Systematic review of effective strategies for reducing screen time among young children

Association between Screen Time and Sociodemographic Factors, Physical Activity, and BMI among Children in Six European Countries (Feel4Diabetes): A Cross-Sectional Study

Screen time among children in most European countries is notably high and is influenced by various sociodemographic and other factors. Our study aimed to explore the associations between parents' sociodemographic characteristics, socioeconomic status, body mass index (BMI), physical activity, risk status for type 2 diabetes, and their children's BMI, physical activity, and screen time. The data were sourced from the 2016 Feel4Diabetes study, involving 12,280 parents and 12,211 children aged 6-9 years (average age 8.21 years) in a cross-sectional study design. We used a logistic regression model to identify potential factors associated with children's screen time. The results showed that mothers with tertiary education (OR = 0.64; 95%CI = 0.49-0.82; p < 0.001), the middle age group (45-54 years) (OR = 0.81 95%CI = 0.66-0.98; p = 0.033), and families with higher incomes (middle-OR = 0.85; 95%CI = 0.75-0.97; p = 0.014; high-OR = 0.8; 95%CI = 0.69-0.93; p = 0.003) were associated with a decreased chance of children spending more than 2 h/day in front of the screen. In contrast, maternal overweight/obesity (OR = 1.15; 95%CI = 1.03-1.29; p = 0.013) and lower physical activity in children were linked to an increased likelihood of more than 2 h of screen time per day. Our findings suggest that targeted interventions should be developed to mitigate excessive screen time, particularly focusing on low-income families and mothers with low educational levels.

Study protocol for the Screen-Free Time with Friends Feasibility Trial

BACKGROUND

Children are spending less leisure time with their friends in person and an increasing amount of time with digital screens. These changes may negatively affect children's physical and mental health. The Screen-Free Time with Friends Feasibility Trial will test the feasibility, including acceptability and compliance, of an intervention designed to reduce screen media usage and encourage physical interaction with friends during leisure time in 9-11-year-old children.

METHODS

A non-randomized single-group feasibility trial will be conducted from March to October 2023 including approximately 75 children (aged 9-11 years) and 75 parents (at least 1 per child) from 3 different schools recruited from 3 different municipalities in Denmark. The Screen-Free Time with Friends intervention is a multicomponent intervention targeting families, afterschool clubs, and local communities. It has been developed using a systematic process guided by the Medical Research Council UK's framework for developing and evaluating complex interventions. With a systems perspective in mind, the intervention and implementation approach has been designed to facilitate adaptation to the specific needs of diverse local communities while maintaining the core components of the intervention. Feasibility and acceptability of the intervention will be assessed during the intervention using process evaluation inspired by the RE-AIM framework including questionnaires and interviews with the municipality project managers, research team members, local ambassadors and stakeholders, parents and school, and afterschool club personnel. In addition, participation, recruitment, retention rate, and compliance to the outcome measurements will be investigated and presented.

DISCUSSION

The trial will investigate the feasibility and acceptability of the Screen-Free Time with Friends intervention, the recruitment strategy, and the planned outcome measurements. This feasibility study will investigate necessary refinements before the implementation of the intervention program in a larger cluster randomized controlled trial to evaluate its impact.

TRIAL REGISTRATION

CLINICALTRIALS

gov, ID: NCT05480085. Registered 29 July 2022. https://clinicaltrials.gov/ct2/show/NCT05480085?cond=Screen+free+time+with+friends&draw=2&rank=1.

Managing Screen Use in the Under-Fives: Recommendations for Parenting Intervention Development

The impact of excessive screen use on children's health and development is a public health concern and many countries have published recommendations to limit and guide the use of screen media in childhood. Despite this, international studies report that the majority of parents and children do not adhere to screen use recommendations. Existing research aiming to understand children' screen use has largely focused on older children, and on demographic and structural aspects of the child's environment. Parents play a central role in determining young children's screen use and identify numerous barriers to developing healthy screen use practices with their children. However, no clear models exist that incorporate key parenting factors in understanding children's screen use, which presents an impediment to intervention development. Likewise, while some evidence exists for interventions to improve children's screen use behaviours, most are focused on older children and parental involvement has generally been limited. In this paper, we overview key factors associated with screen use in young children (< 5 years) and summarise the existing evidence base for interventions designed to support healthy screen use. This paper proposes a conceptual model linking aspects of parenting and the socio-ecological environment to young children's screen use. Our proposed model could be used to design longitudinal studies of screen use predictors and outcomes, and inform intervention development. Finally, the paper provides key recommendations for future research, intervention development and testing.

Association between Children's Difficulties, Parent-Child Sleep, Parental Control, and Children's Screen Time: A Cross-Sectional Study in Japan

Children's screen time may affect their growth and development. However, differences in the impact of various psychiatric and psychological factors on children's screen time is a research gap. This study aimed to explore the differences in the influence of related factors affecting children's screen time based on their sleep, difficulties, and parental control among Japanese elementary and junior high school students. A cross-sectional survey was conducted among parents in Japan. Data on screen time duration, parent-child background, strengths and difficulties, sleep variables, and parental control types were collected from 225 households. A regression analysis revealed that high Strengths and Difficulties Questionnaire (SDQ) scores (β = 0.166, p = 0.008), sleep duration (β = -0.281, p < 0.001), and parental control (β = -0.204, p = 0.001) were significantly related to children's screen time. Additionally, it was found that parents' late bedtimes affect children's screen time by mediating children's sleep duration. This study, together with previous research, provides comprehensive insights into design interventions to decrease the screen time of children in the Japanese context.

Decreasing Sedentary Behaviors in Youth to Prevent and Manage Childhood Obesity: Is It Realistic?

PURPOSE OF REVIEW

Decreasing sedentary behaviors has been proposed as one approach to reduce the rate of obesity in youth. This review summarizes the contemporary literature examining the efficacy of these interventions in the school and community along with an additional focus on the role of socioeconomic status in these interventions.

RECENT FINDINGS

Studies that focus on decreasing sedentary behavior have utilized a wide variety of strategies in a number of settings. The effects of these interventions are often hindered by non-standard outcome measures, study infidelity, and subjective measures of sedentary time. However, interventions that incorporate engaged stakeholders and include younger subjects appear to be the most likely to succeed. Promising interventions to decrease sedentary behaviors have been shown in recent clinical trials; however, replicating and sustaining these results is challenging. From the available literature, school-based interventions have the potential of reaching the largest group of children. In contrast, interventions in younger children, particularly those with invested parents, seem to be the most effective.

A Scoping Review of Digital Well-Being in Early Childhood: Definitions, Measurements, Contributors, and Interventions

Digital well-being concerns the balanced and healthy use of digital technology, and the existing studies in this area have focused on adolescents and adults. However, young children are more vulnerable to digital overuse and addiction than adults; thus, their digital well-being deserves empirical exploration. In this scoping review, we synthesized and evaluated 35 collected studies on young children's digital use and their associated well-being that were published up to October of 2022 to understand the related definitions, measurements, contributors, and interventions. The synthesis of the evidence revealed that (1) there was no consensus about the definition of the concept of digital well-being; (2) there were no effective ways of measuring young children's digital well-being; (3) both child factors (the duration and place of digital use, as well as the child's demographic characteristics) and parent factors (digital use, parental perception, and mediation) contribute to young children's well-being; and (4) there were some effective applications and digital interventions reported in the reviewed studies. This review contributes to the development of this concept by mapping the existing research on young children's digital well-being, as well as proposing a model and identifying the research gaps for future studies.

