The effect of interventions targeting screen time reduction: A systematic review and meta-analysis

Identifying effective obesity prevention intervention components: An umbrella review mapping systematic review evidence

This overview of reviews synthesizes the effectiveness of obesity prevention interventions in children and adults on BMI/zBMI, following JBI and Cochrane Handbook guidelines. The protocol was prospectively registered in OSF in September 2020. Searches for eligible reviews were run in five databases and gray literature in May 2022. Systematic reviews published in 2010 and assessed BMI/zBMI outcomes of obesity prevention interventions were eligible. Screening, data extraction, and quality assessment were performed independently and in duplicate using standardized tools. For similar interventions, the more recent, higher-quality review was included. Thirty reviews reporting on 60 discrete interventions (i.e., a specific intervention component), mapped to 14 of 21 IOM sub-domains, were included. Nine interventions were classified as effective in improving BMI outcomes, including digital health or counseling interventions for adults in 'healthcare environments', behavioral interventions for children (broadly nutrition education), physical education curriculum modifications, and policies targeting food and beverages in 'School environments'. This review extends on previous reviews by consolidating evidence from high-quality, recent reviews to identify effective intervention components. Thus, this review provides direction for implementation efforts and highlights research gaps, where future research is warranted. However, as primary studies were not directly analyzed, gaps may reflect a lack of systematic reviews rather than primary research.

Toddler Screen Use Before Bed and Its Effect on Sleep and Attention: A Randomized Clinical Trial

Importance

Toddler screen time has been associated with poorer sleep and differences in attention. Understanding the causal impact of screen time on early development is of the highest importance.

Objective

To test (1) the feasibility of the 7-week parent-administered screen time intervention (PASTI) in toddlers (aged 16-30 months) who have screen time in the hour before bed and (2) the impact of PASTI on toddlers' sleep and attention.

Design, Setting, and Participants

This assessor-blinded, UK-based randomized clinical trial was conducted between July 2022 and July 2023. This was a single-site study that enrolled families with a toddler aged between 16 and 30 months, living within 75 miles of the Babylab, and with 10 minutes or more of screen time in the hour before bed on 3 or more days a week. Exclusion criteria were (1) a genetic or neurological condition, (2) premature birth (<37 weeks), and (3) current participation in another study.

Interventions

Families were randomized (1:1:1) to (1) PASTI: caregivers removed toddler screen time in the hour before bed and used activities from a bedtime box instead (eg, reading, puzzles); (2) bedtime box (BB only): used matched before-bed activities, with no mention of screen time; or (3) no intervention (NI): continued as usual.

Main Outcomes and Measures

Feasibility outcomes: participation rate, intervention adherence, retention, family experiences, and assessment acceptability. Efficacy outcomes: screen use, actigraphy-measured sleep, and eye-tracking attention measures.

Results

A total of 427 families were screened, 164 were eligible (38.4%), and 105 families were randomized (mean [SD] age, 23.7 [4.6] months; 60 male [57%]). The trial was feasible, with 99% participant (104 of 105) retention and 94% of families (33 of 35) adhering to PASTI. PASTI showed reductions in parent-reported screen time (vs NI: Cohen d = -0.96; 95% CI, -1.32 to -0.60; vs BB only: Cohen d = -0.65; 95% CI, -1.03 to -0.27). PASTI showed small to medium improvements in objectively measured sleep efficiency (vs NI: Cohen d = 0.27; 95% CI, -0.11 to 0.66; vs BB only: Cohen d = 0.56; 95% CI, 0.17-0.96), night awakenings (vs NI: Cohen d = -0.28; 95% CI, -0.67 to 0.12; vs BB only: Cohen d = -0.31; 95% CI, -0.71 to 0.10), and reduced daytime sleep (vs NI: Cohen d = -0.30; 95% CI, -0.74 to 0.13) but no difference compared with BB only. There was no observable effect of PASTI on objective measures of attention. Compared with BB only, PASTI showed a difference on parent-reported effortful control (Cohen d = -0.40; 95% CI, -0.75 to -0.05) and inhibitory control (Cohen d = -0.48; 95% CI, -0.77 to -0.19), due to an increase in BB-only scores.

Conclusions and Relevance

Results of this randomized clinical trial show that, supporting pediatric recommendations, removing screen time before toddler bedtime was feasible and showed modest preliminary beneficial effects on sleep. A future full confirmatory trial is needed before PASTI's adoption by parents and pediatricians.

Trial Registration

ISRCTN.org Identifier: ISRCTN58249751.

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.

A systematic review of economic evidence for community-based obesity prevention interventions in children

Multicomponent community-based obesity prevention interventions that engage multiple sectors have shown promise in preventing obesity in childhood; however, economic evaluations of such interventions are limited. This systematic review explores the methods used and summarizes current evidence of costs and cost-effectiveness of complex obesity prevention interventions. A systematic search was conducted using 12 academic databases and grey literature from 2006 to April 2022. Studies were included if they reported methods of costing and/or economic evaluation of multicomponent, multisectoral, and community-wide obesity prevention interventions. Results were reported narratively based on the Consolidated Health Economic Evaluation Reporting Standards. Seventeen studies were included, reporting costing or economic evaluation of 13 different interventions. Five interventions reported full economic evaluations, five interventions reported economic evaluation protocols, two interventions reported cost analysis, and one intervention reported a costing protocol. Five studies conducted cost-utility analysis, three of which were cost-effective. One study reported a cost-saving return-on-investment ratio. The economic evidence for complex obesity prevention interventions is limited and therefore inconclusive. Challenges include accurate tracking of costs for interventions with multiple actors, and the limited incorporation of broader benefits into economic evaluation. Further methodological development is needed to find appropriate pragmatic methods to evaluate complex obesity prevention interventions.

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.

Association of lifestyle and sociodemographic factors on multimorbidity: a cross-sectional study in Portugal

Background

Lifestyle factors are widely recognized as modifiers and major risk factors for non-communicable diseases. Previous studies on the prevalence of multimorbidity in Portugal predict an unfavourable reality. The aim of the present study was to analyse 1) the prevalence of multimorbidity in Portugal and 2) the association of individuals’ lifestyles and sociodemographic factors with multimorbidity.

Methods

A cross-sectional, population-wide study was conducted on a representative sample of the general population of Portuguese adults aged ≥ 20 years. Categorical variables were described by their respective absolute and relative frequencies (n (%)). All variables with a p-value < 20% were included in the multiple logistic regression model. The variables were removed one by one in descending order of p-value (p) until the model contained only significant variables. The results are presented using the odds ratio and 95% confidence intervals. P-values ​​ < 5% were considered significant.

