruit. Regarding vegetable consumption, it was observed that 29.8% (
n = 31) of children always consumed vegetables, 32.7% (
n = 34) consumed often, 24% (
n = 25) sometimes, 10.6% (
n = 11) of children rarely consumed, and 2.9% (
n = 3) of children never consumed vegetables. The following consumption of milk and dairy products such as cheese and yoghurt was observed: 67.3% (
n = 70) of children always consumed, 22.1% (
n = 23) consumed often, 4.8% (
n = 5) consumed sometimes, 4.8% (
n = 5) of children rarely consumed, and 1% (
n = 1) of children never consumed milk and dairy products. Consumption of starchy products, such as bread, rice, and pasta in children was evaluated as follows, 45.2% (
n = 47) always, 38.5% (
n = 40) often, 14.4% (
n = 15) sometimes, 1.9% (
n = 2) rarely consumed, while there was no child who never consumed starchy products. Looking at the consumption of fast food, such as hamburgers and pizza, it was observed that 24% (
n = 25) of children never consumed, 54.8% (
n = 57) rarely consumed, 20.2% (
n = 21) consumed sometimes, 1% (
n = 1) consumed fast food often, while there were no children who always consumed fast food. Accounting for soft drink consumption, such as cola and soda pop, it was seen that 68.3% (
n = 71) of children never consumed, 26.9% (
n = 28) consumed rarely, 3.8% (
n = 4) sometimes consumed, 1% (
n = 1) of children often consumed soft drinks, and there was no child that always consumed soft drinks. Finally, when looking at the consumption of packaged food, such as crackers, chips, and chocolate, it was observed that 13.5% (
n = 14) of children always consumed, 18.3% (
n = 19) often consumed, 34.6% (
n = 36) consumed sometimes, 29.8% (
n = 31) consumed rarely, and 3.8% (
n = 4) of children never consumed packaged foods.
On
Table 2, where the mean eating behavior score of children is displayed, it is observed that both girls and boys always or often had breakfast, consumed three or more meals, and consumed fresh fruits, starchy products, milk, and dairy products. Moreover, children often or sometimes consumed vegetables, rarely or never consumed soft drinks, and sometimes or rarely consumed packaged food. When looking at the consumption of fast foods, it is observed that girls rarely or sometimes consumed and boys never or rarely consumed fast foods.
A scoring rubric was used to evaluate the quality of eating habits of children. A 1 to 5 points margin was assigned for each questions’ answer option. According to this rubric, it is determined as for “having breakfast”; “consumption of 3 or more than 3 meals per day”; “consumption of fresh fruits”; “consumption of vegetables”; “consumption of milk and dairy products”; “consumption of starchy products” of children; the “always” option is 5 points; “often” option is 4 points; “sometimes” option is 3 points; “rarely” option is 2 points; and “never” option is 1 point. As for the “consumption of fast food”, “consumption of soft drinks”, and “consumption of packaged food” of children, the “always” option is 1 point; “often” option is 2 points; “sometimes” option is 2 points; “rarely” option is 4 points; and “never” option is 5 points. According to this predetermined score, when the highest scores are collected for all the questions, the highest score possible is 45 and the lowest score is 9 for the children’s eating behaviors quality assessment. The produced score (between 9–45 points) is sub-categorized into 3 score group rages: “9–21” (low), “22–33” (medium), and “34–45” (high). The data analysis producing a score for each child participant revealed that there were no children in the “9–21” range group (low score). 6.7% of girls (
n = 7), 16.3% of boys (
n = 17), and a total of 23.1% (
n = 24) of children are in the “22–33” points group (medium), while 32.7% (
n = 34) of girls and 44.2% (
n = 46) of boys are in the “34–54” points group (high) (
Table 3).
According to our results regarding the use of technological devices by children, it is observed that 15.4% (n = 16) of girls, 16.3% (n = 17) of boys, and totally 31.7% (n = 33) of children watched TV during their meal, whereas, 24% (n = 24) of girls, 44.2% (n = 46) of boys, and totally 68.3% (n = 71) of children did not watch TV during their meal. Also, 12.5% (n = 13) of girls, 20.2% (n = 21) of boys, and totally 32.7% (n = 34) of children use a tablet/smart phone during their meal, whereas 26.9% (n = 28) of girls, 40.4% (n = 42) of boys, and totally 67.3% (n = 70) of children do not. When computer use is considered, 1% (n = 1) of girls, 1% (n = 1) of boys, and totally 1.9% (n = 2) of children use the computer, whereas 38.5% (n = 40) of girls, 59.6% (n = 62) of boys, and totally 98.1% (n = 102) do not use a computer during their meal.
