Randomized Controlled Trial of Primary Care Pediatric Parenting Programs Effect on Reduced Media Exposure in Infants, Mediated Through Enhanced Parent-Child Interaction

Objectives: To determine whether pediatric primary care-based programs to enhance parenting and early child development reduce media exposure and whether enhanced parenting mediates the effects. Design: Randomized controlled trial. Setting: Urban public hospital pediatric primary care clinic. Participants: A total of 410 mother-newborn dyads enrolled after childbirth. Interventions: Patients were randomly assigned to 1 of 2 interventions, the Video Interaction Project (VIP) and Building Blocks (BB) interventions, or to a control group. The VIP intervention comprised 1-on-1 sessions with a child development specialist who facilitated interactions in play and shared reading through review of videotapes made of the parent and child on primary care visit days; learning materials and parenting pamphlets were also provided. The BB intervention mailed parenting materials, including age-specific newsletters suggesting activities to facilitate interactions, learning materials, and parent-completed developmental questionnaires (Ages and Stages questionnaires). Outcome Measures: Electronic media exposure in the home using a 24-hour recall diary. Results: The mean (SD) exposure at 6 months was 146.5 (125.0) min/d. Exposure to VIP was associated with reduced total duration of media exposure compared with the BB and control groups (mean [SD] min/d for VIP, 131.6 [118.7]; BB, 151.2 [116.7]; control, 155.4 [138.7]; P = .009). Enhanced parent-child interactions were found to partially mediate relations between VIP and media exposure for families with a ninth grade or higher literacy level (Sobel statistic = 2.49; P = .01). Conclusion: Pediatric primary care may represent an important venue for addressing the public health problem of media exposure in young children at a population level.