Currently submitted to: JMIR Pediatrics and Parenting
Date Submitted: Aug 23, 2026
Open Peer Review Period: Aug 25, 2026 - Oct 20, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
An Examination of Screen Exposure in Primary School Children: Implications for Physical Health, Sleep Quality, and Parental Influence — A Community-Based Cross-Sectional Study
ABSTRACT
Background:
Children’s screen and digital-media use is now near-universal, and aggregate daily duration may be a poor proxy for risk; the timing of use, its domain, and parental behaviour may matter more. Community-based data from rural and semi-urban government-school children in India are limited, and integrated assessment of exposure, sleep, nutrition, and parental habits within one cohort is uncommon.
Objective:
This study aimed to characterise screen exposure in children aged 5-9 years and to test its associations with sleep quality, nutritional status, and parental screen habits, identifying modifiable digital-behaviour targets for anticipatory guidance.
Methods:
We conducted an analytical, community-based, cross-sectional study of 400 children aged 5-9 years attending government primary schools in rural and semi-urban Vadodara District, Gujarat, India, enrolled by consecutive sampling. Parental and child screen exposure were measured with a modified Screen Time Questionnaire and a modified SCREENS-Q; sleep with a modified Children’s Sleep Habits Questionnaire (CSHQ; poor sleep defined as a total sleep score >20); and nutritional status against the Indian Academy of Pediatrics (IAP) 2015 growth charts. Non-parametric tests (Spearman ρ, Mann-Whitney U, Kruskal-Wallis H, chi-square with Cramér V) with effect sizes and 95% CIs were used; a 2-tailed P<.05 defined significance.
Results:
All 400 children had complete data (mean age 8.56, SD 1.20 years; 55.5% male; 84.0% moderate exposure). Parental and child screen scores correlated significantly (ρ=0.160, 95% CI 0.063-0.254; P=.001); the categorical association was strong (χ²₂=32.70; P<.001; Cramér V=0.286), with 20.8% (15/72) of children of high-exposure parents in the high band versus 3.0% (10/328) of children of moderate-exposure parents (relative risk 6.8, 95% CI 3.2-14.6). Screen use within 1 hour of bedtime was associated with poor sleep (U=13,770; P<.001; continuous ρ=0.20, P<.001), localised to sleep-onset delay, bedtime resistance, and sleep duration. Aggregate daily duration was unrelated to sleep (P=.51) or BMI (ρ=−0.072; P=.15). Poor sleep affected 29.25% (95% CI 24.8%-33.7%); 93.0% were normal-weight.
Conclusions:
Parental screen behaviour was a measurable correlate of child exposure, and proximity of screen use to bedtime was a more useful clinical target than aggregate daily duration. Anticipatory guidance should emphasise parental modelling and a screen-free pre-sleep interval.
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