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8/10/2019 Are Kids Too Busy
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R E S E A R C H A R T I C L E
Are Kids Too Busy? Early AdolescentsPerceptions of Discretionary Activities,Overscheduling, and StressSTEPHEN L. BROWN, PhDa BRANDYE D. NOBILING, PhD, CHESb JAMES TEUFELc DAVID A. BIRCH, PhD, CHESd
ABSTRACT
BACKGROUND: The activity patterns of children, especially after-school patterns, are receiving more professional attention.However, evidence regarding the value of various activities in childrens lives is contradictory. The purpose of this study was to
assess perceptions of discretionary activities, overscheduling, and levels of stress from adolescents perspective.
METHODS: A sample of 882 children, ages 9 to 13, recruited at 9 health education centers in the United States was selectedfor this study. Children answered questionnaires using remote, handheld devices. Data were analyzed using descriptive statistics
and multivariate logistic regression. The outcomes of interest were activity-based stress and desire for more free time.
RESULTS: The primary predictor for the desire for more free time was hours of screen time (television, computer, videogames): those who reported 3 or more hours were nearly 3 times more likely to desire more free time. Further, children who
chose their own activities experienced more activity-related stress than those who shared decisions with parents. The single
greatest predictor of activity-related stress was the reported number of hours spent on homework. Students who averaged at
least 2 hours on homework per night were nearly twice as likely to report frequent activity-related stress.
CONCLUSION: Parents of school-aged children should assess activity-related stress and the degree to which children perceivethey are busy. Teachers, school counselors, and school administrators should be aware of these perceptions as they are making
decisions regarding school schedules and should teach personal skills such as time management and stress control.
Keywords: children and adolescent health; perceived stress; overscheduling of activities.
Citation: Brown SL, Nobiling BD, Teufel J, Birch DA. Are kids too busy? Early adolescents perceptions of discretionary activities,
overscheduling, and stress. J Sch Health J Sch Health. 2011; 81: 574-580.
Received on February 12, 2010
Accepted on September 2, 2010
With increasing rates of childhood overweight,more attention has been given to the activitypatterns of children, especially after-school patterns.
Studies have shown that increases in television
viewing and homework among children since the
1970s are leading to more sedentary lifestyles.13
According to the Youth Risk Behavior Study in 2007,
more than a third of adolescents watched television for
3 or more hours on an typical school day,4 and about
one fourth played video games or used computers
for nonscholastic purposes 3 or more hours on an
average school day.
4
Television viewing of more than3 to 4 hours a day has been linked to lower school
performance.5
A recent study by the Youth Media Campaign
Longitudinal Survey (YMCLS) explored the potential
associations among limit-setting, physical activity, and
screen time among 9-13-year-olds.6 This study found
aAssociate Professor, ([email protected]), SouthernIllinois University, 475Clocktower Drive(Mailcode4632),Carbondale, IL 62901.bAssistant Professor, ([email protected]), Salisbury University, 1100Camden Ave,Salisbury, MD.
positive associations among age, male gender, black
race/ethnicity, low-income, and hours of screen time.
Conversely, the study found negative associations
among physical activity (both free-time and organized
activities), parental limits on screen time, and
likelihood to exceed 2 hours of screen time each
day.6 Associations found in this study raise questions
regarding the parental role in screen time restriction
and parental control over other daily activities.
Findings like these have prompted questions about
what childrens schedules are really like. In a culture
where parents are encouraged to value their childrensautonomy,7 are children allowed to be involved in too
many activities? Are parents encouraging too many
activities? And, in addition to calorie imbalances, are
children and adolescents experiencing other undesir-
able side effects? To date, there has been little research
on childrens perceptions of stress and busyness.
574 Journal of School Health September 2011, Vol. 81, No. 9 2011, American School Health Association
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Perhaps the most important study on childrens
time was conducted by Hofferth and Sandberg.7,8 It
investigated how children under the age of 13 spend
their time, and how variables such as parents level of
education, family size, and family dynamics affected
childrens school achievement. They categorized time
usage in 4 ways: (a) time spent in school settings;
(b) free play versus organized activities; (c) learning
activities outside the classroom; and (d) family activ-ities. Although television viewing time did not affect
scores of achievement tests of reading, writing, and
mathematics abilities, family time did.7 Children who
reported more family meal time were more proficient
identifying letters and reading words aloud, as well as
solving word problems. Family time also affected scores
of the behavioral index, which measures parental per-
ceptions of their childrens behavior problems. The
study also found that children with employed mothers
had less free time for both structured and unstructured
activities, primarily due to increased time in daycare
settings.7
Compared to teens in East Asia or Europe, American
teens spend more of their waking hours in discre-
tionary activities, 50% versus 25-35% in East Asia and
35-45% in Europe.5 Hofferth7 compared American
childrens lives in 1997 to those in 1981, concluding
that children have lost 12% of regular free time, 25%
of play activities, and 50% of unstructured activities.