School-Based Family-Oriented Health Interventions to Promote Physical Activity in Children and Adolescents: A Systematic Review

OBJECTIVE

This study aimed to systematically review and analyse intervention programs in a school context centred on the family, focused on increasing youths' physical activity.

DATA SOURCE

The research was carried out in the PubMed, Scopus and Web of Science databases.

STUDY INCLUSION CRITERIA

Studies were included if participants were children or adolescents, focusing on school-based intervention studies with parental involvement and physical activity, sedentary behaviour or physical fitness outcomes.

DATA EXTRACTION

The search was performed according to the PRISMA protocol. A total of 416 articles were identified. After being considered for eligibility and duplicates, 22 studies were identified as relevant for inclusion.

DATA SYNTHESIS

Sample and intervention characteristics, objective, the role of the family, outcomes measures, main findings regarding the outcomes and risk of bias.

RESULTS

Ten studies reported improvements in physical activity, 6 in sedentary behaviour and 9 in the components of physical fitness and/or skills related to healthy behaviours and lifestyles. Most of the interventions adopted a multidisciplinary and multi-component approach.

CONCLUSIONS

Most interventions employed a school's multidisciplinary/multi-component approach to promoting physical activity, nutrition, and general education for healthier lifestyle behaviours. The impact of school-based interventions involving families on youth's physical activity levels is still a relatively emerging theme. Further research is needed given the diversity of the intervention's characteristics and the disparity in the results' efficacy.

The degree of association between overweight and obesity with the use of electronic media among Bangladeshi adolescents

BACKGROUND

Electronic media usage is recently considered a modifiable risk factor for overweight and obesity among adolescents. The purpose of this present study was to evaluate the association of electronic media (EM) usage with overweight and obesity among school-going adolescents.

METHODS

This cross-sectional study was conducted from October to December 2019 among school-going adolescents (14-16 years old) residing in the Jashore Sadar Upazila, Jashore district of Bangladesh. A standardized questionnaire was used to collect information regarding the socio-economic status, time spent watching television, video games playing, computer, and smart mobile phone use through face-to-face interviews. Age- and sex-specific body mass index (BMI) cut-off values for overweight and obesity were determined for Asian adolescents by the International Obesity Task Force (IOTF). Multinomial logistic regression analysis was carried out to determine the association between electronic media use with overweight and obesity.

FINDINGS

The findings suggest that the overall prevalence of overweight and obesity was 13.5% and 25.2%, respectively. Among the total adolescent students, about 49.1% highly (above 3 hours per day) spent their time on EM use whereas 30.6% moderately (≥121 to 180 min/day) use EM. The regression analysis showed that spending high time using total screen-based electronic devices, television viewing, video game playing, computer use, and smartphone use were significantly associated with overweight (RRR: 7.36, 95% CI: 3.64-11.54; RRR: 4.58, 95% CI: 1.46-7.95; RRR: 4.45, 95% CI: 2.75-6.12; RRR: 3.18, 95% CI: 1.87-4.70; RRR: 2.15, 95% CI: 1.23-3.51) and obesity (RRR: 8.72, 95% CI: 4.64-12.54; RRR: 2.89, 95% CI: 1.31-5.21; RRR: 3.88, 95% CI: 1.74-5.13; RRR: 3.08, 95% CI: 1.32-4.86; RRR: 1.19, 95% CI: 0.93-1.48) in adolescents, respectively.

CONCLUSION

The results support the total time spent using electronic media was associated with an increased risk of being overweight and obesity. Finally, this study strongly suggests the proper use of electronic media may be necessary to reduce the risk of being overweight and obesity in early adolescents.

Clinical Practices and Experiences about Screen Time: From the Perspective of Child and Adolescent Psychiatrists in Turkey - An Online Survey

Background

Both mental and physical preventable health problems related to screen time (ST) in children and adolescents are increasing. It is important that psychiatrists have awareness to prevent problems in this area.

Objective

The aim of our study was to evaluate the child psychiatrists' awareness about ST, their interventions for ST, and to what extent the recommendations of the associations are implemented.

Method

All child and adolescent psychiatrists in the country who could be reached via smartphone were invited to participate in the study. Child and adolescent psychiatrists were included regardless of whether they had attended any ST courses/panels. Data were collected through an online questionnaire. A total of 302 physicians volunteered for the study.

Results

It was determined that very few child and adolescent psychiatrists had attended an ST course/training in the past or followed any guidelines. A statistically significant difference was found between physicians who received training/courses and those who did not in terms of informing patients and offering interventions (p<0.05). Similarly, a significant difference was found between those who followed the guidelines and those who did not.

Conclusion

Raising awareness, increasing psychiatrist participation in trainings, and following guidelines can increase the effectiveness of ST interventions, in order to achieve good results.

The Effect of Parent Training Programmes on Screen Time and Social Function in Children with Autism Spectrum Disorder

Background

Children with autism spectrum disorder (ASD) are susceptible to excessive electronic screen media (ESM) use. This study aimed to evaluate the effectiveness of a parent training programme in improving the screen time and social functioning of children with ASD.

Methods

This pre-/post-test quasi-experimental study involved parents by providing them with structured education based on the American Academy of Pediatrics (AAP)' screen time recommendations. In total, 259 children with ASD aged 3 years old-12 years old were eligible. Of those children, 26 were excluded due to comorbidities or taking medications. Additionally, 28 parents participated. Children's screen time were recorded, and social behaviour was scored using the Social Responsiveness Scale pre- and post-intervention.

Results

There were significant reductions in the average daily screen time of children with ASD after their parents attended the training programme (-51.25 min; 95% CI: -78.40, -24.10). In subgroups with reduced screen time, the treatment effect of the intervention was significant in improving the social responsiveness total score (-3.09; 95% CI: -5.96, -0.22), the social communication scale (-3.64; 95% CI: -5.91, -1.36) and the restricted interest and repetitive behaviour (RRB) scale (-5.27; 95% CI: -10.29, -0.25).

Conclusion

Parental training is effective in reducing screen time and improving social functioning in children with ASD.

Parent-based interventions to improve multiple lifestyle risk behaviors among adolescents: A systematic review and meta-analysis

Lifestyle risk behaviors often co-occur and are prevalent among adolescents. Parent-based interventions addressing risk behaviors concurrently have the potential to improve youth and parent outcomes. This systematic review evaluated the efficacy of parent-based interventions targeting multiple lifestyle risk behaviors among adolescents and parents. MEDLINE (Ovid), Embase (Ovid), PsycInfo (Ovid), Scopus, CINAHL, the Cochrane Database of Systematic Reviews (CDSR) and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 2010-May 2021. Eligible studies were randomised controlled trials (RCTs) of parent-based interventions addressing 2+ risk behaviors: alcohol use, smoking, poor diet, physical inactivity, sedentary behaviors, and poor sleep. Studies directly targeting parents, and that assessed adolescent outcomes (11-18 years) were eligible. Where possible, random-effects meta-analysis was conducted. From 11,975 identified records, 46 publications of 36 RCTs (n = 28,322 youth, n = 7385 parents) were eligible. Parent-based interventions were associated with improved adolescent moderate-to-vigorous physical activity (MVPA) [Odds Ratio (OR) = 1.82, 95% CI = 1.18, 2.81; p = 0.007], and reduced screen time (SMD = -0.39, 95% CI = -0.62, -0.16, p = 0.0009) and discretionary food intake (SMD = -0.18; 95% CI = -0.30, -0.06; p = 0.002) compared to controls. However, there was some evidence that interventions increased the odds of ever using tobacco in the medium-term (OR = 1.47, 95% CI = 0.99, 2.18, p = 0.06) and of past month tobacco use in the long-term (OR = 1.46, 95% CI = 1.12, 1.90; p = 0.005). Overall, the quality of evidence was moderate. Parent-based interventions targeting multiple risk behaviors improved adolescent MVPA, and reduced screen time discretionary food intake. Further research is needed to address sleep problems and increase intervention efficacy, particularly for alcohol and tobacco use.