Specifically, for soft drinks, it was observed that 9% (n = 7) of children rarely consumed, 1.3% (n = 1) of children sometimes consumed, and 89.7% (n = 70) of children did not consume soft drinks. Also, it was seen that, 3.8% (n = 3) of children always consumed packaged foods, 6.4% (n = 5) often consumed, 32.1% (n = 25) sometimes consumed, and 28.1% (n = 22) rarely consumed, whereas 29.5% (n = 23) of children did not consume packaged foods while watching TV. When looking at the consumption of fresh fruit when watching TV, 20.5% (n = 16) of children always consumed, 33.3% (n = 26) often consumed, 34.6% (n = 27) sometimes consumed, and 5.1% (n = 4) rarely consumed, whereas 6.4% (n = 5) of children did not consume fresh fruit when watching TV. Moreover, it was seen that 5.1% (n = 4) of children always consumed pastry, 5.1% (n = 4) often consumed, 44.9% (n = 35) sometimes consumed, and 15.4% (n = 12) rarely consumed pastry, whereas 29.5% (n = 23) of children did not consume pastry in front of the TV. When consumption of nuts or dried fruits is considered, 11.5% (n = 9) of children always consumed, 16.7% (n = 13) often consumed, 44.9% (n = 35) sometimes consumed, and 7.7% (n = 6) rarely consumed whereas 19.2% (n = 15) of children did not consume nuts or dried fruits in front of the TV.
Similarly, when looking into the food consumption in front of the tablet/smart phone by the children, for soft drinks, it was observed that 4.7% (n = 2) of children rarely consumed and 95.3% (n = 41) of children did not consume soft drinks. Also, we saw that 4.7% (n = 2) of children always consumed packaged foods, 4.7% (n = 2) often consumed, 34.9% (n = 15) sometimes consumed, and 39.5% (n = 17) rarely consumed, whereas 16.3% (n = 7) of children did not consume packaged foods when using smart devices. Regarding fresh fruit, 7% (n = 3) of children always consumed, 30.2% (n = 13) often consumed, 32.6% (n = 14) sometimes consumed, and 20.9% (n = 9) rarely consumed, whereas 9.3% (n = 4) of children did not consume fresh fruit in front of the tablet/smart phone. Additionally, we observed that 2.3% (n = 1) of children always consumed pastry, 7% (n = 3) often consumed, 44.2% (n = 19) sometimes consumed, and 20.9% (n = 9) rarely consumed pastry, whereas 25.6% (n = 11) of children did not consume pastry in front of the tablet/smart phone. For dried nuts or dried fruits, 4.7% (n = 2) of children always consumed, 26.6% (n = 11) often consumed, 32.6% (n = 14) sometimes consumed, 14% (n = 6) rarely consumed whereas, and 23.3% (n = 10) of children did not consume nuts or dried fruits in front of the tablet/smart phone.
When consumption of foods in front of a computer by children is considered, we observed that only 6 children consumed food when using a computer. When these children and the foods that they consumed were considered, we found that, for soft drinks, 66.7% (n = 4) did not consume any, and 33.3% (n = 2) of children rarely consumed packaged foods; 16.7% (n = 1) of children rarely consumed, 66.7% (n = 4) of children often consumed, and 16.7% (n = 1) of children always consumed fresh fruits; 50% (n = 3) of children sometimes consumed, 16.7% (n = 1) often consumed, 16.7% (n = 1) always consumed, and 16.7% (n = 1) of children did not consume pastry; 33.3% (n = 2) of children often consumed, 16.7% (n = 1) sometimes consumed, 33.3% (n = 2) rarely consumed, and 16.7% (n = 1) of children did not consume nuts or dried fruits when using a computer. Overall, the computer and food engagement was very low, possibly because computers are typically used to perform some sort of work or gaming, so eating and engaging in activity simultaneously would be challenging and impractical.
When evaluating the association between duration of technological devices use and weight status of children, the use of tablet/smart phone was found to have a higher effect on children’s weight status compared to TV and computer use, although this effect was not statistically significant (
p > 0.05) (
Table 4).
However, the association between the type of food consumed in front of technological devices and weight status of the children appears significant in certain cases. More specifically, there is a strong association between the weight status of children and the foods that are consumed in front of the TV (
p = 0.000) (
Table 5). Also, there is an association between the weight status of children and the foods that are consumed in front of the tablet/smart phone (
p = 0.012). However, the foods that are consumed in front of the computer were not significantly associated with the weight status of the children (
p > 0.05).
Finally, when evaluating the association between duration of technological devices use and nutrition score of children, there appears to be a significant association in some cases. While there was not any association between nutrition score of children and computer use (
p > 0.05), tablet/smart phone use and TV viewing were significantly associated with the nutrition score of children (
p = 0.015;
p = 0.025) (
Table 6).
Regarding TV viewing duration, it was observed that parental age was significantly associated with TV viewing duration (
p = 0.000) (
Table 7). Also, it was found that there was a strong association between TV viewing duration and TV location (TV found in child’s room) (
p = 0.010). Besides, TV viewing duration was associated with the foods that children consumed in front of TV (
p = 0.007). However, we did not find an association between TV number in household and child’s TV viewing duration (
p > 0.05). When tablet/smart phone duration of use was taken into consideration, we saw that tablet/smart phone duration of use was significantly associated with the tablet/smart phone that children have (
p = 0.004). Also, rules about when and how often children can use tablet/smart phone were strongly associated with the tablet/smart phone duration of use (
p = 0.000).