Rationale and study protocol for 'Switch-off 4 Healthy Minds' (S4HM): a cluster randomized controlled trial to reduce recreational screen time in adolescents

Treatment effects of therapeutic interventions for gaming disorder: A systematic review and meta-analysis

The prevalence of gaming disorder is assumed to be between 2%-5%. The treatment effect of different therapeutic interventions of gaming disorder has not been studied extensively. This systematic review and meta-analysis sought to identify all intervention studies on gaming disorder with a control group, determine the effect of the interventions, and examine moderators. Studies applying a therapeutic intervention and using an appropriate comparison group were identified by searching electronic databases, previous reviews, and reference lists. Data on type of treatment, name of outcome measurement, symptom level and other study characteristics were extracted and analyzed using meta-analysis and meta-regression. A total of 38 studies and 76 effect sizes, originating from 9524 participants were included. RoB2 and ROBINS-I risk of bias tools were used to assess within-study risk of bias. Correlational hierarchical models with robust variance estimation were fitted to effect size data and yielded a moderate summary estimate. Egger's sandwich test, funnel plot inspections, and other tests were conducted to assess risk of bias between studies. Results indicate that there may be an overall effect of therapeutic interventions for gaming disorder, but confidence in these findings is compromised by small-study effects, possible publication bias, a limited study pool, and a lack of standardization. The field needs more higher quality studies before the evidence-base can support reliable meta-analytic estimates.

Policy Recommendations for Preventing Problematic Internet Use in Schools: A Qualitative Study of Parental Perspectives

Parenting in the digital age has been characterized as one of the most challenging tasks of the modern era. Parents are ambivalent about their mediating role. However, problematic aspects of adolescent online use have not been adequately addressed in education. The present study investigated parental perceptions of intervention needs within schools to prevent excessive/problematic use, enhance parent-child communication, and reduce family conflicts. Nine interviews with parents of adolescents residing in the UK were carried out and analyzed utilizing thematic analysis. Three main themes emerged as parental proposals: (i) schools as digital education providers and prevention hubs, (ii) provision of mental health literacy to raise awareness, resolve ambiguity regarding impacts and mitigate excessive use and impacts, and (iii) psychoeducation and upskilling. The third theme related to impacts from time spent on screens (time displacement), content-related impacts, and context-related impacts. The present study offers recommendations for media literacy during adolescence beyond e-safety (i.e., addressing interpersonal communication problems, privacy vs. disclosure issues), based on parents' views, and provides new insights for media and emotional health literacy collaboration efforts. Future work should investigate the feasibility and effectiveness of such interventions to support the emotional health of young people and prevent problematic internet use escalation.

The Role of Recreational Online Activities in School-Based Screen Time Sedentary Behaviour Interventions for Adolescents: A Systematic and Critical Literature Review

Sedentary behaviours are highly associated with obesity and other important health outcomes in adolescence. This paper reviews screen time and its role within school-based behavioural interventions targeting adolescents between the years 2007 and 2019. A systematic literature review following PRISMA guidelines was conducted across five major databases to identify interventions targeting screen time—in addition to TV/DVD viewing. The review identified a total of 30 papers analysing 15 studies across 16 countries aiming at addressing reduction of recreational screen time (internet use and gaming) in addition to television/DVD viewing. All of the interventions focused exclusively on behaviour change, targeting in the majority both reduction of sedentary behaviours along with strategies to increase physical activity levels. A mix of intervention effects were found in the reviewed studies. Findings suggest aiming only for reduction in time spent on screen-based behaviour within interventions could be a limited strategy in ameliorating excessive screen use, if not targeted, in parallel, with strategies to address other developmental, contextual and motivational factors that are key components in driving the occurrence and maintenance of adolescent online behaviours. Additionally, it raises the need for a differential treatment and assessment of each online activity within the interventions due to the heterogeneity of the construct of screen time. Recommendations for enhancing the effectiveness of school-based sedentary behaviour interventions and implications for public policy are discussed.