Conversely, contemporary children spend 50% more
time involved with structured sports and homework.7
Research regarding the value of structured versus
unstructured activity is unclear. Some studies report
mostly positive outcomes from structured activities,
while others have shown associations with increasedstress and overscheduling conflicts. Similarly, while
a few studies suggest that unstructured (and unsuper-
vised) play can lead to delinquency, others argue that
depriving children of unorganized activities dampens
creativity and decisionmaking.9,10
Social scientists as early as Piaget believed that
unstructured play was an opportunity for vari-
ous forms of development, including social, lin-
guistic, cognitive, and emotional. Research suggests
that unstructured play is crucial in providing chil-
dren opportunities to acquire resiliency skills.11,12
Wenner13 gives 3 propositions to support the need
for free play in childhood: (1) Childhood play iscrucial for social, emotional, and cognitive develop-
ment. (2) Imaginative and rambunctious free play,
as opposed to games or structured activities, is the
most essential type. (3) Kids and animals that do not
play when they are young may grow into anxious,
cDoctoral Candidate, ([email protected]), SouthernIllinois University, 475Clocktower Drive(Mailcode4632), Carbondale, IL 62901.dProfessor, ([email protected]), Department of HealthEducationand Promotion,East Carolina University, 3106Carol BelkBuilding, Greenville, NC27858-4353.
Address correspondence to: Brandye D. Nobiling, Assistant Professor, ([email protected]), Salisbury University, 1100CamdenAve,Salisbury, MD.
socially maladjusted adults13 (p. 24). His last point
alludes to the work of psychiatrist Stuart Brown, who
interviewed approximately 6000 individuals regarding
their childhoods. Browns data suggest a clear asso-
ciation between the amount of free play as children
and adjustment and happiness as adults. Lawson5 sug-
gests that the best approach for development is likely a
combination of structured and unstructured activities
that can teach personal and social skills, develop goodhabits, and allow kids to play as an outlet to combat
daily stressors.
This study investigated early adolescents percep-
tions of the degree of busyness and stress in their
own lives. Eight research questions guided the study.
Although not specifically written to measure the per-
formance indicators related to the National Health
Education Standards, 3 items generally addressed 3
standards (NHES) for grades 3-5 and 6-8 (Table 1).14
METHODS
This study was conducted as part of KidsHealth Kids-
Poll. The project was a collaborative effort among a
university research team, the Nemours Foundation,
the National Association of Health Education Centers
(NAHEC), and participating NAHEC member, health
education centers.
Subjects
Following institutional review board approval, chil-
dren aged 9 to 13 years, who were students at schools
attending classes in 9 health education centers across
6 states, were recruited for the study. Prior to each
schools visit to the center, officials at the schoolwere contacted for permission to administer the sur-
vey to students during the visit to the center. If
the school agreed, passive parent permission for the
survey was obtained with each parents permission
for the student to visit the center. As a sample of
convenience, demographic data for the students in
the sample approximated National Center for Edu-
cation Statistics (NCES) statistics for the same age
group. Students in the group ranged in age from
9 to 13, with an average age of 10.3; 53% were
boys.
Other demographic data were collected at the school
level, rather than from each student. A total of 883students came from 21 schools. At the school level,
61% were White, 23% Black, 13% Hispanic, 2%
Asian or Pacific Islander, and 1% Native American.
The US Census Bureau Metropolitan Statistical Area
(MSA) was used to measure locale. Seventeen percent
of schools were in large city centers, 9% midsize city
Journal of School Health September 2011, Vol. 81, No. 9 2011, American School Health Association 575
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Table 1. Relationship Between Research Questions and National Health Education Standards15 (NHES)
NHESResearch Question
Item
Number
1 How many non-school-relatedactivities are children involvedin?
2 Who chooses childrensactivities?
3 Whatis theaverage amount ofdailyscreentime(ie, TV, videogames,
computer)childrenengagein?