Consensus statement on Singapore integrated 24-hour activity guide for children and adolescents

INTRODUCTION

Lifestyle activities, such as regular physical activity, are important for good metabolic health and the prevention of non-communicable diseases. Epidemiological studies highlight an increase in the proportion of overweight children in Singapore. A workgroup was formed to develop recommendations to encourage children and adolescents (aged 7-17 years) to adopt a holistic approach towards integrating beneficial activities within a daily 24-hour period for good metabolic and general health.

METHODS

The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision framework was employed to formulate the public health question, assess the evidence and draw conclusions for the guide. The evidence for international 24-hour movement guidelines, and guidelines for physical activity, sedentary behaviour, and sleep and eating habits were reviewed. An update of the literature review from August 2018 to end of September 2020 was conducted through an electronic search of Medline and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases.

RESULTS

Ten consensus statements were developed. The statements focused on the overall aim of achieving good metabolic health through integration of these activities and initiatives: light and moderate- to vigorous-intensity physical activity on a regular basis; muscle- and bone-strengthening activities; limiting sedentary behaviour; regular and adequate sleep; good eating habits and choosing nutritionally balanced foods and drinks; practise safety in exercise; and aiming to achieve more or all aforementioned recommendations for the best results.

CONCLUSION

This set of recommendations provides guidance to encourage Singapore children and adolescents to adopt health-beneficial activities within a 24-hour period.

Effect of screen time intervention on obesity among children and adolescent: A meta-analysis of randomized controlled studies

Several studies have investigated the effect of screen time interventions on obesity in children and adolescents, but the existing results were controversial. This study aimed to analyze the effect of screen time intervention on obesity in children and adolescents. PubMed, Cochrane, Web of Science, Embase databases were searched through December 2020 to identify publications meeting a priori inclusion criteria and references in the published articles were also reviewed. Finally, 14 randomized controlled trials and 1894 subjects were included in this meta-analysis. The results showed that interventions targeting screen time are effective in reducing total screen time (MD: -6.90 h/week, 95% CI: [-9.19 to -4.60], p < 0.001) and television time (MD: -6.17 h/week, 95% CI: [-10.70 to -1.65], p < 0.001) in children and adolescents. However, there was no significant difference between the intervention and control groups in body mass index and body mass index-z score. In conclusion, there is no evidence that screen time interventions alone can decrease obesity risk in children and adolescents, though they can effectively reduce screen time.

Relationships between screen viewing and sleep quality for infants and toddlers in China: A cross-sectional study

AIM

Currently young children have more opportunity to access all kinds of media, while their sleep duration has been steadily decreasing. However, little is known about the relationships between screen viewing and sleep quality, and the reasons of screen viewing for children under three years old in China. This study aimed to describe the relationships between screen viewing and sleep quality of infants and toddlers in mainland China.

METHODS

A cross-sectional study was conducted. Eight hundred twenty-seven children were recruited at a health care unit from a university affiliated hospital in China, and the questionnaires were completed by their parents. An extended Brief Infant Sleep Questionnaire and a Screen Viewing Questionnaire were used to collect information on children's sleep quality and screen viewing. Multivariate linear regression models were used to assess the relationships between screen viewing and sleep quality among infants and toddlers, adjusted for sociodemographic variables.

RESULTS

Of the 827 children, 26.9% of the infants and 61.4% of the toddlers did not comply with the World Health Organization (WHO) guideline on screen time. Even after adjusting for the sociodemographic covariates for both infants and toddlers, negative relationships between screen time and total sleep time (P < 0.001), and screen time and nighttime sleep (P < 0.001) existed. TV viewing time was negatively related to infants' total sleep time (β = -0.15, P < 0.001) and toddlers' nighttime sleep (β = -0.1, P < 0.05). Smartphone viewing time was negatively related to toddlers' total sleep time (β = -0.12, P < 0.05) and daytime sleep (β = -0.22, P < 0.05). Parents who offered screen media for children when they needed to do house chores were more likely to report that their children had less total sleep time (β = -0.1, P < 0.05) and shorter longest sleep episode (β = -0.1, P < 0.05).

CONCLUSION

The majority of toddlers did not meet the WHO guidelines on screen time in China. Screen time was negatively related to total sleep time and nighttime sleep among infants and toddlers. Practical strategies, such as education programs on children's screen viewing, more outdoor exercises and indoor parent-child activities, providing other educational materials instead of screening, early sleep, restricted use of TVs and smartphones, and screen co-viewing, are needed to improve young children's sleep quality and promote their development.

Media Awareness and Screen Time Reduction in Children, Youth or Families: A Systematic Literature Review

Excessive use of screen media is a global public health issue and especially extensive screen exposure during very early childhood. This review was conducted in order to update previous reviews on the effectiveness of interventions to reduce screen time. An electronic literature search was carried out in MEDLINE, COCHRANE LIBRARY and CINAHL for articles indexed from June 2011 until October 2019. The search identified 933 publications of which 11 publications were included in this review. There are studies showing interventions with a positive influence on reduction of screen time and the participants' awareness and behavior concerning the use of screen media, as well as studies without such effects. No intervention was identified to be superior. This warrants further investigation of potentially effective combinations of intervention components and long-term follow-up.

Asia-Pacific Consensus Statement on integrated 24-hour activity guidelines for children and adolescents

Non-communicable diseases (NCDs) constitute a significant public health challenge and pose a great burden on health and social systems throughout the world. The Asia-Pacific region is in a vulnerable position as the prevalence of NCDs will inevitably increase with rapid socioeconomic transitions; yet it is ill prepared for this public health challenge as Asian children are among the most physically inactive in the world. Aligned with the WHO's global strategy to control NCDs via preventive measures and health promotion policies, representatives from the Asia-Pacific region came together to develop consensus statement on integrated 24-hour activity guidelines for children and adolescents. These guidelines apply to children and adolescents, aged 5-18 years, in the Asia-Pacific region, regardless of gender, cultural background or socioeconomic status. These guidelines aim to provide the latest evidence-based recommendations, taking a holistic approach to lifestyle activities and adopting a practical perspective by framing these activities within a 24-hour period. Eating and dietary elements were incorporated as they closely influence the energy balance of the movement behaviours and vice versa. By investing in the younger generations through advocacy for healthier lifestyles, we aim to reduce the burden of NCDs in the Asia-Pacific region.

