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METHODS: Data from the National Longitudinal Survey of Youth, 1990 to 1998, were used to analyze reported television viewing at 0 to 35 months of age and to follow the trajectory of a child's viewing from infancy through age 6. Logistic regression models were used to determine risk factors associated with greater television viewing at 0 to 35 months and the association of early viewing habits with school-age viewing.

RESULTS: Seventeen percent of 0- to 11-month-olds, 48% of 12- to 23-month-olds, and 41% of 24- to 35-month-olds were reported to watch more television than the AAP recommends. Compared with college graduates, less-educated women were more likely to report that their children watched more television than recommended. Children who watched >2 hours per day at age 2 were more likely to watch >2 hours per day at age 6 (odds ratio: 2.7; 95% confidence interval: 1.8-3.9), controlling for maternal education, race, marital status and employment, household income, and birth order.

CONCLUSIONS: A substantial number of children begin watching television at an earlier age and in greater amounts than the AAP recommends. Furthermore, these early viewing patterns persist into childhood. Preventive intervention research on television viewing should consider targeting infants and toddlers and their families.

EDITOR--Reardon and Cougle's paper raises at least three concerns.(1)

Firstly, their analyses do not address the stated hypothesis. No results indicate whether "prior psychological state is equally predictive of subsequent depression among women . . . regardless of whether they abort or carry to term." Nevertheless, their unstated hypothesis, focused on abortion and depressive symptoms, may be the more central question.

Secondly, the final sample of women is surprisingly small. Only 421 of the initial 4463 women reported a first abortion or first unintended delivery between 1980 and 1992. Is it possible that the question in 1992 asking pregnancy intention actually referred to a much narrower time frame (that is, a delivery between the biannual surveys)? Little information is given about the abortion question; it is possible that the index unintended pregnancy defined in 1992 resulted in neither the first abortion nor the first delivery.

Thirdly, the discussion omits mention of possible residual confounding. The national longitudinal survey of youth (NLSY) uses a four item abbreviated version (NLSY Cronbach 0.35) of Rotter's original 60 item locus of control scale, which itself is probably an inadequate proxy for prior psychological state. Furthermore, a one year measure of income may be only a modest proxy for a person's lifetime socioeconomic position. (2,3) The robustness of the authors' findings could be examined with other available measures. For example, the 1980 Rosenberg self esteem scale data (NLSY Cronbach 0.83) and the full 12 years of annual income and family size data would be stronger, though still less than optimal, tests of the hypotheses.

This criticism is not an attempt to dismiss research on the topic; rather, such important and highly content ious questions require published studies with equal degrees of rigour and transparency.

(1) Reardon DC, Cougle JR. Depression and unintended pregnancy in the national longitudinal survey of youth: a cohort study. BMJ 2002; 324: 151-152.

(2) Wolfe B, Haveman R, Ginther D, An CB. The "window problem" in studies of children's attainments: a methodological exploration. J Am Stat Assoc 1996; 91: 970-982[ISI].

(3) Smith GD, Hart C, Blane D, Gillis C, Hawthorne V. Lifetime socioeconomic position and mortality: prospective observational study. BMJ 1997; 314: 547-552.

DESIGN/METHODS: We conducted an analysis involving 3285 five to 14 year old children in the 1996 NLSY survey, a nationally representative sample of mothers and their children. Children were defined as being school mobile if they were age 5-9 and attended 2 or more elementary schools or if they were age 9.1-14 and had attended 3 or more schools. Outcomes were the total standard score of the BPI, as well as the externalizing and the internalizing subscales (mean 100, S.D. 15). Bivariate analyses examined the relationship between various demographic, environmental, and clinical variables known to be associated with the 3 BPI measures and school mobility. Multivariable analyses identified those factors independently associated with behavioral problems. Multiple regresion was used for statistical analysis.

RESULTS: 14% of children were school mobile. Mean BPI scores for children that were school mobile were 108.2, 107.8, and 105.5 for the total, externalizing, and internalizing scales respectively, versus 103.7, 103.4, and 102.2 for non-mobile children. School mobile children were more likely to have a non-married mother, a mother with lower levels of involvement at school, and a mother with increased depressive symptoms as measured by the CESD. Maternal percpeption of school quality was lower for school mobile children than school non-mobile children. In multivariable analyses adjusting for demographic, environmental, and clinical variables, school mobility was independently associated with behavioral health problems for the total scale and the externalizing subscale (p<0.01), but not for the internalizing subscale.

CONCLUSIONS: School mobility is independently associated with total and externalizing behavioral problems in children ages 5 to 14. While the cross-sectional nature of the data limits conclusions about causality, policies or programs enacted to reduce school mobility may have a positive impact on behavioral health problems of children. Further research to elucidate this relationship is warranted.

Objective: To examine the relationship between mothers' depressive symptoms and medically attended injuries in their children and the potential mediating role of child behavior.

Design/Methods: A cohort of mother–child dyads from the National Longitudinal Study of Youth followed from 1992 to1994. The primary exposure variable was maternal depressive symptoms as measured by the Center for Epidemiologic Studies Depression Scale in 1992. Child behavior was assessed by the Behavior Problems Index externalizing subscale. Logistic regression was used to examine the relationship between depressive symptoms, child behavior, and injury reported in the prior year in 1994.

Results: 94 medically attended injuries were reported in the 1106 children (8.5%); two-thirds were sustained in the home environment. Maternal depressive symptoms significantly increased the risk of child injury; injury risk increased 4% for every 1-point increase in depressive symptoms (adjusted OR 1.04, 95% CI 1.01 to 1.08, p = 0.02). Increasing maternal depressive symptoms also increased the risk of externalizing behavior problems (adjusted OR 1.06, 95% CI 1.03 to 1.09), but externalizing behavior problems did not significantly mediate the relationship between maternal symptoms and child injury.

Conclusions: Increasing depressive symptoms in mothers was associated with an increased risk of child injury. Child behavior did not significantly mediate the association between maternal depressive symptoms and child injury in this cohort. Greater recognition, referral, and treatment of depressive symptoms in mothers may have effects on child behavior and injury risk.