Abstract
BACKGROUND: Maternal adverse childhood experiences (ACEs) have been linked to negative outcomes in their children. However, limited research has explored their impacts on screen use habits in preschool children. This study aimed to examine the associations of maternal ACEs with early screen exposure and prolonged daily screen time in preschool children whose mothers were their primary caregivers. METHODS: A cross-sectional study was conducted involving 3,131 mother-child dyads in China. Twelve maternal ACEs were assessed using the Adverse Childhood Experiences-International Questionnaire and subsequently categorized into 0, 1, 2, 3, and ≥ 4 ACEs. Early onset of screen use was defined as exposure to screens before the age of 2 years, while prolonged daily screen time was defined as ≥ 1 h/day for children aged 5 years or younger and ≥ 2 h/day for those older than 5 years. Logistic regression analyses were performed to evaluate the associations between maternal ACEs and children's screen use behaviors. Stratified analyses and tests for interaction were carried out based on children's age, gender, single-child status, and maternal age. RESULTS: Among the children included, 51.6% were boys, and the mean age was 4.6 (SD: 1.0) years. Approximately 11.6% of the children were exposed to screens before the age of 2 years and 34.5% exceeded the recommended daily screen time. A higher cumulative number of maternal ACEs was associated with a greater likelihood of both early onset of screen use and prolonged daily screen time, in a dose-response pattern. Specifically, children of mothers with four or more ACEs had increased odds of early screen exposure (OR = 3.871, 95% CI: 2.570-5.831) and prolonged daily screen time (OR = 2.022, 95% CI: 1.514-2.701). These associations remained consistent across various subgroups. However, child or maternal characteristics did not moderate these associations. CONCLUSIONS: Our study identified maternal ACEs as a potential risk factor associated with children's screen use habits. Further research is needed to develop interventions that support both ACE-exposed mothers and their children to reduce the risk of inappropriate screen use habits during early childhood.