A review of different behavior modification strategies designed to reduce sedentary screen behaviors in children

Sedentary Behavior and Physical Inactivity Among Secondary School Students in the 2017 Sierra Leone Global School-Based Student Health Survey

BACKGROUND

The 2020 World Health Organization Guidelines on Physical Activity and Sedentary Behavior are the first to provide evidence-based recommendations for reducing both dimensions of languorous behavior. The relationship between sitting time and exercise remains understudied among diverse adolescent populations worldwide.

METHODS

The 2017 Sierra Leone Global School-based Student Health Survey was a nationally representative cross-sectional study of secondary school students.

RESULTS

Of the 2798 participants, 82% did not engage in moderate or vigorous physical activity for at least an hour every day, 25% sat for 3 or more hours each day outside of school and homework, and 87% were physically inactive and/or sedentary based on those thresholds. Girls who never or rarely exercised tended to maintain light physical activity outside of school rather than sitting, while boys who exercised daily tended to be sedentary when they were not playing sports.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Students spend their waking hours doing a mix of sitting, light physical activity, and moderate or vigorous physical activity. Schools can help reduce sedentarism and increase movement among students.

CONCLUSIONS

Home, school, and community health interventions may be useful for increasing energy expenditure among adolescents in low- and middle-income countries.

Psychosocial Correlates of Recreational Screen Time among Adolescents

The study objective was to identify the psychosocial correlates of recreational screen time among adolescents. Data collection took place in four high schools from the Chaudière-Appalaches region (Quebec, Canada) from late April to mid-May 2021. A total of 258 French-speaking adolescents (69.8% between 15 and 16 years and 66.3% girls) answered an online questionnaire based on the Reasoned Action Approach. Recreational screen time was measured using the French version of a validated questionnaire. Adolescents reported a mean of 5 h and 52 min/day of recreational screen time. Recreational screen time was associated with being a boy (β = 0.33; p < 0.0001) and intention to limit recreational screen time to a maximum of 2 h/day (β = -0.15; p = 0.0001); this model explained 30% of the variance in behavior. Intention to limit recreational screen time to a maximum of 2 h/day in the next month was associated with attitude (β = 0.49; p < 0.0001), self-identity (β = 0.33; p < 0.0001), being a boy (β = -0.21; p = 0.0109), perceived behavioral control (β = 0.18; p = 0.0016), and injunctive norm (β = 0.17; p < 0.0001); this model explained 70% of the variance in intention. This study identified avenues to design public health interventions aimed at lowering recreational screen time among this population.

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.

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

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.

A Sex/Gender Perspective on Interventions to Reduce Sedentary Behaviour in Girls and Boys: Results of the genEffects Systematic Review

This systematic review aims to evaluate the extent of sex/gender consideration and effectiveness of interventions designed to reduce sedentary behaviour (SB). We searched for randomised or non-randomised controlled trials with the outcome SB and a sex/gender analysis in eleven electronic databases. Sixty-seven studies were included. Sex/gender considerations were qualitatively rated. Sex/gender was reported separately in 44.8% of studies, 14.9% of studies conducted a sex/gender interaction analysis, and 19.4% enrolled either girls or boys. SB was significantly reduced for girls in 16.4%, for boys in 11.9% and for both in 13.4%. No sex/gender intervention effect was found in 38.8%. According to the qualitative rating, studies without significant sex/gender effects reached "detailed" rating twice as often as studies finding a significant intervention effect for either girls or boys, or both. Overall, no clear pattern according to the qualitative rating and in terms of intervention effectiveness can be drawn. The results reveal a lack of sufficient sex/gender information in intervention planning and delivery. Further research should consider analysing sex/gender intervention effects as well as consider sex/gender inclusive intervention planning and delivery.

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).

Psychosocial mediators of screen time reduction after an intervention for students from schools in vulnerable areas: A cluster-randomized controlled trial

OBJECTIVES

To investigate whether psychosocial variables mediate the effect of a multicomponent intervention on screen time reduction among Brazilian students from schools located in vulnerable areas.

DESIGN

A cluster-randomized controlled trial with a 4-month follow-up.

METHODS

This study was conducted with 1085 students (548 in the intervention group and 537 in the control group), aged 11-17years. The intervention strategies focused on training teachers, increasing opportunities for physical activity at school, and reducing screen time, as well as health education. The questionnaire was administered before and after intervention with questions about the amount of time spent on TV and computer/video games on weekdays and weekend days (combined screen time). The potential psychosocial mediators (attitude, self-efficacy, family and school support) were measured through validated scales. Socioeconomic status was used as control variable. Multilevel mediation analyses were conducted using a product-of-coefficients test.

RESULTS

Psychosocial factors were not mediators of the effect of the intervention on screen time. The intervention significantly improved school support for both sexes (boys: 1.307; girls: 0.759; p<0.05) and older students (1.154; p<0.001). Attitude (boys: -0.228; 11-13years: -0.133; 14-17years: -0.152; p<0.05) and self-efficacy scales (boys: -0.040; girls: -0.104; 11-13years: -0.048; 14-17years: -0.100; p<0.05) were associated with reduced screen time.