4 Whatis the average time spent doing homeworkduring the school
week?5 Whatarechildrensperceptions of the amount of time dedicatedto
homeworkregularly?
Standard2.8.4:Analyze how theschool andcommunity canimpact
healthpractices andbehaviors
htlaehlanosrepstcapmitnemnorivnewohezylanA:3.8.1dradnatS?emiteerferomdahyehthsiwnerdlihcoD6
7 Dochildrenfeel stressed?
8 Whatwouldchildrenchoosetodowithmorefreetime? Standard5.8.7: Analyze the outcomes of a health-relateddecision
centers, 28% large city fringe, 5% midsize city fringe,
1% large towns, 18% small towns, and 9% rural.
Average school size was 501.
Instrumentation and Procedure
Instrument items were not on a scale; therefore,internal reliability was not applicable. To address
face validity of the survey, the research team along
with experts in the area of child development, school
health education, and stress in children constructed the
instrument. These experts represented both the edu-
cation and medical professions. In addition, the final
version of the instrument was reviewed by school
principals and teachers prior to administration. The
instrument was piloted with 1 class at 1 participating
center. The data collection method, using handheld
devices, had been used at all of the participating cen-
ters in previous KidsHealth KidsPoll studies. Before the
actual administration of the questionnaire, studentswere allowed to practice with the handheld devices.
The 10-item child-friendly questionnaire included
2 demographic items and 8 construct-related items.
Students answered each item using handheld data
collection devices. Items on the instrument addressed
each of the studys 8 research questions, including the
amount and type of activities in which participants are
involved. In this study, child participants were told the
word activity meant activities that are planned or
organized, such as sports, lessons, teams, clubs, groups,
scouts, or tutoring.
Data Analysis
Data collected with handheld response devices were
imported into the Statistical Program for the Social
Sciences (SPSS Inc, Chicago, IL). An alpha level
of .05 was established a priori. Descriptive statistics
such as proportions, central tendency, and variance
were calculated. Inferential statistics included Pearson
product correlation and multivariate logistic regression
for nominal data assessing odds ratios for outcomes
based on predictive variables.
RESULTS
Kids Busyness Levels
The vast majority (62%) of students claim that they
choose their own out-of-school activities, followed by
29% who say they use cooperative decisionmaking
with their parents. Only 9% said their parents chosemost of their activities. Older students were more likely
to claim autonomy over their activities.
Reports of screen time were bimodal; about half
reported 2 or fewer hours of screen time, while over
40% reported more than 3 hours. Boys were more
likely to report more than 3 hours. Older students were
also more likely to report 3 or more hours of screen
time. There were no gender differences among those
who chose the activities or the number of activities.
More than three fourths (82%) of participants
claimed to have an hour or less of homework per
night. Ten percent said they have about 2 hours, and
8% reported having 3 or more hours per night. Neither
gender, age, who chose activities, or number of activ-
ities was associated with time spent on homework.
Interestingly, most participants either said their
school gave the right amount (39%) or way too
much homework (36%). There were no differences by
gender, number of activities, or who chose activities.
About the same proportion of those who reported
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Table 2. Frequencies of Responses by Gender and Age for Items 1-4
Gender Age
Total (%) Boys (%) Girls (%) 9 (%) 10 (%) 11 (%) 12+ (%)
Activitiesbesides school:
None 14 14 15 11 15 13 25
One 25 26 23 34 24 21 19
Two 22 23 21 22 24 21 17
Three 15 13 17 9 13 18 15Four or more 24 24 24 24 24 27 24
Who chooses activities?
My parents/guardians 9 10 6 14 8 7 3
We both choose 29 28 31 33 29 27 28
I choose most activities 62 62 63 53 63 66 69
How manyhours of screen
timeon most schooldays?,
Less than 1 hour 20 15 23 21 23 21 9
1 hour 15 14 17 19 17 12 11
2 hours 16 14 19 16 16 18 15
3 hours 7 7 6 9 6 7 3
3 or more hours 42 50 35 35 38 42 62
Hours of homework on schooldays:
Less than 1 hour 59 59 58 64 56 61 53
1 hour 23 22 23 21 26 21 25
2 hours 10 11 10 7 11 11 12
3 or more hours 8 8 9 8 7 7 10
2 tests statistically significant for age (p < .05); N = 882.