Results

The prevalence of multimorbidity was 48.9% (n = 436), and the odds of multimorbidity increased 4% (p < 0.001) for each year of increase in age. Participants with reasonable general health status had higher odds of multimorbidity (Odds ratio (OR) = 3.04; p < 0.001), and those with poor or very poor general health status had even higher odds (OR = 9.14; p < 0.001). Compared to those who never smoked, participants who quit smoking ≥ 1 year presented an increase of 91% (p = 0.005) in the odds of multimorbidity. Individuals with no good-quality sleep, non-moderate screen time, or non-moderate stress level had higher odds of multimorbidity (OR = 1.98; OR = 1.88; OR = 2.22, respectively. p < 0.001).

Conclusions

This study presented a new approach to multimorbidity in Portugal. Population-based, multidimensional lifestyle interventions are needed. It seems necessary to optimize and adjust measures to prevent non-communicable diseases to improve health in Portugal. In the future, longitudinal studies will be an asset to reinforce and clarify these conclusions.

Effects of interrupting daily sedentary behavior on children's glucose metabolism: A 6-day randomized controlled trial

BACKGROUND

Metabolic disease risk in youth is influenced by sedentary behaviors. Acute in-lab studies show that, during a single day, interrupting a sedentary period with short bouts of physical activity improves glucometabolic outcomes.

OBJECTIVE

To determine if acutely improved glucose metabolism persists after multi-day interruptions of sitting with walking brief bouts. We hypothesized that children who underwent interrupting sitting on multiple days would demonstrate lower insulin area under the curve during an oral glucose tolerance test compared to uninterrupted sitting.

METHODS

Healthy, normoglycemic children (N = 109) ages 7-11 years were randomized to one of two conditions: Control (3 h of daily Uninterrupted Sitting) or Interrupted Sitting (3-min of moderate-intensity walking every 30 min for 3 h daily); with dietary intake controlled through provision of foodstuffs for the entire experiment. Participants attended six consecutive daily visits at a research ambulatory unit. The primary outcome was insulin area under the curve during the oral glucose tolerance test on day 6 during interrupted or uninterrupted sitting; secondary outcomes included glucose and c-peptide area under the curve, energy intake at a buffet meal on day 6, and free-living activity.

RESULTS

Among 93 children (42 uninterrupted sitting, 51 interrupted sitting), daily interrupted sitting resulted in 21% lower insulin (β = 0.102 CI:0.032-0.172, p = 0.005) and a 10% lower C-peptide (β = 0.043, CI:0.001-0.084, p = 0.045) area under the curve. Matsuda and Glucose Effectiveness Indices were also improved (p's < 0.05). There were no group differences in energy intake or expenditure.

CONCLUSIONS

Sustained behavioral change by interrupting sedentary behaviors is a promising intervention strategy for improving metabolic risk in children.

Machine learning and ontology in eCoaching for personalized activity level monitoring and recommendation generation

Leading a sedentary lifestyle may cause numerous health problems. Therefore, passive lifestyle changes should be given priority to avoid severe long-term damage. Automatic health coaching system may help people manage a healthy lifestyle with continuous health state monitoring and personalized recommendation generation with machine learning (ML). This study proposes a semantic ontology model to annotate the ML-prediction outcomes and personal preferences to conceptualize personalized recommendation generation with a hybrid approach. We use a transfer learning approach to improve ML model training and its performance, and an incremental learning approach to handle daily growing data and fit them into the ML models. Furthermore, we propose a personalized activity recommendation algorithm for a healthy lifestyle by combining transfer learning, incremental learning, the proposed semantic ontology model, and personal preference data. For the overall experiment, we use public and private activity datasets collected from healthy adults (n = 33 for public datasets; n = 16 for private datasets). The standard ML algorithms have been used to investigate the possibility of classifying daily physical activity levels into the following activity classes: sedentary (0), low active (1), active (2), highly active (3), and rigorous active (4). The daily step count, low physical activity, medium physical activity, and vigorous physical activity serve as input for the classification models. We first use publicly available Fitbit datasets to build the initial classification models. Subsequently, we re-use the pre-trained ML classifiers on the real-time MOX2-5 dataset using transfer learning. We test several standard algorithms and select the best-performing model with optimized configuration for our use case by empirical testing. We find that DecisionTreeClassifier with a criterion "entropy" outperforms other ML classifiers with a mean accuracy score of 97.50% (F1 = 97.00, precision = 97.00, recall = 98.00, MCC = 96.78) and 96.10% (F1 = 96.00, precision = 96.00, recall = 96.00, MCC = 96.10) in Fitbit and MOX2-5 datasets, respectively. Using transfer learning, the DecisionTreeClassifier with a criterion "entropy" outperforms other classifiers with a mean accuracy score of 97.99% (F1 = 98.00, precision = 98.00, recall = 98.00, MCC = 96.79). Therefore, the transfer learning approach improves the machine learning model performance by ≈ 1.98% for defined datasets and settings on MOX2-5 datasets. The Hermit reasoner outperforms other reasoners with an average reasoning time of 1.1-2.1 s, under defined settings in our proposed ontology model. Our proposed algorithm for personalized recommendations conceptualizes a direction to combine the classification results and personal preferences in an ontology for activity eCoaching. The proposed method of combining machine learning technology with semantic rules is an invaluable asset in personalized recommendation generation. Moreover, the semantic rules in the knowledge base and SPARQL (SPARQL Protocol and RDF Query Language) query processing in the query engine helps to understand the logic behind the personalized recommendation generation.

Effect of a 16-week multi-level classroom standing desk intervention on cognitive performance and academic achievement in adolescents

The replacement of traditional classroom desks for active-permissive desks has been tested to reduce sitting time during classes. However, their impact on other domains is still unclear. We aimed to verify the potential effects of a classroom standing desk intervention on cognitive function and academic achievement in 6th-grade students. This was a controlled trial conducted with two classes [intervention (n = 22) and control (n = 27)] from a public school in Lisbon, Portugal. The intervention was carried out for 16 weeks and consisted of multi-level actions (students, parents, and teachers) centered on the implementation of standing desks in the intervention classroom. The control group had traditional classes with no use of standing desks or any other interference/action from the research team. Pre- and post-assessments of executive functions (attention, inhibitory function, memory, and fluid intelligence) and academic achievement were obtained. No differences between groups were found at baseline. Both groups improved (time effect) academic achievement (p < 0.001), memory span (p < 0.001), and inhibitory function (p = 0.008). Group versus time interactions were observed regarding operational memory (intervention: + 18.0% and control: + 41.6%; p = 0.039) and non-verbal fluid intelligence (intervention: − 14.0% and control: + 3.9%; p = 0.017). We concluded that a 16-week classroom standing desk intervention did not improve cognitive performance or academic achievement more than the traditional sitting classes.

Trial registration: ClinicalTrials.gov Identifier (NCT03137836) (date of first registration: 03/05/2017).

