Table 2 Characteristics of included studies which examined rates of screen-viewing and/or screen-viewing opportunities in childcare

▪ Bacigalupa (2005) [47]

▪ United States

▪ Mixed-methods

▪ 1 home-based childcare facility

▪ Three-fold:

▪ Field notes (direct observation)

▪ Each child permitted 18 minutes of video games/day:

▪ 6 preschoolers (mean age = ~5 years^†∇; 50% male)

1. Examine video game use by young children

- Children sat and watched the others play (6 children x 18mins = 108 mins/day or 1.8 hrs/day)

2. Explore the nature of children’s interactions during video game use

- Could “earn” extra minutes for good behavior

3. Assess video game usage within the home childcare environment

▪ Brown et al. (2009) [43]

▪ United States

▪ Cross-sectional

▪ 24 center-based childcare facilities

▪ Two-fold:

▪ OSRAC-P (direct observation)

▪ 0.15 hrs/day (or 8.92 mins/day) per child

▪ 476 preschoolers (mean age = 4.2 years [SD = 0.7]; 50% male)

1. Describe the PA behaviors and the accompanying environmental/social events of preschoolers in childcare

- 2% was in light PA

1. Examine which conditions were predictors of MVPA and total PA

- 98% was sedentary

▪ Christakis & Garrison (2009) [50]

▪ United States

▪ Cross-Sectional

▪ 168 childcare facilities (84 home-based, 74 center-based)

▪ Two-fold:

▪ Telephone survey (proxy-report measure)

▪ Mean (SD) television viewing across all participating facilities:

▪ Preschoolers’ age range = 3–5 years

1. Investigate characteristics of programs that predict screen-viewing

- Home-based: 2.4 hrs/day (1.8)

2. Quantify television viewing in childcare settings

- Center-based: 0.4 hrs/day (0.9)

▪ Mean (SD) television viewing across facilities that reported any screen-use in care:

- Home-based: 3.4 hrs/day (2.8)

- Center-based: 1.2 hrs/day (1.3)

▪ Preschoolers in home-based childcare engaged in significantly more television than those in center-based care (p < .001)

▪ > 90% of childcare facilities reported television being for educational or educational and entertainment purposes

▪ Christakis et al. (2006) [11]

▪ United States

▪ Cross-sectional

▪ 2,672 childcare facilities (583 home-based; 2,089 center-based)

▪ Two-fold:

▪ Survey (proxy-report measure)

▪ Mean hours of daily television viewing:

▪ Preschoolers’ age range = 3–5 years

1. Describe the amount and frequency of television viewing among preschoolers in childcare

- Home-based: 1.39 hrs/day^∇

2. Explore predictors of television viewing in the childcare setting

- Center-based: 0.36 hrs/day^∇

▪ Preschoolers in home-based childcare watched ~4x more television than those in center-based care

▪ Dowda et al. (2004) [51]

▪ United States

▪ Cross-sectional

▪ 9 center-based childcare facilities:

▪ Determine if levels of MVPA among preschoolers varied with differences in policies/practices, and overall quality of childcare facilities

▪ ECERS-R (direct observation)

▪ 3 PAP centers, < 45 mins/day (or < 0.75 hrs/day):

- 3 PAP centers (83 children)

- 5.7% (SD = 1.6) was in MVPA

- 6 NPAP centers (183 children)

- 57.5% (SD = 4.8) was sedentary

▪ 266 preschoolers (mean age = 4 years^∇; 47% males)

▪ 6 NPAP centers, ≥ 45 mins/day (or ≥ 0.75 hrs/day):

- 7.1% (SD = 1.1) was in MVPA

- 56.7% (SD = 3.4) was sedentary

▪ Finch et al. (2012) [52]

▪ Australia

▪ Quasi-experimental (intervention, 2-arm)

▪ 484 center-based childcare facilities (275 intervention, 209 control)

▪ Describe impact of an intervention tasked with increasing the adoption of PA-promoting policies/practices in center-based childcare

▪ Telephone survey (proxy-report measure)

▪ Prevalence of PA policies/practices in centers (at baseline):

▪ Preschoolers’ age range = 3–5 years

- 45-60%: policy that limits screen time

- 17-23%: children are allowed to watch screens less than once per week

▪ Finch et al. (2014) [53]

▪ Australia

▪ Cluster randomized control trial

▪ 20 center-based childcare facilities (10 in intervention, 10 in control)

▪ Evaluate the impact of a cluster randomized trial on the PA levels of 3–5 year old children attending center-based childcare

▪ EPAO (direct observation)

▪ Mean (SD) television viewing = 6.90 (21.82) mins/day

▪ 457 preschoolers; age range = 3–5 years; ~55% male)

▪ Gunter et al. (2012) [54]

▪ United States

▪ Cross-sectional

▪ 53 home-based childcare facilities

▪ Asses the current status of PA- and nutrition-related policies/practices in home-based childcare facilities to help inform the Journey to a Healthy Child Care Home childhood obesity intervention

▪ NAP SACC (proxy-report measure)

▪ Prevalence of screen-viewing policies/practices in centers:

▪ 205 preschoolers (age range = 2–5 years)

- 60.4%: television is turned on every day for at least part of the day

- 58.5%: children are allowed to watch television/videos or play video games at least once a day

- 20.8%: children are allowed to use a computer for educational purposes or games at least once a day

▪ McWilliams et al. (2009) [55]

▪ United States

▪ Cross-sectional

▪ 96 center-based childcare facilities (only 42 with television data)