2 tests statistically significant for gender (p < .05).
activity (32% vs. 19%), whereas girls were more apt to
select time with friends (52% vs. 39%). Older students
were also more likely to name time with friends (9 =
37%, 10 = 43%, 11 = 49%, 12+ = 58%) (Table 3).
To statistically control for intercorrelation among
variables, odds ratios were calculated using multivari-
ate logistic regression. The outcomes of interest wereactivity-based stress and desire for more free time.
When analyzed together, the primary predictor for
desire for more free time was hours of screen time.
Those who reported 3 or more hours of screen time
per day were nearly 3 times more likely to desire more
free time than those who reported 2 or fewer hours of
screen time.
When analyzed with the effect of the other vari-
ables, participants who said they cooperate with their
parents in choosing activities were less likely to be
frequently stressed about all they do than those
who either chose their own activities or whose parents
chose most of their activities. Further, having moreactivities, particularly 3 or more, doubled the likeli-
hood that children will say they are stressed by all they
do. Excessive screen time also doubled the likelihood of
frequent stress. The single greatest predictor of activity-
related stress was the reported number of hours spent
on homework. Students who said they average about
2 hours of homework per night were nearly twice as
likely to report frequent activity-related stress. Those
who said they do 3 or more hours per night were
almost 5 times as likely to report this stress (Table 4).
DISCUSSION
Results of average screen time reported in this study
are consistent with existing literature. Other studies
have found that children spend an average range
of 13-30 hours per week watching television.15,16
Participants most often recorded that if they had more
free time they would most likely choose to spend it
hanging out with friends. Since the term hanging
out is likely to involve unstructured activities, this
finding supports research indicating that children and
adolescents prefer free play.9,10,13 And although a few
research studies warn that excessive unstructured play
with peers may lead to delinquency,8 spending more
time with others can build interpersonal skills and
foster the development of social health.12
Studies have also linked levels of child busyness
to levels of parents busyness, implying that the
busier parents are, the busier their children tend to
be. Quist posits that if parents are the ones whoare too busy, perhaps the children are registered in
a myriad of organized activities because Mom and
Dad dont have the time in their schedule to spend
with them10 (p. 27). Clearly interventions including
parents are necessary to promote the importance
of spending quality and quantity time with their
children. Quantity time does not have to be structured;
deliberate activities, such as doing chores around the
house, going for a walk, or sitting outside together,
can offer many teaching moments. For quantity time to
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Table 3. Frequencies of Responses by Gender and Agefor Items 5-8
Gender Age
Total (%) Boys (%) Girls (%) 9 (%) 10 (%) 11 (%) 12+ (%)
Doyouthink schoolgives you:
Somewhat or way too little homework 11 11 10 11 9 15 8
About right amount of homework 39 36 44 40 43 43 24
Somewhat too much homework 14 13 15 10 13 13 24
Way too much homework 36 40 31 39 35 29 44
Which matchesyour feelings:
Wish had a little or a lot less free time 4 3 4 4 3 4 2
Feel have the right amount of free time 18 16 22 22 17 18 14
Wish had a little more free time 17 15 20 13 20 17 17
Wish had a lot more free time 61 66 54 61 60 61 67
Howoftendoyoufeel stressed?
Never 10 11 7 10 11 10 5
Once in a while 26 24 29 33 27 25 17
Some of the time 23 23 24 18 23 23 29
Most of the time 17 16 18 17 15 18 23
Always 24 26 22 22 24 24 26
What wouldyoudo withmoretime?,
Play sports/physical activity 26 32 19 29 28 23 24
Spend time with family 13 12 15 12 16 15 5
Read 6 5 6 11 4 4 4
Hang out/play with friends 45 39 52 37 43 49 58
None of these 10 12 8 11 9 9
2 tests statistically significant for age (p < .05); N = 882.
2 tests statistically significant for gender (p < .05).
occur, parents and children alike need to unschedule
themselves5 (p. 27).
Future studies should explore childrens perceptions
of their parents busyness. Recent polling data17,18
have shown that many parents (especially middle-
class parents) have become increasingly aware and
concerned about these trends, yet feel powerless to
make changes and stem the tide. A Search Institute
poll found that 41% of parents said their child
being overscheduled in so many activities made
parenting difficult19 (p. 9). School and community
officials can also add to the problem of overscheduled
children by promoting numerous extracurricular
activities to children without considering the possible
consequences these activities may have on the family
unit.