Stress-related psychopathology during the COVID-19 pandemic

The COVID-19 pandemic has introduced widespread societal changes that have required ongoing adaptation. Unsurprisingly, stress-related psychopathology has increased during the pandemic, in both children and adults. We review these patterns through the lens of several leading conceptual models of the link between stress and psychopathology. Some of these models focus on characteristics of environmental stressors-including cumulative risk, specific stressor types, and stress sensitization approaches. Understanding the specific aspects of environmental stressors that are most likely to lead to psychopathology can shed light on who may be in most need of clinical intervention. Other models center on factors that can buffer against the onset of psychopathology following stress and the mechanisms through which stressors contribute to emergent psychopathology. These models highlight specific psychosocial processes that may be most usefully targeted by interventions to reduce stress-related psychopathology. We review evidence for each of these stress models in the context of other widescale community-level disruptions, like natural disasters and terrorist attacks, alongside emerging evidence for these stress pathways from the COVID-19 pandemic. We discuss clinical implications for developing interventions to reduce stress-related psychopathology during the pandemic, with a focus on brief, digital interventions that may be more accessible than traditional clinical services.

Interventions to Promote Physical Activity and Healthy Digital Media Use in Children and Adolescents: A Systematic Review

OBJECTIVES

To identify effective interventions that promote healthy screen time use and reduce sedentary behavior in school-age children and adolescents (SACA) in all settings, over the last 20 years.

METHODS

Searches were conducted from 2000 until March 2021 using PubMed, Embase, Medline, PsycINFO, Ovid SP, The Cochrane Library, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, and the WHO regional databases, including Google Scholar and reference lists of relevant articles and reviews. Randomized-controlled trials and quasi-experimental studies assessing interventions to reduce sedentary behaviors and screen time in healthy SACA (aged 5-19.9 years) globally. Data were extracted by 2 reviewers and where possible, pooled with a random-effects model.

RESULTS

The review included 51 studies, of which 23 were included in meta-analyses with 16 418 children and adolescents. Nondigital randomized-controlled trials reported a small, but significant reduction of TV-specific screen time (minutes per day) (mean difference, -12.46; 95% confidence interval, -20.82 to -4.10; moderate quality of evidence) and sedentary behavior (minutes per day) (mean difference, -3.86; 95% confidence interval, -6.30 to -1.41; participants = 8920; studies = 8; P = .002; moderate quality of evidence) as compared with control groups. For quasi-experimental studies, nondigital interventions may make little or no difference on screen time (minutes per day) or sedentary behavior (minutes per day), given the high uncertainty of evidence. Most studies were conducted in a high-income country. Generalizability of results to low- and middle- income countries remain limited.

CONCLUSIONS

Public health policies and programs will be necessary to reduce excessive sedentary behavior and screen time, especially in the post-coronavirus disease 2019 reality.

Moderating Role of Physical Fitness in the Association Between TV Time and Adiposity Parameters in Adolescents

PURPOSE

To identify whether physical fitness (PF) components play a moderating role in the relationship between TV time and adiposity levels.

DESIGN

Cross-sectional study.

SETTING

Few studies have examined if different PF levels modify the association between TV time and adiposity in adolescents. Studies often focus on the isolated relationships between obesity and TV time, or obesity and PF levels.

SUBJECTS

1071 adolescents (617 girls), aged 12 to 17 years.

MEASURES

Cardiorespiratory fitness (CRF), abdominal muscular endurance, and lower limb strength were evaluated using the protocols of the Projeto Esporte Brasil fitness testing battery. TV time was obtained using a self-reported questionnaire. Body mass index (BMI) and waist circumference (WC) were also assessed. Moderation analyses were conducted through multiple linear regression models with the following associations tested in different models: PF components, TV time, and interaction (PF component x TV time) with adiposity parameters (BMI and WC).

RESULTS

A significant interaction term was found for CRF and TV time in the association with both WC (β: -.005; 95% CI: -.009; -.001; P = .012) and BMI (β: -.002; 95% CI: -.004; -.001; P = .009).

CONCLUSION

CRF moderates the relationship between TV time and adiposity measures in this cross-sectional analysis. These data support strategies looking at increasing physical activity levels to improve CRF and avoid the development of excess abdominal obesity and excess weight.

Correlates of screen-based behaviors among adults from the 2019 Brazilian National Health Survey

We aimed to investigate correlates of TV viewing and other types of screen-based behaviors in a nationally representative sample of Brazilian adults. In the 2019 Brazilian National Health Survey (including 88,509 adults), TV viewing time and other types of screen behaviors (computer, tablet, and cellphone use) were self-reported and different geographical, sociodemographic, behavioral, and health status factors were investigated as potential correlates. Multinomial logistic regression models were used for the main analyses. Living in capital cities, urban areas, being unemployed, high consumption of soft drinks, obesity, and elevated depressive symptoms were each associated with more TV viewing and more time using other types of screens. There were differential associations between TV viewing and the use of other types of screen across age and socioeconomic variables. For instance, younger adults have a more diverse portfolio of screen time than older adults. To conclude, levels of screen-based behaviors vary by geographical, sociodemographic, behavioral, and health status characteristics. Interventions should focus on high-risk population groups and may benefit from targeting specific sedentary behaviors of interest.

The role of motivation on physical activity and screen time behaviors among parent-adolescent dyads: The FLASHE study

Behavioral theories inform the development of lifestyle interventions to address low participation in physical activity (PA); however, relatively little is known about the value of self-determination theory (SDT) for explaining screen time (ST) behaviors or in extending SDT into a dyadic context. Actor-partner (i.e., parent-adolescent) interdependence models (APIMs) allow for examination of these interpersonal relationships. The purpose of this study was to examine PA and ST among parent-adolescent dyads using the cross-sectional Family Life, Activity, Sun, Health, and Eating (FLASHE) Study. Parent-adolescent dyads provided responses to online surveys addressing PA (n = 1177 dyads) and ST (n = 1489 dyads) behaviors. We examined the influence of SDT-based constructs (perceived competence and motivation) on PA and ST behaviors. Structural equations were used to estimate APIMs in STATA 15.1. Full models provided a good fit to the data. For both PA and ST, perceived competence was more strongly associated with motivation among adolescents compared with parents (PA: β = 0.72 vs. 0.58, ST: β = 0.34 vs. 0.22, p's < 0.001). Parental motivation was associated with parental PA and both adolescent motivation for PA and ST (p's < 0.001). Parental motivation was not associated with adolescent ST-behavior. Adolescent motivation was only associated with parent motivation for PA. In the FLASHE study, SDT constructs extend acceptably to the dyadic setting, with PA models providing a slightly better fit to the data than ST models. Longitudinal studies that target perceived competence and the self-regulation of motivation in parents and their adolescents are a next logical step to understanding both PA and ST behaviors.