Changes in Families' Leisure, Educational/Work and Social Screen Time Behaviours before and during COVID-19 in Australia: Findings from the Our Life at Home Study

This study aimed to understand differences in leisure, educational/work and social screen time behaviours experienced by parents and children due to COVID-19 lockdown restrictions, which may inform behaviour change strategies and policy in the transition to a COVID-normal life. Participants in the "Our Life at Home" study (n = 218 parents from Australia, 43.4 ± 6.8 years, 88% female) completed a cross-sectional online survey in April/May 2020. Parents recalled their own and their child (8.7 ± 2.0 years, 42% female) or adolescents (15.0 ± 1.5 years, 50% female) participation in nine screen time behaviours in the past month (during lockdown) and retrospectively for February 2020 (pre-lockdown), providing data on 436 individuals. Screen time behaviours included leisure (computer/laptop and tablet/smartphone for leisure, TV/videos/DVDs and game consoles); education/work (computer/laptop and tablet/smartphone for work/education); and social screen time (computer/tablet/smartphone for social communication with friends, family and work (parents only)). Wilcoxon signed-rank tests and effect sizes (r) compared the time spent in each behaviour pre-lockdown and during lockdown. Large differences were observed in social (parents: r = 0.41-0.57; children: r = 0.55-0.65; adolescents: r = 0.28-0.43) and education (children: r = 0.50-0.65 and adolescents: r = 0.25-0.37) behaviours. There were small or no differences in leisure time screen use. COVID-19 lockdown restrictions have impacted parent's and children's screen time, and future research and policy should consider strategies to support families to manage screen time.

Evaluating the effectiveness of interventions to reducing screen time in children: meta-analysis of randomized controlled trials

Purpose

The purpose of this paper is to evaluate the impact of interventions focused on reducing screen time in children.

Design/methodology/approach

Studies that aim to investigate the effects of interventions aimed at reducing the time spent in front of the screen (i.e. screen time). A Random-effects model was used to calculate the pooled standard mean differences. The outcome was to evaluate the screen time in children in the 0–18 age range. A subgroup analysis was performed to reveal the extent to which the overall effect size varied by subgroups (participant age, duration of intervention and follow).

Findings

For the outcome, the meta-analysis included 21 studies, and the standard difference in mean change in screen time in the intervention group compared with the control group was −0.16 (95% confidence interval [CI], −0.21 to −0.12) (p < 0.001). The effect size was found to be higher in long-term (=7 months) interventions and follow-ups (p < 0.05).

Originality/value

Subgroup analysis showed that a significant effect of screen time reduction was observed in studies in which the duration of intervention and follow-up was =7 months. As the evidence base grows, future researchers can contribute to these findings by conducting a more comprehensive analysis of effect modifiers and optimizing interventions to reduce screen time.

Identifying effective intervention strategies to reduce children's screen time: a systematic review and meta-analysis

BACKGROUND

Excessive screen time ([Formula: see text] 2 h per day) is associated with childhood overweight and obesity, physical inactivity, increased sedentary time, unfavorable dietary behaviors, and disrupted sleep. Previous reviews suggest intervening on screen time is associated with reductions in screen time and improvements in other obesogenic behaviors. However, it is unclear what study characteristics and behavior change techniques are potential mechanisms underlying the effectiveness of behavioral interventions. The purpose of this meta-analysis was to identify the behavior change techniques and study characteristics associated with effectiveness in behavioral interventions to reduce children's (0-18 years) screen time.

METHODS

A literature search of four databases (Ebscohost, Web of Science, EMBASE, and PubMed) was executed between January and February 2020 and updated during July 2021. Behavioral interventions targeting reductions in children's (0-18 years) screen time were included. Information on study characteristics (e.g., sample size, duration) and behavior change techniques (e.g., information, goal-setting) were extracted. Data on randomization, allocation concealment, and blinding was extracted and used to assess risk of bias. Meta-regressions were used to explore whether intervention effectiveness was associated with the presence of behavior change techniques and study characteristics.

RESULTS

The search identified 15,529 articles, of which 10,714 were screened for relevancy and 680 were retained for full-text screening. Of these, 204 studies provided quantitative data in the meta-analysis. The overall summary of random effects showed a small, beneficial impact of screen time interventions compared to controls (SDM = 0.116, 95CI 0.08 to 0.15). Inclusion of the Goals, Feedback, and Planning behavioral techniques were associated with a positive impact on intervention effectiveness (SDM = 0.145, 95CI 0.11 to 0.18). Interventions with smaller sample sizes (n < 95) delivered over short durations (< 52 weeks) were associated with larger effects compared to studies with larger sample sizes delivered over longer durations. In the presence of the Goals, Feedback, and Planning behavioral techniques, intervention effectiveness diminished as sample size increased.

CONCLUSIONS

Both intervention content and context are important to consider when designing interventions to reduce children's screen time. As interventions are scaled, determining the active ingredients to optimize interventions along the translational continuum will be crucial to maximize reductions in children's screen time.

Development and feasibility testing of a mobile phone application to track children's developmental progression

Given that mobile phone usage has increased rapidly throughout the world, one possibility to increase parental involvement in monitoring their children's progression is to train parents or primary caregivers on the use of mobile phone technology to track their children's developmental milestones. The current paper aimed to describe the development of a mobile phone application for use among primary caregivers and establish the feasibility and preliminary impact of caregivers using a mobile phone application to track the progression of their children's development in a context where there is a paucity of similar studies. This study is a substudy that focusses on the intervention group only of a recently completed two-armed quasi-experimental study in an informal settlement in Nairobi. The mobile phone application which consisted of questions on children's developmental progression, as well as stimulation messages, was developed through a step-wise approach. The questions covered five child developmental domains: communication; fine motor; gross motor; personal-social; and, problem-solving. Depending on the response received, the child would be classified as having 'achieved a milestone' or 'milestone not achieved.' If a child had achieved the milestone for a specific age, a caregiver would receive an SMS on how to stimulate the child to achieve the next milestone. Where the milestone was not achieved, the caregiver would get a message to enhance development in the area of delay. Caregivers with children aged between six months and two years were recruited into the study and received questions and messages regarding their children's development (age-specific) on a monthly basis for 12 months. Caregiver adherence to the intervention was above 90% in the first three months of implementation. Thereafter, the response rate fluctuated between 76% and 86% across the subsequent months of the intervention. The high level and fairly stable caregivers' rate of response to the 12 rounds of messaging indicated feasibility of the mobile technology. Further, in the first three months of intervention implementation, the majority of caregivers were able to keep track of how their children attained their developmental milestones. The intervention seems to be scalable, practical and potentially low-cost because of the wide coverage of phones.

Trend Shifts in Age-Specific Incidence for In Situ and Invasive Cutaneous Melanoma in Sweden

BACKGROUND

The incidence of invasive cutaneous melanoma (CM) is increasing in Sweden. The aim was to present age- and sex-specific trends of the age-standardised incidence and the average annual percentage change (AAPC) for in situ and invasive CM.

METHODS

Joinpoint regression models were used to analyse data from the Swedish Cancer Register and the Swedish Melanoma Registry 1997-2018 (N = 35,350 in situ CM; 59,932 CM).

RESULTS

The AAPC of CM for women was 4.5 (4.1-5.0; p < 0.001) for the period 1997-2018. For men, the APCC was 4.2 (3.0-5.4; p < 0.001), with a significantly higher annual percentage change (APC) for the period 2000-2018 (5.0; 4.6-5.4; p < 0.001) compared to 1997-1999. An increasing annual incidence of CM ≤ 0.6 mm and 0.7 mm Breslow tumour thickness was found for men with a significant incidence shift for the period 2006-2015, respectively. Similarly for women, with a significantly higher APC for CM ≤ 0.6 mm from 2005. The incidence of intermediate thick CM (2.1-4.0 mm) has not increased since 2011. The incidence of CM > 4.0 mm has been increasing among both sexes, with a significantly lower APC among women from 2005.