New initiatives, such as Family Time First and Fam-
ily Time IN, community action initiatives developed
by Doherty20 and colleagues with Eden Prairie and
Southeast Minnesota community members, respec-
tively, have been developed to teach families how toincrease and prioritize family time. These community-
organizing approaches, though relatively new, expect
to strengthen the family by trying to prevent family
overscheduling and hyperactivity.20
Family mealtime has also been receiving more focus
as a research topic. Controlling for variables such as
income, family structure, and social class, frequency of
family mealtime is positively associated with childhood
well-being.21,22 Unfortunately there has been a decline
in the proportion of married-couple households who
eat dinner together.23 One study showed a decrease
from 50% in 1977 to 34% in 1999.7 Family structure
and age of children also influence family mealtime. For
instance, families where mothers are employed16 and
families whose children are older23 spend less time eat-
ing as a family. Investigating how societal family time
trends are filtered through cultural influences may
also deserve further exploration. For example, Whitefamilies spend less time eating together than Black and
Hispanic families, who in turn eat together less than
Asian families.22 All of these researches suggest that
the decline in family mealtime due to busier sched-
ules of children and parents may have implications for
children and parents alike.
These societal changes also show up in other parent-
child time interactions. For instance, children in male
breadwinner-female homemaker families read more
than children in any other types of families. The
researchers concluded that the differences were largely
predicted by the amount of time the parent had
available.7
Interestingly, the study found no significantassociation between homework during the elemen-
tary grades and academic achievement, meaning the
amount of homework given by elementary school
teachers predicts nothing in terms of childrens aca-
demic achievement. However, there was a significant
association with the amount of time spent reading
outside the classroom. All these perhaps suggest that
educators and parents should work together to ensure
that more homework time is devoted to reading at
home.
578 Journal of School Health September 2011, Vol. 81, No. 9 2011, American School Health Association
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Table 4. OddsRatio (OR) (With 95% CI) for Wish for More Free
Time and Stressed Always or Most of the Time Because
ofTooMuch toDo
Wish for More
Free Time
Stressed Always or
Most of the TimeOR (CI) OR (CI)
Gender
Girls 1.0 1.0
Boys 1.3 (0.88-1.94) 1.1(0.77-1.54)
Age(years)
9 1.0 1.0
10 1.4 (0.82-2.30) 1.1 (0.72-1.79)
11 1.1 (0.68-1.91) 1.1 (0.70-1.80)
12+ 1.5(0.74-3.01) 1.2(0.66-2.08)
Who chooses activities?
Child 1.0 1.0
50/50 0.8 (0.53-1.27) 0.6 (0.40-0.90)
Parent 1.1 (0.52-2.36) 1.5 (0.78-2.78)
Number of activities
0 1.0 1.0
1 1.0 (0.50-2.03) 1.2 (0.59-2.28)
2 1.0 (0.51-2.12) 1.4 (0.73-2.82)
3 1.7 (0.77-3.90) 2.1
(1.01-4.23)4 or more 1.4 (0.68-2.90) 2.2 (1.13-4.29)
Hoursof homework
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for example, may allow students to analyze outcomes
of health-related decisions (NHES, 5.8.7).14
Human Subjects Approval Statement
This study was approved by the institutional review
board at Southern Illinois University Carbondale.
REFERENCES
1. Forum of Child and Family Statistics. Americas children: key
national indicators of well-being. 2009. Available at: http://
www.childstats.gov/americaschildren/tables.asp. Accessed May
19, 2009.
2. Lowry R, Weschler H, Galuska DA, Fulton JE, Kann L. Televi-
sion viewing and its associations with overweight, sedentary
lifestyle, and insufficient consumption of fruits and vegetables
among US high school students: differences by race, ethnicity,
and gender. J Sch Health. 2002;72(10):413-421.
3. Robinson TM. Does television cause childhood obesity?JAMA.
1998;279(12):959-960.
4. National Center for Chronic Disease Prevention and Health
Promotion, Division of Adolescent and School Health.
YRBSS: Youth risk behavior surveillance system. Avail-able at: http://www.cdc.gov/HealthyYouth/yrbs/index.htm.