Association of mentally-active and mentally-passive sedentary behaviour with depressive symptoms among adolescents

BACKGROUND

The evidence on the association between sedentary behaviour and depression in adolescence is mixed. We aimed to investigate the association between mentally-active and mentally-passive sedentary behaviours at 11 years (11y) and depressive symptoms at 14y, and to examine potential mediators.

METHODS

UK Millennium Cohort Study data were used (n=7,124; 49% boys). At 11y, participants self-reported frequency of mentally-passive (listening to music, internet use) and mentally-active sedentary behaviours (reading, playing electronic games). Additional parental-reported behaviours (mentally-passive: TV viewing; mentally-active: homework) were summed with self-reported behaviours to represent continuous indicators of mentally-active and mentally-passive sedentary behaviour. Depressive symptoms were assessed (at 11y and 14y) using the short-version of Mood and Feelings Questionnaire. Body mass index (BMI), mentally-passive sedentary behaviour and cognition at 14y were examined as potential mediators. Linear regression models were adjusted for confounders and stratified by sex. Subsequent mediation analyses reporting e-values were used to assess unmeasured confounding.

RESULTS

Among girls, mentally-passive sedentary behaviour at 11y was associated with later depressive symptoms (14y) [β:0.089 (95%CI:0.055-0.122), e-value:1.32]. This association was mediated by BMI [5.6% (95%CI:4.1%-8.6%)] and mentally-passive sedentary behaviour [105.6% (95%CI:79.6%-156.7%)]. No associations were observed in boys or between mentally-active sedentary behaviour and later depressive symptoms.

LIMITATIONS

The parental report of behaviours and the assessment of mediators and outcome in the same wave are the main limitations.

CONCLUSION

Future interventions aiming to improve mental health among girls could aim to reduce mentally-passive sedentary behaviour in early teens and could target potential mediators including BMI.

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.

Limiting Television to Reduce Childhood Obesity: Cost-Effectiveness of Five Population Strategies

Objective: To quantify the potential population-wide costs, number of individuals reached, and impact on obesity of five effective interventions to reduce children's television viewing if implemented nationally. Study Design: Utilizing evidence from systematic reviews, the Childhood Obesity Intervention Cost Effectiveness Study (CHOICES) microsimulation model estimated the cost, population reach, and impact on childhood obesity from 2020 to 2030 of five hypothetical policy strategies to reduce the negative impact of children's TV exposure: (1) eliminating the tax deductibility of food and beverage advertising; (2) targeting TV reduction during home visiting programs; (3) motivational interviewing to reduce home television time at Women, Infants, and Children (WIC) clinic visits; (4) adoption of a television-reduction curriculum in child care; and (5) limiting noneducational television in licensed child care settings. Results: Eliminating the tax deductibility of food advertising could reach the most children [106 million, 95% uncertainty interval (UI): 105-107 million], prevent the most cases of obesity (78,700, 95% UI: 30,200-130,000), and save more in health care costs than it costs to implement. Strategies targeting young children in child care and WIC also cost little to implement (between $0.19 and $32.73 per child reached), and, although reaching fewer children because of the restricted age range, were estimated to prevent between 25,500 (95% UI: 4600-59,300) and 35,400 (95% UI: 13,200-62,100) cases of obesity. Home visiting to reduce television viewing had high costs and a low reach. Conclusions: Interventions to reduce television exposure across a range of settings, if implemented widely, could help prevent childhood obesity in the population at relatively low cost.

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.

Associations between neighbourhood built characteristics and sedentary behaviours among Canadian men and women: findings from Alberta's Tomorrow Project

Evidence of associations between neighbourhood built characteristics and sedentary behaviours is mixed. The study aim was to investigate the associations between objectively-derived neighbourhood built characteristics and self-reported sedentary behaviours among Canadian men and women. This study sourced survey data from Alberta's Tomorrow Project (2008; n = 14,785), in which sitting and motor vehicle travel times during the last 7 days was measured. Geographic Information System was used to calculate neighbourhood built characteristics within a 400 m buffer of participant's home and a walkability score was estimated. To estimate the associations between neighbourhood characteristics and sedentary behaviours, covariate-adjusted generalized linear regression models were used. Walkability, 3-way intersections, and population count were positively associated with sitting time. Business destinations and greenness were negatively associated with sitting time. Walkability, 3-way, and 4-way intersections were negatively associated with motor vehicle travel time. Sex-specific associations between neighbourhood characteristics and sedentary behaviour were found. Among men, business destinations were negatively associated with sitting time, and 3-way intersections, population count, and walkability were negatively associated with motor vehicle travel time. Among women, Normalized Difference Vegetation Index was negatively associated with sitting time. Interventions to reduce sedentary behaviours may need to target neighbourhoods that have built characteristics which might support these behaviours. More research is needed to disentangle the complex relationships between different neighbourhood built characteristics and specific types of sedentary behaviour.

Behavioral Medicine for Sedentary Behavior, Daily Physical Activity, and Exercise to Prevent Cardiovascular Disease: A Review

PURPOSE OF REVIEW

Behavioral medicine is a multidisciplinary field that has a key role in reducing risk factors for cardiovascular disease (CVD). The purpose of this review is to describe the role of behavioral medicine for CVD prevention, using physical activity behaviors (e.g., sedentary behavior, daily physical activity, or exercise) as an exemplar. Application of behavioral medicine to improve dietary behaviors is also briefly discussed.

RECENT FINDINGS

Behavioral medicine interventions that address physical activity behaviors are associated with improved cardiovascular risk factors. Interventions framed in behavior change theory that integrate behavior change techniques to reduce sedentary behavior and promote daily physical activity and exercise have similarly been applied to improve certain dietary behaviors and show promise for reducing CVD risk factors. Behavioral medicine has an important role in improving various physical activity behaviors for all populations, which is essential for preventing or managing CVD. Further investigation into behavioral medicine interventions that address personal, environmental, and social factors that influence participation in physical activity behaviors, as well as the adoption of a more optimal dietary pattern, is warranted.