CONCLUSIONS

The incidence of in situ and low-risk CM ≤ 1.0 mm in tumour thickness has been rising among both sexes since the 2000s.

What behavior change techniques are associated with effective interventions to reduce screen time in 0-5 year olds? A narrative systematic review

•

Daily screen time reduced by 25–39 min in interventions targeting 0–5 year olds.

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Eleven behavior change techniques (BCTs) were considered promising.

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Promising BCTs included “behavior substitution” and “demonstration of the behavior”.

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Promising BCTs related to self-efficacy, role modelling, and developmental outcomes.

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BCTs are identified which can be included in future public health interventions.

Screen time has been linked to obesity in young children. Therefore, this systematic review aims to investigate which Behavior Change Techniques (BCTs) are associated with the effectiveness of interventions to reduce screen time in 0–5 year olds.

Seven databases were searched, including PsycInfo, PubMed, and Medline. Grey literature searches were conducted. Inclusion criteria were interventions reporting pre- and post- outcomes with the primary objective of reducing screen time in 0-5 year olds. Studies were quality assessed using the Effective Public Health Practice Project criteria. Data extracted included participant characteristics, intervention characteristics and screen time outcomes. The BCT Taxonomy was used to extract BCTs. Interventions were categorised as “very”, “quite” or “non” promising based on effect sizes. BCTs were deemed promising if they were in twice as many very/quite promising interventions as non-promising interventions.

Seven randomised controlled trials were included, involving 642 participants between 2.5 and 5.0 years old. One very promising, four quite promising, and two non-promising interventions were identified. Screen time decreased by 25-39 min per day in very/quite promising interventions. Eleven BCTs were deemed promising, including “behavior substitution” and “information about social and environmental consequences”.

This review identified eleven promising BCTs, which should be incorporated into future screen time interventions with young children. However, most included studies were of weak quality and limited by the populations targeted. Therefore, future methodologically rigorous interventions targeting at-risk populations with higher screen time, such as those of a low socioeconomic status and children with a high BMI, should be prioritized.

Home vs. bedroom media devices: socioeconomic disparities and association with childhood screen- and sleep-time

BACKGROUND

The literature has shown a widespread use of portable electronic devices among children over the last years. This study aimed to identify the availability of different media devices at home versus in children's bedroom according to the socioeconomic status (SES), and analyze the association between that availability and children's screen- and sleep-time on week and weekend days.

METHODS

Data from 3 to 10 year-old children (n = 8430) from a cross-sectional study conducted in Portugal (2016/17) was used. Screen- and sleep-time, availability of media devices, father and mother education (as a proxy measured of SES) were assessed via questionnaire.

RESULTS

Available devices at home were significantly more common among high-SES families; while media devices in the bedroom were more frequent in low-SES families (p < 0.001). In preschool and elementary school-aged children, media devices in the bedroom were associated with increase screen-time and shorter sleep per day. Also, mobile devices in the bedroom were shown to exert similar, or even more, influence on children's screen- and sleep-time as television.

CONCLUSIONS

Further research is needed to explore the pathways by which different electronic media negatively impacts on children's sleep and screen-time and to develop effective strategies to minimize device access at bedtime.

[Lifestyle of adolescent students from public and private schools in Recife: ERICA]

This study analyzes the behavior patterns related to the lifestyle of adolescents in Recife, Brazil. A cross-sectional study was conducted with data from the Cardiovascular Risk Study among Adolescents (ERICA) and 2400 students aged 12 to 17 were interviewed. The prevalence of physical activity, eating behavior, smoking and alcohol consumption were analyzed. The Chi-square test and 95% confidence interval (95%CI) were used to evaluate the statistical significance of the measurements. It was observed that 60% of the adolescents presented inadequate eating behaviors regarding the consumption of breakfast, daily water intake and meals eaten in front of the TV. About 40% (95%CI: 39.7-45) did not sit down to meals with their parents or guardians. The prevalence of physical inactivity was 52.4% (95%CI: 50-55). Female adolescents were more inactive (68.7%, 95%CI: 65-72) than males (36.4%, 95%CI: 33-40). Teenagers of economic classes D and E were the most inactive (60.7%, 95%CI: 46-73). Alcohol consumption was 18.7% (95%CI: 2.6-5.6) and smoking was prevalent in 3.8% (95%CI: 2-6) of the individuals. Inadequate eating behaviors and physical inactivity were the main areas responsible for an unhealthy lifestyle, followed by alcohol consumption and smoking.

A systematic review of screen-time literature to inform educational policy and practice during COVID-19

There is an urgent need for consensus around the matter of screen time (ST) during the COVID-19 pandemic. Some governments announced restrictions for online schooling time per day to protect students from perceived risks of prolonged screen-use, but critics and an emerging body of research question such regulations. Our review of 52 empirical studies found (a) an overwhelming majority of literature shows effect sizes too small to be of practical or clinical significance, and (b) findings more specifically on educational ST are inconclusive and critically underrepresented. These facts, along with the undeniable benefits of online learning in the absence of brick-and-mortar schooling and the ominous forecasts of learning loss caused by prolonged school closure, inform our recommendations for a more moderate policy and practical stance on restrictions - one that is focused on responsibly leveraging the educational and social benefits of ST in a world still recovering from the COVID-19 pandemic.

Protocol paper for the Movimente school-based program: A cluster-randomized controlled trial targeting physical activity and sedentary behavior among Brazilian adolescents

BACKGROUND

A better understanding of how multicomponent school-based interventions work and their effects on health and education outcomes are needed. This paper described the methods of the Movimente Program, a school-based intervention that aims to increase physical activity (PA) and decrease sedentary behavior (SB) among Brazilian students.

METHODS

This is a cluster randomized controlled trial with adolescents from 7th to 9th grade in public schools from Florianopolis, Southern Brazil. After agreement, 6 schools were randomly selected to intervention or control groups (3 schools each), and all eligible students were invited to the study. The Movimente intervention program was performed during a school year and included 3 main components: Teacher training (including face-to-face meeting, social media platform, and handbook with lesson plans); improvements in the PA environment in school; and educational strategies. Control schools continued with their traditional schedule. Baseline (March/April 2017), postintervention (November/December 2017), and maintenance (June/July 2018) evaluations included PA and SB as primary outcomes (assessed by self-report and accelerometry). Secondary outcomes included psychosocial factors related to PA and SB (e.g., social support and self-efficacy), as well as health (e.g., quality of life and nutritional status) and education (e.g., academic achievement) outcomes. A program evaluation was performed based on the RE-AIM framework. Participants, intervention staffs, and evaluators were not blinded to group assignment, but a standardized evaluation protocol was applied independently of the trial allocation.

RESULTS

Statistical analyses will include a multilevel approach for repeated measurements and mediation analysis. Any side effects of the intervention will be recorded. The sample size close to that expected (n = 1090) was reached (n = 999). The results of this trial will involve valuable information about the effect and the evaluation of a multicomponent intervention carried out in a middle-income country.

CONCLUSION

By creating opportunities for adolescents to be active at school using multicomponent strategies, the Movimente program has the potential to enhance students health and academic performance which may encourage the school community (e.g., teachers, principals) to adopt the program. Also, this trial will provide evidence for practitioners, policy makers, and researchers on how multicomponent program may be implemented in a school setting.