Updated April 2, 2009. Accessed May 21, 2009.
5. Lawson RW. How U.S. children and adolescents spend
their time: what it does (and doesnt) tell us about their
development.Curr Dir Psychol Sci. 2001;10(5):160-164.
6. Carlson SA, Fulton JE, Lee SM, Foley JT, Heitzler C, Huh-
man M. Influence of limit-setting and participation in physical
activity on youth screen time. Pediatrics. 2010;126(1):89-96.
7. Hofferth SH, Sandberg JF. How American children spend their
time.J Marriage Fam. 2001;63(2):295-308.
8. Newman PR, Newman BM. Development Through Life: A Psy-
chosocial Approach.10th ed. Belmont, CA: Wadsworth Cengage
Learning; 2009.
9. Burdette HL, Whitaker RC. Resurrecting free play in young
children. Arch Pediatr Adolesc Med. 2005;159:46-50.
10. Quist D. Whos Playing Around Now? Overscheduled Parents Mean
Overscheduled Kids. IMFC Review. Canada: Institute of Marriage
and Family; 2007. Available at: http://www.imfcanada.org/
article_files/Whos_Playing_Around_Now.pdf. Accessed May
18, 2009.
11. McHale SM, Crouter AC, Tucker CJ. Free-time activities in
middle childhood: links with adjustment in early adolescence.
Child Dev.2001;72(6):1764-1778.
12. Ginsburg KR. The importance of play in promoting healthy
child development and maintaining strong parent-child bonds.
Pediatrics.2007;119(1):182-191.
13. Wenner M. The serious need for play. Sci Am Mind.
2009;20(1):22-29.
14. Centers for Disease Control and Prevention. National
Health Education Standards. Available at: http://www.cdc.gov/
HealthyYouth/SHER/standards/index.htm. Updated October
15, 2007. Accessed December 5, 2009.
15. Bianchi SM, Robinson J. What did you do today? Childrens
use of time, family composition, and the acquisition of social
capital.J Marriage Fam. 1997;59(2):332-344.
16. Medrich EA, Roizen J, Rubin V, Buckley S.The Serious Business
of Growing Up: A Study of Childrens Lives Outside School. Berkeley,
CA: University of California Press; 1982.
17. Anderssen E, McIlroy A. Quebec distinct in nursery too,
poll finds. The Globe and Mail. 2004. Available at:
www.theglobeandmail.com. Accessed May 19, 2009.
18. Center for the New American Dream. What do kids really
want that money cant buy? 2003. Available at: http://www.
newdream.org/publications/bookrelease.php. Accessed May
21, 2009.
19. Roehlkepartain EC, Scales PC, Roehlkepartain JL, Gallo C,
Rude SP. Building strong families: highlights from a pre-
liminary survey from YMCA of the USA and Search Insti-
tute on what parents need to succeed. 2002. Available at:http://www.abundantassets.org/pdfs/BSF-Highlights.pdf. Ac-
cessed May 21, 2009.
20. Anderson JR, Doherty WJ. Democratic community initiatives:
the case of overscheduled children. Fam Relat.2005;54:654-665.
21. Neumark-Sztainer D, Hannan PJ, Story M, Croll J, Perry C.
Family meal patterns: associations with sociodemographic
characteristics and improved dietary intake among adolescents.
J Am Diet Assoc. 2003;103(3):317-322.
22. Eisenberg ME, Neumark-Sztainer D, Feldman S. Does TV
viewing during family meals make a difference in adolescent
substance use?Prev Med. 2009;48(6):585-587.
23. Putnam R. Bowling Alone: The Collapse and Revival of American
Community.New York, NY: Simon & Schuster; 2000.
24. National Center for Education Statistics. State profiles: Illinois.
2006. Available at: http://nces.ed.gov/nationsreportcard/states/profile.asp. Accessed October 21, 2009.
25. Birch DA. Step by Step to Involving Parents in Health Education.
Santa Cruz, CA: ETR Associates; 1996.
26. Miller BM. The promise of after-school programs. Educ
Leadersh. 2001;58(7):6-12.
27. Posner JK, Lowe Vandell D. Low-income childrens after-
school care: are there beneficial effects of after-school
programs?Child Dev. 1999;65:440-456.
580 Journal of School Health September 2011, Vol. 81, No. 9 2011, American School Health Association