Patients' Perspectives about Lifestyle Behaviors and Health in the Context of Family Medicine: A Cross-Sectional Study in Portugal

Lifestyle interventions are recognized as essential in the prevention and treatment of non-communicable diseases. Previous studies have shown that Portuguese patients tend to give more importance to diagnostic and laboratory tests than to lifestyle measures, and seem unaware that behavioral risks are the main modifiable risk factors. The study aimed to analyze patients’ perspectives about lifestyle behaviors and health in the context of family medicine in Portugal. A population-based cross-sectional study was carried out in Portugal (the mainland). A total of 900 Portuguese patients aged ≥20 years, representative of the population, were surveyed using face-to-face questionnaires. Participants were selected by the random route method. Descriptive statistics and non-parametric tests were performed to evaluate differences between the personal beliefs and the personal behavior self-assessment, as well as between the level of importance given to the family doctor to address health behaviors and the reported approach implemented by the family doctor, and its association with bio-demographic variables. The results indicate that the vast majority of this Portuguese cohort has informed beliefs regarding lifestyle behaviors, tends to overestimate their own behavior self-assessment, and strongly agrees that it is important that their family doctor asks/advises on these lifestyle behaviors, although the proportion of those who totally agree that their family doctor usually does this is significantly lower. Differences concerning bio-demographic variables were found. Future research directions should focus on the politics, economics, and policy aspects that may have an impact in this area. It will also be important to understand more broadly the relationships between lifestyle behaviors and clinical, physical, and sociodemographic variables.

The effect of computer game playing habits of university students on their sleep states

OBJECTIVE

The aim of this study is to evaluate the effect of computer game playing habits of university students on their sleep states.

DESIGN AND METHODS

The study was conducted cross-sectionally with the online survey method.

FINDING

In this study, it was determined that the students who played games for an average of ≥2 hours per day had later bedtime and later wake-up time, poorer sleep quality, and higher daytime sleepiness. It was found that as the level of game addiction increased, sleep quality decreased, the severity of daytime sleepiness increased, and the wake-up time shifted to a later time.

PRACTICE IMPLICATIONS

Nurses should develop effective intervention strategies involving technology management and sleep hygiene studies to reduce game-playing time of students.

Screen Time and Cardiovascular Risks Among Middle-Aged Women

BACKGROUND

Screen time is a marker of sedentary behavior that threatens the health of women. Extended screen time is associated with depression, insomnia, cardiovascular disease, and decreased quality of life.

OBJECTIVE

In this study, we examined the factors associated with screen time and whether screen time is associated with the physiological and psychosocial health of middle-aged women. We applied a psycho-socioeconomic biobehavioral model of health and studied the outcomes of cardiometabolic biomarkers, insomnia, and quality of life.

METHODS

Secondary data analysis was performed using data from a cross-sectional study conducted with 423 women between 40 and 65 years of age. Socioeconomic, physiological, psychosocial, and behavioral characteristics were measured. Self-reported screen time during the past week was measured using an ordinal scale. The data were analyzed using multivariate analysis of covariance, analysis of covariance, and logistic regression analysis.

RESULTS

Twenty-four percent of subjects had at least 3 hours per day of screen time on weekdays, whereas 30.7% had at least 3 hours per day on weekends. Older women, unemployed women, and those who do not perform regular exercise were more likely to have at least 3 hours per day of screen time (P < .05). Screen time was associated with total cholesterol and low-density lipoprotein cholesterol levels, insomnia, and menopause-specific quality of life (P < .05).

CONCLUSIONS

Based on a psycho-socioeconomic biobehavioral framework, we found that screen time is associated with the physiological and psychosocial health of women independent of socioeconomic and biobehavioral variables. Efforts to reduce the amount of screen time targeting middle-aged women will help improve cardiometabolic biomarkers and quality of life.

The effectiveness of sedentary behaviour interventions on sitting time and screen time in children and adults: an umbrella review of systematic reviews

BACKGROUND

There is increasing concern about the time people spend in sedentary behaviour, including screen time, leisure and occupational sitting. The number of both primary research studies (published trials) and reviews has been growing rapidly in this research area. A summary of the highest level of evidence that provides a broader quantitative synthesis of diverse types of interventions is needed. This research is to articulate the evidence of efficacy of sedentary behaviour interventions to inform interventions to reduce sitting time. The umbrella review, therefore, synthesised systematic reviews that conducted meta-analyses of interventions aiming at reducing sedentary behaviour outcomes across all age group and settings.

METHOD

A systematic search was conducted on six databases (MEDLINE Complete, PsycINFO, CINAHL, Global Health via EBSCOhost platform, EMBASE, and Cochrane Central Register of Systematic Reviews). Included articles were systematic reviews with meta-analysis of interventions aiming at reducing sedentary behaviour (screen time, sitting time or sedentary time) in the general population across all age group.

RESULTS

Seventeen reviews met the inclusion criteria (7 in children and adolescent, 10 in adults). All reviews of sedentary behaviour interventions in children and adolescents investigated intervention effectiveness in reducing screen time. Six out of 11 meta-analyses (reported in 7 reviews) showed small but significant changes in viewing time. All reviews of sedentary behaviour interventions in office workplaces indicated substantial reduction in occupational sitting time (range: 39.6 to 100 min per 8-h workday). Sub-group analyses reported a trend favouring environmental change components such as sit-stand desks, active permissive workstations etc. Meta-analyses indicated that sedentary behaviour interventions were superior to physical activity alone interventions or combined physical activity and sedentary behaviour interventions in reducing sitting time.

CONCLUSION

The current systematic reviews and meta-analyses supported sedentary behaviour interventions for reducing occupational sitting time in particular, with small changes seen in screen time in children and adolescents. Future research should explore approaches to maintaining behaviour change beyond the intervention period and investigate the potential of sedentary behaviour reduction interventions in older age groups in non-occupational settings.

Demographic, psychological, behavioral, and cognitive correlates of BMI in youth: Findings from the Adolescent Brain Cognitive Development (ABCD) study

BACKGROUND

Previous research has implicated demographic, psychological, behavioral, and cognitive variables in the onset and maintenance of pediatric overweight/obesity. No adequately-powered study has simultaneously modeled these variables to assess their relative associations with body mass index (BMI; kg/m2) in a nationally representative sample of youth.

METHODS

Multiple machine learning regression approaches were employed to estimate the relative importance of 43 demographic, psychological, behavioral, and cognitive variables previously associated with BMI in youth to elucidate the associations of both fixed (e.g. demographics) and potentially modifiable (e.g. psychological/behavioral) variables with BMI in a diverse representative sample of youth. The primary analyses consisted of 9-10 year olds divided into a training (n = 2724) and test (n = 1123) sets. Secondary analyses were conducted by sex, ethnicity, and race.

RESULTS

The full sample model captured 12% of the variance in both the training and test sets, suggesting good generalizability. Stimulant medications and demographic factors were most strongly associated with BMI. Lower attention problems and matrix reasoning (i.e. nonverbal abstract problem solving and inductive reasoning) and higher social problems and screen time were robust positive correlates in the primary analyses and in analyses separated by sex.

CONCLUSIONS

Beyond demographics and stimulant use, this study highlights abstract reasoning as an important cognitive variable and reaffirms social problems and screen time as significant correlates of BMI and as modifiable therapeutic targets. Prospective data are needed to understand the predictive power of these variables for BMI gain.

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.

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.

Video Games, Obesity, and Children

PURPOSE OF REVIEW

To examine associations between video game play and obesity in children.