TRIAL REGISTRATION

The trial is registered at the Clinical Trial Registry (Trial ID: NCT02944318; date of registration: 18 October 2016).

Interventions to control children's screen use and their effect on sleep: A systematic review and meta-analysis

Prolonged viewing of screen-based media is associated with poor sleep in children. Previous systematic reviews have analysed the effectiveness of interventions that aim to limit children's screen use; however, none have evaluated its effect on sleep. The aim of this systematic review was to evaluate the effect of interventions that incorporate strategies to control children's screen use on screen use and sleep. The databases Pubmed, Embase, Eric, Scopus and PsycInfo were searched during October 2017 and updated in February 2019 for experimental studies with a control that assessed interventions to control screen use in children aged 2-14 years and reported both screen use and sleep outcomes. From 3,872 initial records, 11 studies (six randomized control [RCT], four cluster RCT and one cluster, quasi-experimental) were eligible for inclusion. A total of 4,656 children aged 2-13 years were included in the studies. The mean reduction in screen time was 0.56 hr (33 min)/day (95% confidence interval [CI], 0.92, 0.20) and the mean sleep duration increased by 0.19 hr (11 min)/day (95% CI, 0.05, 0.33). Bedtime was advanced by 0.16 hr (10 min) on weekdays and by 1.0 hr at the weekend. Subgroup analyses indicated stronger intervention effects for interventions of shorter duration (<3 months), which specifically targeted screen use or sleep, and those with direct participant contact. In conclusion, small improvements in screen time and sleep duration can be achieved in children. It is not possible to determine if a reduction in screen time directly improves sleep, due to the limited number of studies, the presence of co-interventions, issues with studies' methodological quality and heterogeneity.

Effectiveness of Family-Based Behavior Change Interventions on Obesity-Related Behavior Change in Children: A Realist Synthesis

Effective treatment interventions for childhood obesity involve parents, are multicomponent and use behavior change strategies, but more information is needed on the mechanisms influencing behavioral outcomes and the type of parental involvement that is efficacious in behavioral treatment interventions with school-age children. This review aimed to understand key characteristics of programs that contribute to dietary and physical activity behavioral outcomes, and through which key mechanisms. This was a systematic review with narrative synthesis following PRISMA guidelines and realist analysis using RAMESES guidelines to explain outcome patterns and influence of parental involvement. Overall, the findings contribute to understanding the complex relationship between family barriers to behavior change, strategies employed in treatment interventions and behavioral outcomes. Implications for enhancing future policy and practice include involving parents in goal setting, motivational counselling, role modeling, and restructuring the physical environment to promote mutual empowerment of both parents and children, shared value and whole-family ownership in which intrinsic motivation and self-efficacy are implicit. These characteristics were associated with positive dietary and physical activity behavior change in children and may be useful considerations for the design and implementation of future theory-based treatment interventions to encourage habitual healthy diet and physical activity to reduce childhood obesity.

Time-varying Effects of Screen Media Exposure in the Relationship Between Socioeconomic Background and Childhood Obesity

BACKGROUND

We investigated to what extent social inequalities in childhood obesity could be reduced by eliminating differences in screen media exposure.

METHODS

We used longitudinal data from the UK-wide Millennium Cohort Study (n = 11,413). The study measured mother's educational level at child's age 5. We calculated screen media exposure as a combination of television viewing and computer use at ages 7 and 11. We derived obesity at age 14 from anthropometric measures. We estimated a counterfactual disparity measure of the unmediated association between mother's education and obesity by fitting an inverse probability-weighted marginal structural model, adjusting for mediator-outcome confounders.

RESULTS

Compared with children of mothers with a university degree, children of mothers with education to age 16 were 1.9 (95% confidence interval [CI] = 1.5, 2.3) times as likely to be obese. Those whose mothers had no qualifications were 2.0 (95% CI = 1.5, 2.5) times as likely to be obese. Compared with mothers with university qualifications, the estimated counterfactual disparity in obesity at age 14, if educational differences in screen media exposure at age 7 and 11 were eliminated, was 1.8 (95% CI = 1.4, 2.2) for mothers with education to age 16 and 1.8 (95% CI = 1.4, 2.4) for mothers with no qualifications on the risk ratio scale. Hence, relative inequalities in childhood obesity would reduce by 13% (95% CI = 1%, 26%) and 17% (95% CI = 1%, 33%). Estimated reductions on the risk difference scale (absolute inequalities) were of similar magnitude.

CONCLUSIONS

Our findings are consistent with the hypothesis that social inequalities in screen media exposure contribute substantially to social inequalities in childhood obesity.

Latin American interventions in children and adolescents' sedentary behavior: a systematic review

OBJECTIVE To identify and evaluate the effects of community-based interventions on the sedentary behavior (SB) of Latin American children and adolescents. METHODS A systematic review on community-based trials to reduce and/or control SB in Latin American countries (Prospero: CRD42017072157). Five databases (PubMed, Web of Science, Scopus, SciELO and Lilacs) and a reference lists were searched. RESULTS Ten intervention studies met the eligibility criteria and composed the descriptive synthesis. These studies were conducted in Brazil (n=5), Mexico (n=3), Ecuador (n=1) and Colombia (n=1). Most interventions were implemented in schools (n=8) by educational components, such as meetings, lessons, and seminars, on health-related subjects (n=6). Only two studies adopted specific strategies to reduce/control SB; others focused on increasing physical activity and/or improving diet. Only one study used an accelerometer to measure SB. Seven studies investigated recreational screen time. Eight studies showed statistically significant effects on SB reduction (80%). CONCLUSIONS Latin America community-based interventions reduced children and adolescents' SB. Further studies should: define SB as a primary outcome and implement strategies to reduce such behaviour; focus in different SBs and settings, other than recreational screen time or at-home sitting time; and use objective tools together with questionnaires to measure sedentary behaviour in.

A multivariate multilevel analysis of the risk factors associated with anthropometric indices in Iranian mid-adolescents

BACKGROUND

The present study was conducted to jointly assess some specific factors related to body fat measures using a multivariate multilevel analysis in a representative sample of Iranian mid-adolescents.

METHODS

This study was conducted among 2538 students (1286 boys) aged 14-20 years old, who were randomly selected among 16 public high schools by multi-stage random sampling procedure from all education districts of Shiraz, Iran. Data on demographic characteristics, family history of obesity, physical activity, socio-economic (SES) variables and screen time were collected. Height, weight, triceps (TST), abdominal (AST), and subscapular (SST) skinfold thickness were measured and their body mass index (BMI) was calculated. A multivariate multilevel approach was used to analyze the factors associated with obesity measures of the TST, AST, SST at the child and district levels.

RESULTS

In this study, the prevalence of overweight and obesity was estimated to be 10.2 and 5.1%, respectively. Overall, the major portion of the total variance in TST (97.1%), AST (97.7%), and SST (97.5%) was found at the child level. The results of multivariate multilevel method revealed that being girls, having a family history of obesity, and SES were significantly associated with increasing of three body fat measures (all the p-values were less than 0.05). There were significant positive associations between moderate to vigorous physical activities with AST and SST (for AST: β =2.54, SE = 1.40, p = 0.05; for SST: β =2.24, SE = 1.20, p = 0.05). Compared to children in 14-16 age group, children in age group 16-18 years had less TST (β = - 0.67, SE = 0.34, p = 0.04). Furthermore, other age groups and screen time did not play an important role in three outcome variables.

