Preschool and School Age Activities:
Comparison of Urban and Suburban
Populations
Dorothy Damore, MD
Weill Cornell Medical College
New York, NY
Published in Journal of Community Health
2002;27:203-211.
Objective
• To compare the activities of urban and
suburban children in the New York
metropolitan area
Background
• Leisure time activities may be related to the living
environment.
• Studies have found greater illicit drug use and
greater smokeless tobacco use in rural children
and teenagers when compared with their urban
counterparts.
• This substance abuse is associated with criminal
activity.
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Finke L et al. J Drug Educ 1999;29:279-291.
Kuria MW. East Afr Med J 1996;73:339.
Olds RS. J Sch Health 1988;58:374-378.
Gordon WR et al. Adolescence 1996;31:883-901.
Background
• The average American child watches
between 21 and 27 hours of television a
week which accounts for more time spent
watching television than on any other
activity except sleep including school and
homework.
• AC Nielsen Company, Nielsen Media Research, 1989.
Background
• In certain individuals watching violent television
programming relates to aggressive behavior.
• Violent television viewing in the third grade has
been shown to correlate with aggressive behaviors
10 to 22 years later.
• Increased television viewing is associated with
decreased sporting activities, decreased time spent
outdoors and obesity.
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•
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Cantor J. J Adolesc Health 2000;27:S30-34.
Dietz WH et al. Curr Probl Pediatr 1991;8-31.
Gortmaker SL et al. Arch Pediatr Adolesc Med 1996;150:356-362.
Tucker LA. Adolescence 1986;21:797-806.
Dietz WH et al. Pediatrics 1985;75:807-812.
Methods
• Prospective survey
• Convenience sample
• Conducted at one urban and one suburban
primary care pediatric office
• Urban office in the Upper East Side of
Manhattan
• Suburban office in Westchester County, just
north of New York City
Methods
• The primary investigator asked the caretakers of
preschool and school age children to complete a
questionnaire about their child’s activities.
• Questionnaire available in Spanish
• Only one questionnaire per family
• Exclusion: children with physical handicaps
Questionnaire
• Activities included:
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sports
time spent outdoors
reading
library use
video or television watching
computer use
summer camp
• 34 questions, 5 pages
• Took most parents 5 minutes to complete
Methods
• Preschool and school age activities were compared
between urban and suburban populations.
• Suburban school age activities were compared
between the school year and summer.
• Due to time constraints, data collection for the
urban school age children during the summer was
not performed.
Methods
• Assuming that 80% of urban children watched TV
or videos for 3 or more hours a day and that a
difference of 50% in the suburban children would
be considered significant, to detect this difference
with 80% power, a sample size of 45 in each
group was determined using a chi-square test
(two-tailed, alpha=0.05).
Methods
• Mann-Whitney test was used for numeric or
quantitative variables.
• Fisher’s Exact test was used for categorical
variables.
• Informed consent from a legal guardian
• The Institutional Review Board approval
Results
• Completed Questionnaires
– 66 urban preschool children
– 70 suburban preschool children
– 57 urban school age children
– 61 suburban school age children
– 63 suburban school age children during the summer
Results
• Refusal rates from 1 - 12% in the different
groups
• Four questionnaires completed in Spanish
Preschool Results
• The preschool groups were similar in
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mean age
gender
health insurance
parental level of education
• Urban preschool children had greater ethnic
diversity (p<.01).
Preschool Results
• Suburban preschool children
– spent more time outdoors, with 86% of suburban
children spending 4 or more days outdoors per week
versus 52% of urban children (p<.01)
– were read to more frequently, with 97% of suburban
children being read to 4 or more days per week versus
83% of urban children (p=.01)
– visited the library more frequently, with 66% of
suburban children visiting the library at least 1 to 3
times per month versus 47% of urban children (p=.03)
– and more often attended summer camp (p<.01)
School Age Results
• The school age groups were similar in
– mean age
– gender
– health insurance
• Urban school age children had greater
ethnic diversity (p<.01).
• The parental level of education was greater
in the suburban group (p=.01).
School Age Results
• Suburban school age children
– spent more time outdoors, with 87% of suburban
children spending 4 or more days outdoors per week
compared with 54% of urban children (p<.01)
– more frequently participated in a community sport
league, 62% of suburban children vs. 23% of urban
children (p<.01)
– and more often attended summer camp (p<.01)
• Urban school age children
– watched more TV or videos, with 25% of urban
children watching more than 3 hours per day vs. 100%
of suburban children watching 3 hours or less per day
(p<.01)
Suburban School Age Children
School Year vs. Summer Results
• The suburban groups, school year vs.
summer, were similar in
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mean age
gender
ethnicity
health insurance
parental level of education
Suburban School Age Children
School Year vs. Summer Results
• School year
– used the library more frequently, with 41%
visiting the library at least 1 to 3 times per week
during the school year vs. 18% during the
summer (p=.01)
• Summer
– spent more time outdoors, with 63% spending 1
hour or more per day outdoors during the
summer vs. 23% during the school year (p<.01)
Discussion
• Suburban preschool and school age children spent
more time outdoors.
• Suburban school age children tended to spend
more time playing sports than urban school age
children.
• Easier for suburban children to spend time
outdoors near their homes.
• Transportation may be easier in suburban settings.
Discussion
• One study found greater physical activity to be
associated with greater time spent outdoors.
• In contrast, adults living in urban settings have
been found to be more active than those living in
rural settings.
• Klesges RC et al. Health Psychol 1990;9:435-449.
• MMWR. 1998;47:1097-1100.
Discussion
• In our school age children, 36 – 53% played sports
4 or more days per week and 51 – 79% played
sports more than 30 minutes a day.
• Vigorous activity for 3 days a week or more and
20 minutes or more at a time is one of the
objectives of Healthy People 2000.
• Other studies have found that 60 – 80% of school
age children meet this criteria.
• US Department of Health and Human Services, 1991.
• Molnar D et al. Eur J Pediatr 2000;159:S45-55.
• Andersen RE et al. JAMA 1998;279:938-942.
Discussion
• Most of our children 75 – 100% watched TV or
videos, 3 hours or less per day.
• However, in the urban school age group, 25%
watched 3 or more hours per day.
• The American Academy of Pediatrics recommends
that Pediatricians encourage their parents to limit
their child’s viewing of TV to less than 2 hours per
day.
• In one study with over 4000 school age children,
67% watched >2 hours of TV per day and 26%
watched >4 hours per day.
• Andersen RE et al. JAMA 1998;279:938-942.
Limitations
• Responses depended on parental interpretation of
sports activities as well as parental estimations of
the number of days and amount of time their
children spent outdoors, playing sports, reading,
using the library or using the computer.
• Most of the children had private insurance which
makes the groups similar but may not apply to
other children with different insurance.
Limitations
• Greater ethnic diversity was seen in the urban
preschool and school age groups and a greater
parental level of education in the suburban school
age group which may account for some of the
differences seen between the various groups.
• Since this study was conducted in the New York
metropolitan area, other urban and suburban areas
may have different findings.
Conclusions
• Important differences exist between the
activities of urban and suburban children in
two practices in the New York metropolitan
area.
• Pediatricians caring for urban children may
have an important opportunity to promote
participation in sports and educational
activities.