RECENT FINDINGS

Based on a scoping review of 26 studies (25 cross-sectional; 1 longitudinal) published in 2013-2018, 14 studies (53%) reported no association between video game play and obesity, and 12 studies reported positive associations. In a review of 8 systematic reviews, there was preliminary evidence on the effectiveness of exergame (physically active) play for weight reduction and to attenuate weight gain but little indication that interventions effectively reduced video game play or general screen time. This review found ambiguous evidence on the extent to which video game play is or is not significantly associated with obesity in children and preliminary evidence of exergame play as a tool for weight reduction and attenuation of weight gain. Several gaps existed in understanding the relationship between video game play and obesity, and prospective and interventional trials are needed.

Reducing screen-time and unhealthy snacking in 9-11 year old children: the Kids FIRST pilot randomised controlled trial

Background

Many young people form unhealthy behavioural habits, such as low intake of fruit and vegetables, high intake of energy-dense snack foods, and excessive sedentary screen-based behaviours. However, there is a shortage of parent-and home-focused interventions to change multiple health behaviours in children.

Methods

Kids FIRST was a 12-week, home- and school-based pilot randomised controlled trial to reduce screen-time and unhealthy snacking with assessments at pre- (baseline) and post-intervention. Four UK schools were randomised to control or one of three interventions targeting reductions in (1) screen-time and unhealthy snacking (ST + Sn), (2) screen-time (ST only), (3) unhealthy snacking (Sn only), and parents with children aged 9–11 years were recruited via schools. Intervention group parents received four online ‘sessions’ and four packages of resources tailored to each group. Children received four 30-min lessons during school time. Children and parents reported their own screen-time behaviours, children reported their own snacking behaviours. Descriptive analyses were undertaken using principles of intention to treat.

Results

Initial feasibility was shown in that this study successfully recruited schools and families into all four study arms and retained them over a period of 13 weeks (retention rate ≥ 74%). Seventy-five children and 64 parents provided full baseline questionnaire data. Reductions in children’s school day and weekend day TV/DVD viewing and computer game use were found in the ST + Sn and ST groups, while self-reported smartphone use increased in these groups. Similar results were found for parents’ TV/DVD, computer and smartphone use in these groups. Little to no changes were found in reports of the dietary variables assessed in any intervention group for children or parents.

Conclusions

These preliminary findings show some promise for the Kids FIRST intervention. Based on these findings, a future full trial should recruit a more diverse sample of families and optimise the intervention and intervention resources to more fully engage parents with the dietary-based components of the intervention programme, where fewer changes were seen. Although most parents reporting receiving the intervention resources, further development work is required to achieve higher levels of engagement. This might include greater parent and child engagement work early in the development of the project.

Trial registration

Retrospectively registered in June 21st 2019 with ClinicalTrials.gov (number NCT03993652).

Parental Perception of Flourishing in School-Aged Children: 2011-2012 National Survey of Children's Health

OBJECTIVE

Flourishing reflects positive mental health and thriving and is important for children's development and well-being. Few national studies of flourishing among school-aged children exist. Exposure to socioeconomic disadvantage is negatively associated with social and health outcomes, including flourishing. This analysis describes independent associations of the child, family, school, and neighborhood factors with flourishing, which we hypothesized may contribute to sociodemographic disparities.

METHODS

Data from the 2011-2012 National Survey of Children's Health were used to examine parental perception of flourishing among school-aged children (6-17 years of age; n = 59,362). Flourishing was defined as curiosity about learning, resilience, and self-regulation. Unadjusted and adjusted associations between sociodemographic, child, family, school and neighborhood factors and flourishing were explored using χ tests and sequential logistic regression models.

RESULTS

Overall, 48.4% of school-aged children were perceived by parents to be flourishing. There were significant sociodemographic disparities with non-Hispanic black children (37.4%) and those below the federal poverty level (37.9%) among the least likely to flourish. After adjustment, sex, race/ethnicity, parent education, child's age, physical activity, special health care needs status, adequate sleep, adverse childhood experiences, family meals, hours of television watched, extracurricular activities, school safety, neighborhood safety, neighborhood support, and presence of amenities were significantly associated with flourishing (p < 0.05). Disparities by poverty level and household structure were no longer significant.

CONCLUSION

Addressing factors associated with parent-perceived flourishing including child, family, school and neighborhood factors such as physical activity, adequate sleep, and school/neighborhood safety may promote flourishing and reduce disparities.

Association Between Screen Media Use and Academic Performance Among Children and Adolescents: A Systematic Review and Meta-analysis

IMPORTANCE

The health consequences of excessive screen media use in children and adolescents are increasingly being recognized; however, the association between screen media use and academic performance remains to be elucidated.

OBJECTIVES

To estimate the association of time spent on screen-based activities with specific academic performance areas in children and adolescents and to examine this association separately in these populations.

DATA SOURCES

MEDLINE, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and ERIC were searched from database inception through September 2018.

STUDY SELECTION

Cross-sectional studies of the association between time or frequency of screen media use and academic performance in children and adolescents were independently screened by 2 researchers. A total of 5599 studies, published between 1958 and 2018 from 23 countries, were identified.

DATA EXTRACTION AND SYNTHESIS

Data were processed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Random-effects models were used to estimate the pooled effect size (ES).

MAIN OUTCOMES AND MEASURES

Academic performance areas included composite scores, language, and mathematics. Screen media measurements included time or frequency of computer, internet, mobile phone, television, video game, and overall screen media use.

RESULTS

In total, 58 cross-sectional studies (1.0%) of 5599 articles were included in the systematic review, of which 30 (52%) were included in the meta-analysis. The systematic review studies involved 480 479 participants aged 4 to 18 years, ranging from 30 to 192 000 people per study, and the meta-analysis studies involved 106 653 total participants, ranging from 70 to 42 041 people per study. Across studies, the amount of time spent on overall screen media use was not associated with academic performance (ES = -0.29; 95% CI, -0.65 to 0.08). Individually, television viewing was inversely associated with composite academic performance scores (ES = -0.19; 95% CI, -0.29 to -0.09), language (ES = -0.18; 95% CI, -0.36 to -0.01), and mathematics (ES = -0.25; 95% CI, -0.33 to -0.16). Video game playing was inversely associated with composite scores (ES = -0.15; 95% CI, -0.22 to -0.08). Subgroup analyses found that television viewing was inversely associated with language only in children (ES = -0.20; 95% CI, -0.26 to -0.15), whereas both television viewing (ES = -0.19; 95% CI, -0.30 to -0.07) and video game playing (ES = -0.16; 95% CI, -0.24 to -0.09) were inversely associated with composite scores only in adolescents.