CONCLUSIONS

The results showed some factors that contribute to three body fat measures. Therefore, it is necessary to develop effective interventions to prevent the effects of individual and environmental undesirable factors on childhood obesity in both family and community levels.

Low fitness and increased sedentary time are associated with worse asthma-The National Youth Fitness Survey

BACKGROUND

Asthma is the most common chronic illness in children and is independently impacted by obesity and by fitness. The National Youth Fitness Survey collected data on aerobic fitness, body composition, and health outcomes in children 6 to 11 years old. The goal of this study is to test hypotheses regarding relationships between asthma, aerobic fitness, and sedentary time in this uniquely studied cohort of young children.

METHODS

A total of 665 children (6-11 years old; 49% male) were included in analyses. We explored relationships between asthma outcomes and aerobic fitness (measured by endurance time), self-reported sedentary time, and body mass index categories. Fitness was categorized as unfit (lowest 25% of endurance times) or fit. Multivariate logistic regression models were created for asthma outcomes and adjusted for race, age, sex, poverty status, and overweight/obesity.

RESULTS

Among the participants, 17.9% had a previous history of asthma and 11.4% had current asthma. Additionally, 37.3% of participants were overweight or obese. Low fitness was significantly associated with increased odds of past asthma, current asthma, asthma attacks, wheeze with exercise, and wheeze with activity limitations in multivariate models. Increased sedentary time was significantly associated with increased odds of previous asthma, current asthma, asthma attacks, and wheeze with activity limitations.

CONCLUSION

Decreased aerobic fitness and increased sedentary time were associated with worse asthma outcomes in this group of children (6-11 years old). This data suggest that fitness and sedentary time, both modifiable factors, each have an independent effect on asthma and should be included in assessments and management of asthma health.

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.

Joint Associations of Leisure Screen Time and Physical Activity with Academic Performance in a Sample of Japanese Children

Studies have shown the potential effects of sedentary behavior and physical activity on not only physical and mental health but also academic performance in children. Nevertheless, studies have only focused on either sedentary behavior or physical activity. Examining the joint effects of both behaviors on academic performance provides detailed insights into the patterns of these behaviors in relation to children’s academic achievement. The present study investigated the joint longitudinal associations of physical activity and screen time with academic performance among Japanese children. The screen time and physical activity of 261 children aged 7–10 years were assessed, and their academic performance was evaluated one year later. Multivariate logistic regression analysis was used to examine the joint associations of screen time and physical activity with academic performance adjusted for demographic characteristics. Children with low screen time and physical activity had 2.04 (95% confidence interval: 1.11–3.78) times greater odds of having high academic performance compared to children with high screen time and low physical activity, while children with low screen time and high physical activity had 2.75 (1.17–6.43) times greater odds (boys; 4.12 (1.19–14.24)). Low screen time was related to high academic performance after one year, regardless of the physical activity level.

Type of screen time moderates effects on outcomes in 4013 children: evidence from the Longitudinal Study of Australian Children

Background

Excessive engagement with digital screens is harmful to children’s health. However, new evidence suggests that exposure at moderate levels may not be harmful and may even provide benefit. Therefore, our objective was to determine if there are curvilinear relationships between different types of screen time and a diverse set of outcomes, including health and education.

Methods

We address our objective using a repeated measures design. Children (N = 4013), initially aged 10–11 were assessed every 2 years between 2010 and 2014. Children’s screen time behavior was measured using time-use diaries, and categorized into five types: social, passive, interactive, educational, or other. We used measures of children’s physical health, health-related quality of life, socio-emotional outcomes, and school achievement. The analysis plan was pre-registered. Models were adjusted for gender, socio-economic status, ethnicity, number of siblings, and housing factors.

Results

There were linear associations between total screen time and all outcomes, such that more screen time was associated with worse outcomes. However, there was variability when examined by screen time type. Passive screen time (e.g., TV) was associated with worse outcomes, educational screen time (e.g., computer for homework) was associated with positive educational outcomes and had no negative relations with other outcomes. Interactive screen time (e.g., video games) had positive associations with educational outcomes but negative associations with other outcomes. In all instances, these significant associations were small or very small, with standardised effects < 0.07. We found little evidence of curvilinear relationships.

Conclusions

The small effects of screen time on children’s outcomes appear to be moderated by the type of screen time. Policy makers, educators, and parents should consider the type of screen time when considering the benefits and harms of use.

Screen Time: The Impact of Digital Technology on Children and Strategies in Care

Media and digital devices are an integral part of the world today. Despite potential benefits of media time, excessive or inappropriate use of technology is having a significant impact on the development and health of children. There is a relationship between increased screen time and greater risk of physical health complications, mental health concerns, and negative outcomes on cognitive, language, social, and emotional development. Successful evidence-based interventions and screening initiatives are available for reducing unhealthy media use in children. Providers need to be aware of media-use guidelines, screen for at-risk media use, and provide parental education as well as recommend interventions when indicated. [Journal of Psychosocial Nursing and Mental Health Services, 57(11), 15-20.].

Screen Use During Meals Among Young Children: Exploration of Associated Variables

Background and Objectives: There is evidence that eating meals or snacks while watching TV is an obesogenic factor. Moreover, the patterns of TV and other screen use during meals begin early and persist. However, there are only a few studies to date which address the prevalence and predictors of young children’s exposure to screen during mealtimes. Thus, the present study aimed to investigate the prevalence and the associated factors of screen use during meals in early childhood. Materials and Methods: A cross sectional survey was conducted in Lithuania. Data of 847 children aged 2 to 5 years old (51.5% boys) were analyzed in this study. Parents completed the Child Behavior Checklist (CBCL/1½-5) and reported their children’s daily screen time, exposure to background TV, screen use during child’s meals, child and parental height and weight, and sociodemographic data. Results: More than half of children were exposed to screen during meals: 33.7% occasionally, several times per week or per month, and 22%—daily or during every meal. Overall daily screen time, background TV, consumption of junk food, child age, and emotional and behavioral problems were related to mealtime screen use (all associations significant at p < 0.01). Longer daily screen time (OR 1.01; 95% CI 1.00–1.01), more background TV (OR 1.26; 95% CI 1.10–1.45), and elder child age (OR 1.02; 95% CI 1.00–1.03) were significant predictors of occasional use of screen during meals. Also, longer daily screen time (OR 0.99; 95% CI 0.98–0.99), background TV (OR 0.78; 95% CI 0.66–0.91) together with no siblings’ status of a child (OR 0.42; 95% CI 0.25–0.69) increased the probability that children were fed in front of screens daily. Conclusions: This study confirmed the unfavorable associations among screen use during meals, daily screen time and junk food consumption in early childhood. In addition, first-time parents should get particular health providers’ attention as they are more likely to use screens during child’s mealtime.

