Research article
Identifying Subgroups of U.S. Adults at Risk for Prolonged Television Viewing to Inform Program Development

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Background

Although adverse health effects of prolonged TV viewing have been increasingly recognized, little population-wide information is available concerning subgroups at greatest risk for this behavior.

Purpose

This study sought to identify, in a U.S. population–derived sample, combinations of variables that defined subgroups with higher versus lower levels of usual TV-viewing time.

Methods

A total of 5556 adults from a national consumer panel participated in the mail survey in 2001 (55% women, 71% white, 13% black, and 11% Hispanic). Nonparametric risk classification analyses were conducted in 2008.

Results

Subgroups with the highest proportions of people watching >14 hours/week of TV were identified and described using a combination of demographic (i.e., lower household incomes, divorced/separated); health and mental health (i.e., poorer rated overall health, higher BMI, more depression); and behavioral (i.e., eating dinner in front of the TV, smoking, less physical activity) variables. The subgroup with the highest rates of TV viewing routinely ate dinner while watching TV and had lower income and poorer health. Prolonged TV viewing also was associated with perceived aspects of the neighborhood environment (i.e., heavy traffic and crime, lack of neighborhood lighting, and poor scenery).

Conclusions

The results can help inform intervention development in this increasingly important behavioral health area.

Introduction

Prolonged TV-viewing time among adults has adverse health associations, including overweight and obesity,1, 2 type-2 diabetes and abnormal glucose metabolism,3, 4, 5 and the metabolic syndrome.6, 7 Such relationships have been observed to be independent of physical activity levels.3, 6, 8 There is evidence of dose–response relationships between high levels of TV-viewing time and biomarkers of cardio–metabolic risk, with stronger associations reported at 2 or more hours/day (i.e., more than 14 hours/week).1, 3, 4, 5, 6, 7, 9

In a recent U.S. survey, 59% of adults reported watching more than 2 hours of TV/day,10 and similarly high levels have been reported in other industrialized nations.1 Among those characteristics that have been associated with higher levels of TV viewing are older age, less education, lower income, unemployment, higher BMI, cigarette smoking, increased alcohol consumption, and less physical activity.1, 4, 5, 10, 11, 12, 13 However, few studies have explored the combinations of demographic, health, and behavioral characteristics that may define population subgroups at risk for high levels of TV viewing. Such efforts are commensurate with the individualized-medicine perspectives that have been emphasized across a range of health fields.14, 15, 16

The purpose of this study was to identify combinations of variables that defined subgroups with higher versus lower levels of usual TV-viewing time that could inform targeted intervention development in this field.16 Using data from a cross-sectional population-based study of U.S. adults, the current study identified the attributes of subgroups who engaged in the higher levels of TV-viewing time (more than 2 hours/day) that have been shown to be associated with increased health risk.5, 6 This investigation was considered exploratory and hypothesis generating.16 A social–ecologic perspective was applied in identifying variables to explore.17

Section snippets

Overview of Survey

In the spring of 2001, the American Cancer Society (ACS) commissioned Porter Novelli to conduct a national mail survey of the behavioral health and media habits of U.S. adults. A total of 12,000 surveys were mailed to a nationally representative sample of households belonging to a consumer opinion panel (Synovate, Inc.) of approximately 600,000 people recruited on an ongoing basis. Minority and low-income households were oversampled. The resultant database included post-stratified data weights

Demographics

Table 1 summarizes the descriptive characteristics of the full study sample (n=5556). In addition, Table 1 contrasts the characteristics of participants who reported watching >14 hours of TV/week with the characteristics of those reporting ≤14 hours of TV/week.

Discussion

This investigation identified the combinations of demographic, health, and behavioral variables that best discriminated subgroups watching TV at levels associated with deleterious health outcomes. For the sample generally, the strongest discriminator of TV viewing was the frequency of eating dinner in front of the TV. This is consistent with results from screen time–reduction studies in children demonstrating corresponding reductions in meals eaten in front of the TV and energy intake.31, 42, 43

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