CONCLUSIONS AND RELEVANCE

Findings from this study suggest that each screen-based activity should be analyzed individually for its association with academic performance, particularly television viewing and video game playing, which appeared to be the activities most negatively associated with academic outcomes. Education and public health professionals should consider supervision and reduction to improve the academic performance of children and adolescents exposed to these activities.

Severe Obesity in the Pediatric Population: Current Concepts in Clinical Care

PURPOSE OF REVIEW

This review describes (1) the clinical assessment of pediatric patients with severe obesity, including a summary of salient biological, psychological, and social factors that may be contributing to the patient's obesity and (2) the current state of treatment strategies for pediatric severe obesity, including lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery.

RECENT FINDINGS

Lifestyle modification therapy alone is insufficient for achieving clinically significant BMI reduction for most youth with severe obesity and metabolic and bariatric surgery, though effective and durable, is not a scalable treatment strategy. Pharmacological agents in the pipeline may 1 day fill this gap in treatment. Treatment of severe pediatric obesity requires a chronic care management approach utilizing multidisciplinary teams of health care providers and multi-pronged therapies.

Microsimulation model of child and adolescent overweight: making use of what we already know

BACKGROUND

New Zealand has high rates of child overweight and obesity when compared with other countries. Despite an abundance of research documenting the problem, it is unclear what the most effective policy changes or interventions are, and how policy changes might unfold over time within complex systems.

METHODS

We use estimates derived from meta-analyses to create a dynamic microsimulation model of child overweight (including obesity). Using census records we created a synthetic birth cohort of 10,000 children. Information on parental education, ethnicity and father's socio-economic position at birth were taken from census records. We used the New Zealand Health Survey to estimate population base rates for the prevalence of overweight and obesity. Information on other modifiers (such as maternal smoking, breastfeeding, preterm birth, regular breakfast consumption and so forth) were taken from three birth cohorts: Christchurch Health and Development Study, The Dunedin Multidisciplinary Health and Development Study and the Pacific Islands Families Study. Published intervention studies were used to derive plausible estimates for changes to modifiers.

RESULTS

Reducing the proportion of mothers classified as overweight and obesity (-3.31(95% CI -3.55; -3.07) percentage points), reducing the proportion of children watching two or more hours of TV (-3.78(95% CI -4.01; -3.54)), increasing the proportion of children eating breakfast regularly (-1.71(95% CI -1.96; -1.46)), and reducing the proportion of children born with high birth weights (-1.36(95% CI -1.61; -1.11)), lead to sizable decreases in the estimated prevalence of child overweight (including obesity). Reducing the proportion of mothers giving birth by caesarean (-0.23(95% CI -0.49; -0.23)) and increasing parental education (-0.07(95% CI -0.31; 0.18)) did not impact upon child overweight rates.

CONCLUSIONS

We created a working simulation model of New Zealand children that can be accessed by policy makers and researchers to determine known relationships between predictors and child overweight, as well as potential gains from targeting specific pathways.

The association between television viewing time and percent body fat in adults varies as a function of physical activity and sex

BACKGROUND

Data suggest that sedentary behavior is an independent risk factor for obesity; however, the extent to which physical activity (PA) and sex alter this relationship remains unclear. To address this gap, the current study examined the association between television (TV) viewing time and percent body fat (%BF) as a function of PA level and sex.

METHODS

Trained interviewers assessed 454 adults at their place of residence. Participants completed questionnaires to determine h of TV watched per week, PA level (inactive = not meeting PA guidelines vs. active = meeting PA guideline), and covariates including demographics (e.g., sex), depression symptoms, perceived stress, fruit and vegetable intake, and environmental support for PA. Foot-to-foot bioelectrical impedance (Tanita TBF-300, Tokyo, Japan) was used to assess %BF. Mixed models were generated to examine the association between TV h/wk. and %BF as a function of PA level and sex while accounting for the multi-level nature of the data (neighborhood- and individual-levels) and covariates.

RESULTS

Participants were 44.4 ± 14.0 (Mean + Standard Deviation) years of age with 33.2 ± 11.1%BF, and watched 19.3 ± 15.5 h/wk. of TV. Most were female (70.9%) and inactive (63.2%). Mixed model regression demonstrated that among inactive participants, each additional h of TV viewed/wk. was associated with a 1.03% increase in %BF; TV h/wk. and %BF were not associated in active adults. When models were further stratified by sex, h of TV viewed/wk. were significantly associated with %BF only in inactive females. Each additional h of TV viewed/wk. was associated with an increase in %BF of 1.14%.

CONCLUSION

Interventions targeting PA and/or TV viewing time may be a high-priority to curb excess BF accumulation especially among inactive females.

Impact of a classroom standing desk intervention on daily objectively measured sedentary behavior and physical activity in youth

OBJECTIVES

We investigated the impact of a standing desk intervention on daily objectively monitored sedentary behavior and physical activity in 6th grade school students.

DESIGN

Cluster non-randomised controlled trial.

METHOD

Two classes (intervention students: n=22 [aged 11.8±0.4years]; control students: n=27 [11.6±0.5years]) from a public school in Lisbon were selected. The intervention involved replacing traditional seated classroom desks for standing desks, for a total duration of 16 weeks, in addition to performing teacher training and holding education/motivation sessions with students and parents. Sedentary behavior (ActivPAL inclinometer) and physical activity (Actigraph GT3X+ accelerometer) were measured for seven days immediately before and after the intervention.

RESULTS

There were no differences in baseline behaviors between intervention and control groups (p>0.05). At follow-up (16 weeks), it was observed that the intervention group had decreased time spent sitting (total week: -6.8% and at school: -13.0% relative to baseline) and increased standing (total week: 16.5% and at school: 31.0%) based on inclinometer values (p-value for interaction group*time <0.05). No significant differences in activity outcomes were observed outside school time (week or weekend) between groups.

CONCLUSION

We conclude that a 16 week classroom standing desk intervention successfully reduced sitting time and increase standing time at school, with no observed compensatory effects outside of school time.

Effectiveness of interventions to control screen use and children's sleep, cognitive and behavioral outcomes: a systematic review protocol

REVIEW QUESTIONS.

INSIGHT responsive parenting intervention reduces infant's screen time and television exposure

Background

Sedentary behaviors, including screen time, in childhood have been associated with an increased risk for overweight. Beginning in infancy, we sought to reduce screen time and television exposure and increase time spent in interactive play as one component of a responsive parenting (RP) intervention designed for obesity prevention.

Methods

The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study is a randomized trial comparing a RP intervention with a safety control intervention. Primiparous mother-newborn dyads (N = 279) were randomized after childbirth. Research nurses delivered intervention content at infant ages 3, 16, 28, and 40 weeks and research center visits at 1 and 2 years. As one component of INSIGHT, developmentally appropriate messages on minimizing screen time, reducing television exposure in the home, and promoting parent-child engagement through interactive play were delivered. Mothers self-reported their infant’s screen time at ages 44 weeks, 1, 1.5, 2 and 2.5 years; interactive play was reported at 8 and 20 weeks and 2 years.