Screen Time and Health Indicators Among Children and Youth: Current Evidence, Limitations and Future Directions

Despite accumulating evidence linking screen-based sedentary behaviours (i.e. screen time) with poorer health outcomes among children and youth <18 years of age, the prevalence of these behaviours continues to increase, with roughly half of children and youth exceeding the public health screen time recommendation of 2 h per day or less. The purpose of this article is to provide an overview of key research initiatives aimed at understanding the associations between screen time and health indicators including physical health, quality of life and psychosocial health. Available evidence suggests that screen time is deleteriously associated with numerous health indicators in child and youth populations, including adiposity, aerobic fitness, quality of life, self-esteem, pro-social behaviour, academic achievement, depression and anxiety. However, few longitudinal or intervention studies have been conducted, with most of these studies focusing on physical health indicators. While most studies have used self-reported assessments of screen time, the availability of more objective assessment methods presents important opportunities (e.g. more accurate and precise assessment of sedentary time and screen time) and challenges (e.g. privacy and participant burden). Novel statistical approaches such as isotemporal substitution modelling and compositional analysis, as well as studies using longitudinal and experimental methodologies, are needed to better understand the health impact of excessive screen time, and to develop strategies to minimise or reverse the negative impacts of these behaviours. The evidence to date suggests a clear need for policy aimed at minimising the hazardous health consequences associated with screen time among children and youth.

Socio-Demographic, Social-Cognitive, Health-Related and Physical Environmental Variables Associated with Context-Specific Sitting Time in Belgian Adolescents: A One-Year Follow-Up Study

INTRODUCTION

More knowledge is warranted about multilevel ecological variables associated with context-specific sitting time among adolescents. The present study explored cross-sectional and longitudinal associations of ecological domains of sedentary behaviour, including socio-demographic, social-cognitive, health-related and physical-environmental variables with sitting during TV viewing, computer use, electronic gaming and motorized transport among adolescents.

METHODS

For this longitudinal study, a sample of Belgian adolescents completed questionnaires at school on context-specific sitting time and associated ecological variables. At baseline, complete data were gathered from 513 adolescents (15.0±1.7 years). At one-year follow-up, complete data of 340 participants were available (retention rate: 66.3%). Multilevel linear regression analyses were conducted to explore cross-sectional correlates (baseline variables) and longitudinal predictors (change scores variables) of context-specific sitting time.

RESULTS

Social-cognitive correlates/predictors were most frequently associated with context-specific sitting time. Longitudinal analyses revealed that increases over time in considering it pleasant to watch TV (p < .001), in perceiving TV watching as a way to relax (p < .05), in TV time of parents/care givers (p < .01) and in TV time of siblings (p < .001) were associated with more sitting during TV viewing at follow-up. Increases over time in considering it pleasant to use a computer in leisure time (p < .01) and in the computer time of siblings (p < .001) were associated with more sitting during computer use at follow-up. None of the changes in potential predictors were significantly related to changes in sitting during motorized transport or during electronic gaming.

CONCLUSIONS

Future intervention studies aiming to decrease TV viewing and computer use should acknowledge the importance of the behaviour of siblings and the pleasure adolescents experience during these screen-related behaviours. In addition, more time parents or care givers spent sitting may lead to more sitting during TV viewing of the adolescents, so that a family-based approach may be preferable for interventions. Experimental study designs are warranted to confirm the present findings.

Intervention to reduce recreational screen-time in adolescents: Outcomes and mediators from the 'Switch-Off 4 Healthy Minds' (S4HM) cluster randomized controlled trial

INTRODUCTION

The primary objective was to evaluate the impact of the 'Switch-off 4 Healthy Minds' (S4HM) intervention on recreational screen-time in adolescents.

METHODS

Cluster randomized controlled trial with study measures at baseline and 6-months (post-intervention). Eligible participants reported exceeding recreational screen-time recommendations (i.e., >2h/day). In total, 322 adolescents (mean age=14.4±0.6years) from eight secondary schools in New South Wales, Australia were recruited. The S4HM intervention was guided by Self-Determination Theory and included: an interactive seminar, eHealth messaging, a behavioral contract and parental newsletters. The primary outcome was recreational screen-time. Secondary outcomes included mental health (i.e., well-being, psychological distress, self-perceptions), objectively measured physical activity, and body mass index (BMI). Outcome analyses were conducted using linear mixed models and mediation was examined using a product-of-coefficients test.

RESULTS

At post-intervention, significant reductions in screen-time were observed in both groups, with a greater reduction observed in the intervention group (-50min/day versus -29min, p<0.05 for both). However, the adjusted difference in change between groups was not statistically significant (mean=-21.3min/day, p=0.255). There were no significant intervention effects for mental health outcomes, physical activity or BMI. Significant mediation effects for autonomous motivation were found.

CONCLUSIONS

Participants in both the S4HM intervention and control groups significantly reduced their screen-time, with no group-by-time effects. Enhancing autonomous motivation might be a useful intervention target for trials aimed at reducing adolescents' recreational screen-time.

TRIAL REGISTRATION

ACTRN12614000163606.