Associations of Television Viewing With Eating Behaviors in the 2009 Health Behaviour in School-aged Children Study

OBJECTIVE: To examine associations of television viewing with eating behaviors in a representative sample of US adolescents. DESIGN: Cross-sectional survey. SETTING: Public and private schools in the United States during the 2009-2010 school year. PARTICIPANTS: A total of 12,642 students in grades 5 to 10 (mean [SD] age, 13.4 [0.09] years; 86.5% participation). MAIN EXPOSURES: Television viewing (hours per day) and snacking while watching television (days per week). MAIN OUTCOME MEASURES: Eating (≥1 instance per day) fruit, vegetables, sweets, and sugary soft drinks; eating at a fast food restaurant (≥1 d/wk); and skipping breakfast (≥1 d/wk). RESULTS: Television viewing was inversely related to intake of fruit (adjusted odds ratio, 0.92; 95% CI, 0.88-0.96) and vegetables (0.95; 0.91-1.00) and positively related to intake of candy (1.18; 1.14-1.23) and fast food (1.14; 1.09-1.19) and skipping breakfast (1.06; 1.02-1.10) after adjustment for socioeconomic factors, computer use, and physical activity. Television snacking was related to increased intake of fruit (adjusted odds ratio, 1.06; 95% CI, 1.02-1.10), candy (1.20; 1.16-1.24), soda (1.15; 1.11-1.18), and fast food (1.09; 1.06-1.13), independent of television viewing. The relationships of television viewing with fruit and vegetable intake and with skipping breakfast were essentially unchanged after adjustment for television snacking; the relationships with intake of candy, soda, and fast food were moderately attenuated. Age and race/ethnicity modified relationships of television viewing with soda and fast food intake and with skipping breakfast. CONCLUSION: Television viewing was associated with a cluster of unhealthy eating behaviors in US adolescents after adjustment for socioeconomic and behavioral covariates.