Results

More RP than control parents reported their infants met the American Academy of Pediatrics’ no screen time recommendation at 44 weeks (53.0% vs. 30.2%) and at 1 year on weekdays (42.5% vs. 27.6%) and weekends (45.5% vs. 26.8%), but not after age 1 year. RP mothers and RP children had less daily screen time than controls at each time point (p ≤ 0.01). Fewer RP than control group mothers reported the television was ever on during infant meals (p < 0.05). The frequency of tummy time and floor play did not differ by study group; approximately 95% of infants spent time in restrictive devices (i.e. swing) at 8 and 20 weeks. At 2 years of age, there were no study group differences for time children spent in interactive play.

Conclusion

From infancy to early childhood, the INSIGHT RP intervention reduced screen time and television exposure, but did not increase the frequency or amount of interactive play.

Trial registration

clinicaltrials.gov NCT01167270. Registered on 21 July 2010.

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0657-5) contains supplementary material, which is available to authorized users.

Personalized Physical Activity Coaching: A Machine Learning Approach

Living a sedentary lifestyle is one of the major causes of numerous health problems. To encourage employees to lead a less sedentary life, the Hanze University started a health promotion program. One of the interventions in the program was the use of an activity tracker to record participants' daily step count. The daily step count served as input for a fortnightly coaching session. In this paper, we investigate the possibility of automating part of the coaching procedure on physical activity by providing personalized feedback throughout the day on a participant's progress in achieving a personal step goal. The gathered step count data was used to train eight different machine learning algorithms to make hourly estimations of the probability of achieving a personalized, daily steps threshold. In 80% of the individual cases, the Random Forest algorithm was the best performing algorithm (mean accuracy = 0.93, range = 0.88-0.99, and mean F1-score = 0.90, range = 0.87-0.94). To demonstrate the practical usefulness of these models, we developed a proof-of-concept Web application that provides personalized feedback about whether a participant is expected to reach his or her daily threshold. We argue that the use of machine learning could become an invaluable asset in the process of automated personalized coaching. The individualized algorithms allow for predicting physical activity during the day and provides the possibility to intervene in time.

Effectiveness of interventions for reducing non-occupational sedentary behaviour in adults and older adults: a systematic review and meta-analysis

Background

No systematic reviews of the effectiveness of interventions for reducing non-occupational sedentary behaviour are available. Therefore, the aim of this systematic review was to assess the effectiveness of interventions for reducing non-occupational sedentary behaviour in adults and older adults.

Methods

An electronic search of nine databases was performed. Randomised controlled trials (RCT) and cluster RCTs among adults testing the effectiveness of interventions aimed to reduce non-occupational sedentary behaviour were considered for inclusion. Two review authors independently screened studies for eligibility, completed data extraction and assessed the risk of bias.

Results

Nineteen studies that evaluated multicomponent lifestyle interventions, counselling or education, television (TV) control devices and workplace interventions were included. Evidence from the meta-analyses suggested that interventions can reduce leisure sitting time in adults in the medium term (−30 min/day; 95% CI −58 to –2), and TV viewing in the short term (−61 min/day; 95% CI −79 to –43) and medium term (−11 min/day; 95% CI −20 to –2). No significant pooled effects were found for transport sitting time, leisure-time computer use and longer term outcomes. No evidence was available on the effectiveness of interventions for reducing non-occupational sedentary time in older adults.

Conclusions

The findings of this systematic review suggest the interventions may be effective in reducing non-occupational sedentary behaviour in the short to medium term in adults. However, no significant effect was found on longer term outcomes. The quality of evidence was, however, low to very low. No evidence was available on the effectiveness of non-occupational interventions on reducing sedentary time in older adults. Further high-quality research with larger samples is warranted.

Screen time is associated with adiposity and insulin resistance in children

BACKGROUND

Higher screen time is associated with type 2 diabetes (T2D) risk in adults, but the association with T2D risk markers in children is unclear. We examined associations between self-reported screen time and T2D risk markers in children.

METHODS

Survey of 4495 children aged 9-10 years who had fasting cardiometabolic risk marker assessments, anthropometry measurements and reported daily screen time; objective physical activity was measured in a subset of 2031 children.

RESULTS

Compared with an hour or less screen time daily, those reporting screen time over 3 hours had higher ponderal index (1.9%, 95% CI 0.5% to 3.4%), skinfold thickness (4.5%, 0.2% to 8.8%), fat mass index (3.3%, 0.0% to 6.7%), leptin (9.2%, 1.1% to 18.0%) and insulin resistance (10.5%, 4.9% to 16.4%); associations with glucose, HbA1c, physical activity and cardiovascular risk markers were weak or absent. Associations with insulin resistance remained after adjustment for adiposity, socioeconomic markers and physical activity.

CONCLUSIONS

Strong graded associations between screen time, adiposity and insulin resistance suggest that reducing screen time could facilitate early T2D prevention. While these observations are of considerable public health interest, evidence from randomised controlled trials is needed to suggest causality.

Sedentary behaviour and adiposity in youth: a systematic review of reviews and analysis of causality

Background

Sedentary behaviour (sitting time) has becoming a very popular topic for research and translation since early studies on TV viewing in children in the 1980s. The most studied area for sedentary behaviour health outcomes has been adiposity in young people. However, the literature is replete with inconsistencies.

Methods

We conducted a systematic review of systematic reviews and meta-analyses to provide a comprehensive analysis of evidence and state-of-the-art synthesis on whether sedentary behaviours are associated with adiposity in young people, and to what extent any association can be considered ‘causal’. Searches yielded 29 systematic reviews of over 450 separate papers. We analysed results by observational (cross-sectional and longitudinal) and intervention designs.

Results

Small associations were reported for screen time and adiposity from cross-sectional evidence, but associations were less consistent from longitudinal studies. Studies using objective accelerometer measures of sedentary behaviour yielded null associations. Most studies assessed BMI/BMI-z. Interventions to reduce sedentary behaviour produced modest effects for weight status and adiposity. Accounting for effects from sedentary behaviour reduction alone is difficult as many interventions included additional changes in behaviour, such as physical activity and dietary intake. Analysis of causality guided by the classic Bradford Hill criteria concluded that there is no evidence for a causal association between sedentary behaviour and adiposity in youth, although a small dose-response association exists.

Conclusions

Associations between sedentary behaviour and adiposity in children and adolescents are small to very small and there is little to no evidence that this association is causal. This remains a complex field with different exposure and outcome measures and research designs. But claims for ‘clear’ associations between sedentary behaviour and adiposity in youth, and certainly for causality, are premature or misguided.