The Effect of Primary Care Interventions on Children’s Media Viewing Habits and Exposure to Violence Jill Aragon Neely, MD; Julia Hudnut-Beumler, BA; Margaret White Webb, MD; Antwon Chavis, MD; Mary S. Dietrich, PhD; Len Bickman, PhD; Seth J. Scholer, MD, MPH From the Vanderbilt University School of Medicine, Nashville, Tenn (Dr Aragon Neely, Ms Hudnut-Beumler, Dr White Webb); School of Nursing, School of Medicine (Biostatistics) (Dr Dietrich); Center for Evaluation and Program Improvement, Peabody Administration Building, Vanderbilt University, Nashville, Tenn (Dr Bickman); Meharry College of Medicine, Nashville Tenn, (Mr Chavis); and Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville Tenn (Dr Scholer) The Play Nicely program is owned by Vanderbilt University, and Dr Scholer is one of the authors of the program. The Play Nicely program can be viewed at no cost at www.playnicely.org. The other authors declare that they have no conflict of interest. Address correspondence to Seth J. Scholer, MD, MPH, Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children’s Hospital at Vanderbilt, 8232 DOT, Nashville, TN 37232 (e-mail: Seth.Scholer@Vanderbilt.edu). Received for publication February 12, 2013; accepted May 18, 2013. ABSTRACT OBJECTIVE: To determine if brief primary care interventions can affect children’s media viewing habits and exposure to violence. METHODS: English- and Spanish-speaking parents of 2- to 12-year-old children presenting to a pediatric primary care clinic participated in a randomized controlled trial. There were 2 intervention groups; one group viewed 5 minutes from the Play Nicely program and another received a handout, "Pulling the Plug on TV Violence." There were 2 control groups; the primary control group received standard primary care, and the alternative control group viewed a program about obesity prevention. The outcome measure was parental report of changes in media viewing habits and changes in exposure to violence. RESULTS: A total of 312 of 443 parents who were random- ized completed a 2-week follow-up survey. Compared with the primary control group, parents in the video intervention group were more likely to report a change in their children’s media viewing habits (odds ratio [OR] 3.29; 95% confidence interval [CI] 1.66–6.51) and a change in their children’s expo- sure to violence (OR 4.26; 95% CI 1.95–9.27). Compared with the primary control group, parents in the handout group were more likely to report a change in their children’s media viewing habits (OR 4.35; 95% CI 2.20–8.60) and a change in their children’s exposure to violence (OR 3.35; 95% CI 1.52–7.35). CONCLUSIONS: Brief primary care interventions can affect children’s media viewing habits and children’s exposure to violence. These results have implications for how to improve primary care services related to decreasing children’s media exposure and violence prevention. KEYWORDS: aggression; child abuse; child behavior; coun- seling; education; intervention; parenting; pediatrics; preven- tion and control; primary care; violence ACADEMIC PEDIATRICS 2013;13:531–539 WHAT’S NEW Solutions are needed to educate parents about media violence within the context of the primary care clinic. Both multimedia video programs and handouts can affect children’s media viewing habits and exposure to violence. CHILDREN’S EXPOSURE TO media violence is associ- ated with aggressive behavior, desensitization to violence, anxieties, depression, and sleep disturbances. 1–9 Regardless of the content, media viewing is associated with childhood obesity and poor school performance. 10 Of concern, the average child in the United States spends 6 hours per day watching television, witnesses thousands of acts of media violence during childhood, and has a TV in their bedroom. 8 To address these unhealthy media- viewing habits, the American Academy of Pediatrics recommends that parents limit media viewing time, reduce children’s exposure to violence in the media, and not allow a TV in their children’s bedrooms. 8 The primary care setting offers a unique opportunity for physicians to educate parents about healthy media viewing habits. 8,10 There is evidence that interventions can affect media viewing habits, but most of the studies have been conducted in a home or school setting and have focused on reducing media time. 11,12 Although promising, the few studies conducted in primary care have yielded mixed results. 13–15 It is unknown whether a brief primary care intervention, integrated into a primary care visit, can influence children’s media viewing habits and children’s exposure to violence at home. To address this gap in the literature, we conducted a randomized controlled trial of 2 primary care interventions. The objective was to determine if brief interventions, incorporated into the well-child visit of 2- to 12-year old children, can affect children’s media viewing habits and children’s exposure to violence. If brief interventions are effective, these findings would have implications for how ACADEMIC PEDIATRICS Volume 13, Number 6 Copyright ª 2013 by Academic Pediatric Association 531 November–December 2013