Ask the Expert zyxw Television Viewing and Children’s Health Jyu-LinChen and Christine M. Kennedy Column Editor: Ann Froese-Fretz zyxwvuts Ask the Expert provides research-based answers to practice questions submitted by JSPN readers. Question: There is a great deal of talk about television and its negative impact on children. Does television re- ally affect children that much, and if so, how? What can I as a pediatric nurse do to help children and families? Jyu-Lin Chen and Christine M. Kennedy respond: Television viewing has been negatively implicated in the physical health, psychosocial well-being, and cognitive development of children. For example, pediatric studies have demonstrated the effect of commercials on poor di- etary intake, possible childhood obesity, and risk-taking behaviors (Kennedy, 1998; Kennedy zyxwvu & Lipsitt, 1998; Robinson, 1995). Moreover, heavy television viewing (more than 2 hours/day) is associated with fewer physi- cal activities, less satisfying social relationships, few in- terpersonal interactions, low reading skills, low social achievements, and aggressive behaviors (Dorr & Rabin, 1995; Van Evra, 1998). How are children hooked into television and how are their behaviors influenced? One of the first factors to consider is content of televised shows and commercials. Persuasive advertising aimed at children is extremely prevalent in the United States, with estimates that chil- dren watch up to 20,000 advertisements per year (Un- nikrishnan & Bajpai, 1996). zyxwvut An analysis of products ad- vertised to children revealed that more than two thirds were related to food. The majority of these commercials zyxwv are for foods high in fat, sugar, or salt. More important than number or content, however, children’s advertisements zyxwvut link products with happiness, fun, and personal enhancement. Young children are es- pecially vulnerable to advertising with emotional ploys, since they have the least developed cognitive skills to understand what is real or not, what the ads intend to sell, and the hidden link between product and feelings. Children learn to associate a positive feeling or an ac- complishment with the purchase or ingestion of a prod- uct. This may be achieved in younger children through the use of cute animals, cartoon characters, and desirable figures that emulate popular actors or sports figures. Older youth zyxw are targeted with advertisements that build powerful associations with developmental needs such as popularity, individuality, and sexual identity. This is par- ticularly obvious in music and print media. One health issue associated with television viewing is the increasing problem of obesity in children and youth. Data from the most recent Third National Health and Nutrition Examination Survey (Troiano & Flegal, 1998) indicates that 14%of children and 12% of adolescents are overweight. The prevalence of obesity increased from 12%in 1991 to 17.9% in 1998. Obesity is increasing even among the youngest children in the United States. The number of obese young children under 5 years of age in- creased from 18.6%in 1988 to 21.6% in 1995 (Mei et al., 1998). The cost related to medical expenses and lost pro- ductivity attributed to obesity in children and adults was a staggering $99 billion in 1995 (Wolf & Colditz, 1998). Thus, decreasing the rate of obesity among children and adolescents has been identified as a national healthcare priority in the federal agenda for Healthy People 2020. (U.S. Department of Health and Human Services,2000). Children whose body mass index (BMI) is 295% are more likely to be obese as adults (Jefferyet al., 2000). Sev- eral health problems in adults are now correlated to childhood obesity, including cardiovascular diseases, sleep disorders, type II diabetes, and mental health prob- lems (Epstein, Klein, & Wisniewski, 1994; Guillaume, Lapidus, Bjomtorp, & Lambert, 1997). Of greater concern is how some obesity-related conditions, such as type I1 diabetes, which have historically only been seen in adult- hood, are now being diagnosed in children (Rudloff & Feldmann, 1999).Moreover, obese children often de- velop psychosocial problems, such as low self -esteem and social withdrawal. Although studies show that certain genetic factors play an important role in determining individual suscep- tibility to obesity, the environment also can promote be- haviors that lead to obesity. American families spend more time watching television and eating outside the home than ever before. This increases the frequency of high-fat food consumption and decreases the amount of JSPN VOL 6, NO. 1, Jan~ary-March, 2001 zyxwvutsrq 35