▪ Demonstrate how current practices of a large sample of childcare centers compare to best-practice PA guidelines

▪ EPAO (proxy-report measure)

▪ Number of centers engaging in television viewing time (with television present in classroom):

▪ 66 children/center (median enrollment; where ~50% were 3–5 years)

- 17: ≤ 30 mins/day (or ≤ 0.50 hrs/day)

- 16: ≥ 31 ≤ 60 mins/day (or ≥ 0.50 ≤ 1 hr/day)

- 9: > 60 mins/day (or > 1 hr/day)

▪ Natale et al. (2013) [56]

▪ United States

▪ Cross-sectional

▪ 1,140 childcare facilities (842 center-based, 298 home-based)

▪ Explore and differentiate between the PA and nutrition patterns of center- and home-based childcare facilities

▪ Physical Activity Frequency Questionnaire (proxy-report measure)

▪ Television viewing limited to ≤ 60 mins/day (or ≤ 1 hr/day; once a week)

▪ Preschoolers’ age range = 3–5 years (~50% male)

▪ Center-based: 474

▪ Home-based: 113*

▪ Computer use limited to ≤ 60 mins/day (or ≤ 1 hr/day; once a week)

▪ Center-based:410

▪ Home-based: 186*

▪ Sisson et al. (2012) [57]

▪ United States

▪ Cross-sectional

▪ 314 center-based childcare facilities

▪ To determine the obesogenic practices of full-day childcare centers

▪ NAP SACC (proxy-report measure)

▪ Prevalence of screen-viewing practices in centers:

▪ Preschoolers’ age range = 2–5 years

- 57.4%: television is rarely/never used

▪ Tandon et al. (2011) [58]

▪ United States

▪ Cross-sectional

▪ 6,050 preschoolers (1,900 in home-based childcare; 4,150 in center-based childcare; mean age = 4.37 years [SE = 0.01]; 51% male)

▪ Three-fold:

▪ Telephone survey (proxy-report measure)

▪ Mean television viewing:

1. Assess preschoolers cumulative daily screen time

- Home-based: 1.8 hrs/day^∇

2. Measure the contributions of the home and childcare setting to this total

- Center-based: 0.1 hrs/day^∇

3. Characterize children most at risk for excessive screen time

▪ Preschoolers in center-based childcare watched significantly less television in comparison to those attending home-based care (p < .001)

▪ Taverno Ross et al. (2013) [48]

▪ United States

▪ Multi-component intervention

▪ 16 center-based childcare facilities

▪ Explore the separate influences of “childcare television” vs. “home television” vs. “cumulative television” on preschoolers’ PA and weight

▪ 3-item survey examining the rules, use, and availability of television in childcare (proxy-report measure)

▪ Childcare environment was highly conducive to television viewing

▪ 339 preschoolers (mean age = 4.5 years [SD = 0.3]; 52.2% males)

▪ Mean (SD) of summed scores (i.e., TV availability, rules, use) at baseline = 4.1 (1.8) out of 11 (where a lower score indicates an screen-viewing supportive environment)

▪ Trost et al. (2009) [59]

▪ United States

▪ Cross-sectional

▪ 297 home-based childcare facilities

▪ Describe nutrition- and PA-related policies/practice in a representative sample of home-based childcare facilities

▪ NAP SACC (proxy-report measure)

▪ Prevalence of screen-viewing policies/practices in centers:

▪ Preschoolers’ age range = 2–5 years

- 64.6%: television is turned on every day for at least part of the day

- 55.1%: children are allowed to watch television/videos or play video games at least once a day

- 33.2%: children are allowed to use a computer for educational purposes or games at least once a day

▪ Trost et al. (2011) [60]

▪ United States

▪ Quasi-experimental (intervention)

▪ 236 home-based childcare facilities

▪ Determine the impact of a community-based train-the-trainer intervention on the nutrition- and PA-related policies/practice of home-based childcare facilities

▪ NAP SACC (proxy-report measure)

▪ Mean (SD) score for television use and viewing: 2.9 (0.8) [out of 4, where a score of 4 = best practice of never/rarely watching screens]

▪ Preschoolers’ age range = 2–5 years

▪ Wolfenden et al. (2010) [61]

▪ Australia

▪ Cross-sectional

▪ 261 center-based childcare facilities (112 pre-schools, 149 long-day care settings)

▪ Two-fold:

▪ Telephone survey (proxy-report measure)

▪ 25-30% of centers (preschools and long-day care settings, respectively) provided daily opportunities to engage in screen activities

▪ 27 children/pre-school (mean enrolment; age range = 3–5 years)

1. Describe PA-related policies/practices of childcare programs

▪ Policy supports limiting screen recreation

▪ 39 children/long-day care setting (mean enrollment; age range = 6 weeks-under 6 years)

2. Ascertain whether characteristics like socio-economic status, remoteness, or size predict these policies and/or practices

- Preschools = 35

- Long-day care settings = 69

▪ Zevenbergen & Logan (2008) [62]

▪ Australia

▪ Cross-sectional

▪ 25 childcare facilities

▪ Determine the amount of access young children had to computers at home and in the childcare setting

▪ Survey (proxy-report measure)

▪ Mean frequency of access to computers in childcare = 1.04^±∇ (out of 3, where a score of 3 = frequent)

▪ 150 preschoolers (age range = 4–5 years)

▪ Majority of activities undertaken while using the computer were educational games, followed by non-educational games