Sedentary Behaviors in Today's Youth: Approaches to the Prevention and Management of Childhood Obesity: A Scientific Statement From the American Heart Association

This scientific statement is about sedentary behavior and its relationship to obesity and other cardiometabolic outcomes in youth. A deleterious effect of sedentary behavior on cardiometabolic health is most notable for screen-based behaviors and adiposity; however, this relation is less apparent for other cardiometabolic outcomes or when sedentary time is measured with objective movement counters or position monitors. Increasing trends of screen time are concerning; the portability of screen-based devices and abundant access to unlimited programming and online content may be leading to new patterns of consumption that are exposing youth to multiple pathways harmful to cardiometabolic health. This American Heart Association scientific statement provides an updated perspective on sedentary behaviors specific to modern youth and their impact on cardiometabolic health and obesity. As we reflect on implications for practice, research, and policy, what emerges is the importance of understanding the context in which sedentary behaviors occur. There is also a need to capture the nature of sedentary behavior more accurately, both quantitatively and qualitatively, especially with respect to recreational screen-based devices. Further evidence is required to better inform public health interventions and to establish detailed quantitative guidelines on specific sedentary behaviors in youth. In the meantime, we suggest that televisions and other recreational screen-based devices be removed from bedrooms and absent during meal times. Daily device-free social interactions and outdoor play should be encouraged. In addition, parents/guardians should be supported to devise and enforce appropriate screen time regulations and to model healthy screen-based behaviors.

The Healthy Homes/Healthy Kids 5-10 Obesity Prevention Trial: 12 and 24-month outcomes

BACKGROUND

Pediatric primary care is an important setting for addressing obesity prevention.

OBJECTIVE

The Healthy Homes/Healthy Kids 5-10 randomized controlled trial evaluated the efficacy of an obesity prevention intervention integrating pediatric primary care provider counseling and parent-targeted phone coaching.

METHODS

Children aged 5 to 10 years with a BMI between the 70th and 95th percentile and their parents were recruited from pediatric primary care clinics. Participants received well-child visit provider counseling about obesity and safety/injury prevention and were then randomized to a 14-session phone-based obesity prevention (OP; n = 212) or safety and injury prevention contact control (CC; n = 209) intervention. The primary outcome was 12 and 24-month child BMI percentile.

RESULTS

There was no overall significant treatment effect on child BMI percentile. Caloric intake was significantly lower among OP compared with CC participants at 12 months (P < .005). In planned subgroup analyses, OP condition girls had significantly lower BMI percentile (P < .05) and BMI z-score (P < .02) at 12 and 24 months relative to CC girls and were less likely to be overweight (38.0% vs 53.0%, P < .01) or (obese 3.4% vs 8.8%, P < .10) at follow-up.

CONCLUSIONS AND RELEVANCE

An obesity prevention intervention integrating brief provider counseling and parent-targeted phone counseling did not impact 12 and 24-month BMI status overall but did have a significant impact on BMI in girls.

Increasing socioeconomic disparities in sedentary behaviors in Chinese children

BACKGROUND

Sedentary behaviors are prevalent in Chinese children, however, the studies on their trends and socioeconomic disparities are scarce. We examined the time trends of daily television (TV) viewing and video game playing and the associated socioeconomic factors in Chinese children in Hong Kong, the most developed and westernized city in China.

METHODS

In a panel data study involving 538,300 primary four and 510,294 primary six students from 1999/2000 to 2008/09, data on socioeconomic status, sedentary behaviors (TV viewing and video game playing) and other lifestyle habits were collected using a self-administered questionnaire. Trends in sedentary behaviors over time were assessed. Their socioeconomic disparities were examined by interactions in generalized estimating equations with the adjustment for weight status and extracurricular physical activities.

RESULTS

The age and sex-standardized prevalence of ≥2 h daily TV viewing decreased from 51.4% (95% confidence interval [CI] 51.1-51.8%) in 1999/2000 to 43.8% (95% CI 43.4-44.2%) in 2008/09 (P for trend < 0.001), whereas that of ≥1 h daily video game playing increased from 8.2% (95% CI 7.9-8.4%) to 22.4% (95% CI 22.0-22.7%). Both sedentary behaviors were more prevalent in boys than girls, but the disparities decreased over time (Ratio of odds ratio [ROR] = 0.996 and 0.924 for TV viewing and video game playing, respectively). In contrast, both sedentary behaviors were increasingly more prevalent in children whose parents had lower education levels or non-managerial/professional occupations (ROR 1.006-1.082).

CONCLUSIONS

Children in lower socioeconomic families in Hong Kong were increasingly at risk of having sedentary behaviors over years and thus deserve more attention. Effective strategies targeting children and/or their parents of lower socioeconomic status are needed to reduce sedentary behaviors.

"If You Let Them, They Will Be on It 24 Hours a Day": Qualitative Study Conducted in the United States Exploring Brazilian Immigrant Mothers' Beliefs, Attitudes, and Practices Related to Screen Time Behaviors of Their Preschool-Age Children

BACKGROUND

The increasing prevalence of excessive screen time (ST) among children is a growing public health concern, with evidence linking it to an increased risk of overweight and obesity among children.

OBJECTIVE

This study aimed to explore the beliefs, attitudes, and practices of Brazilian immigrant mothers living in the United States related to their preschool-age children's ST behaviors.

METHODS

A qualitative study comprising 7 focus group discussions (FGDs) was conducted with Brazilian immigrant mothers living in the United States. All FGDs were audio-recorded and professionally transcribed verbatim. The Portuguese transcripts were analyzed using thematic analysis.

RESULTS

In total, 37 women participated in the FGDs. Analyses revealed that although most mothers expressed concerns for their preschool-age children's ST, nearly all viewed ST as an acceptable part of their children's daily lives. Furthermore, mothers perceived that ST has more benefits than disadvantages. The mothers' positive beliefs about (eg, educational purposes and entertainment) and perceived functional benefits of ST (eg, ability to keep children occupied so tasks can be completed and facilitation of communication with family outside the United States) contributed to their acceptance of ST for their preschool-age children. Nevertheless, most mothers spoke of needing to balance their preschool-age children's ST with other activities. Mothers reported using several parenting practices including monitoring time and content, setting limits and having rules, and prompting their children to participate in other activities to manage their preschool-age children's ST.

CONCLUSIONS

This study provides new information on the beliefs, attitudes, and practices of Brazilian immigrant mothers living in the United States related to their preschool-age children's ST. Study findings revealed several potentially modifiable maternal beliefs and parenting practices that may provide important targets for parenting- and family-based interventions aimed at limiting preschool-age children's ST.

The Association between Children's and Parents' Co-TV Viewing and Their Total Screen Time in Six European Countries: Cross-Sectional Data from the Feel4diabetes-Study

In many European children, high levels of screen time can be found, which is associated with several adverse health outcomes. Therefore, there is a need for identifying effective intervention strategies that reduce screen time in children. A factor that may contribute to excessive screen time in children may be “co-TV viewing” (i.e., the time that parents and children spend on watching TV together), as parents often recognize the importance of limiting children’s (individual) screen time, but often encourage TV viewing as a family because of its perceived benefits (e.g., educational purposes). The primary aim of this study was to investigate the (sex-specific) association between co-TV viewing and both children’s and parents’ screen time, and these associations were investigated across and within six European countries. In total, 10,969 parents (Mean_age = 40.7 ± 5.3 years, Mean_BMI = 24.4 ± 4.6) of primary school children (Mean_age = 8.2 ± 1.0 years, 49.0% boys, Mean_BMI = 17.3 ± 2.8) completed a questionnaire assessing co-TV viewing and screen time. Multilevel regression analyses were conducted. Across countries, positive associations were found between co-TV viewing and both children’s (β = 11.85, SE = 3.69, p < 0.001) and parents’ screen time (β = 14.47, SE = 4.43, p = 0.001). Similar associations were found in most (but not all) countries. The results suggest that targeting co-TV viewing might be a promising intervention strategy because of its potential to limit screen time of both children and parents.