CONCLUSIONS

The intervention produced a significant improvement of school support for both sexes, as well as older students. Enhancing attitude and self-efficacy may be a useful strategy for reducing screen time among boys and students of any age groups.

TRIAL REGISTRATION

ClinicalTrials.Gov: NCT02439827. Registration date: May 3, 2015.

Clinical Approaches of Whole-Body Vibration Exercises in Individuals with Stroke: A Narrative Revision

Stroke is associated with long-term disability and patients experience numerous physical impairments including muscle weakness, particularly in the paretic limbs, balance, and functional mobility. During acute stroke rehabilitation, when individuals are less likely to be functionally independent and rely on rehabilitative care, the efficacy of low skill interventions that can reduce sedentary behaviour should be established. As such, this narrative revision focused on the use of empirical studies of whole-body vibration exercise (WBVE) on different health outcomes in stroke patients. The effects of WBVE on neuromuscular performance (muscular strength and power), mobility, spasticity, and cardiovascular responses have been highlighted. Although some positive results were reported we can conclude that there is no solid evidence confirming the beneficial effects of WBVE among people with stroke compared with either other types of physical activities or sham WBVE. Therefore, further research should be performed in this area, testing the feasibility and efficacy of using WBVE in a more homogeneous sample of stroke patients or comparing different WBVE parameters.

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

REVIEW QUESTIONS.

[Reduce sedentary behaviour among children - a systematic review]

BACKGROUND AND OBJECTIVES

Sedentary behaviour is itself a health-related behaviour. This systematic review examines whether family-based interventions can reduce sitting time among children and adolescents and which variables moderate potential intervention effects.

METHODS

Using a systematic literature search we identified family-based randomised controlled intervention studies that focus on sedentary behaviour in 3‑ to 18-year-old children and youth. The methodological quality of studies as well as the intervention effects according to different outcomes (screen-based vs. overall sitting) were analysed and evaluated for moderating effects.

RESULTS

Of 29 studies, 17 reported significant effects and 11 studies showed positive trends for reduced sitting time. The content of interventions, the level of theoretical underpinning as well as the methodological quality of studies were heterogeneous. Most often, screen-based sitting and seldom overall sitting was examined. Concise characteristics of intervention success were not clearly apparent. The proportion of positive intervention effects was higher in reducing sitting in front of TVs compared to other outcomes. An analysis of moderators highlighted that intervention programs among pre-schoolers showed more often positive intervention effects.

DISCUSSION

There are many promising opportunities to reduce sitting time using family-based approaches. Statements in terms of replication of interventions and explanations of the effective mechanisms within interventions are limited. Therefore, future interventions should use subjective as well as objective evaluation measures and consider overall sitting time. To strengthen the basis of interventional effort in this research field, a theoretical planning approach is recommended.

Interventions to reduce sedentary behaviour in 0-5-year-olds: a systematic review and meta-analysis of randomised controlled trials

AIM OR OBJECTIVE

To evaluate the effectiveness of behavioural interventions that report sedentary behaviour outcomes during early childhood.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Academic Search Complete, CINAHL Complete, Global Health, MEDLINE Complete, PsycINFO, SPORTDiscus with Full Text and EMBASE electronic databases were searched in March 2016.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Inclusion criteria were: (1) published in a peer-reviewed English language journal; (2) sedentary behaviour outcomes reported; (3) randomised controlled trial (RCT) study design; and (4) participants were children with a mean age of ≤5.9 years and not yet attending primary/elementary school at postintervention.

RESULTS

31 studies were included in the systematic review and 17 studies in the meta-analysis. The overall mean difference in screen time outcomes between groups was -17.12 (95% CI -28.82 to -5.42) min/day with a significant overall intervention effect (Z=2.87, p=0.004). The overall mean difference in sedentary time between groups was -18.91 (95% CI -33.31 to -4.51) min/day with a significant overall intervention effect (Z=2.57, p=0.01). Subgroup analyses suggest that for screen time, interventions of ≥6 months duration and those conducted in a community-based setting are most effective. For sedentary time, interventions targeting physical activity (and reporting changes in sedentary time) are more effective than those directly targeting sedentary time.

SUMMARY/CONCLUSIONS

Despite heterogeneity in study methods and results, overall interventions to reduce sedentary behaviour in early childhood show significant reductions, suggesting that this may be an opportune time to intervene.

TRIAL REGISTRATION NUMBER

CRD42015017090.

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

Previous studies have evaluated the effectiveness of interventions aimed at screen time reduction, but the results have been inconsistent. We therefore conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to summarize the accumulating evidence of the impact of interventions targeting screen time reduction on body mass index (BMI) reduction and screen time reduction. The PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for RCTs on the effect of interventions targeting screen time reduction. The primary and secondary outcomes were the mean difference between the treatment and control groups in the changes in BMI and changes in screen viewing time. A random effects model was used to calculate the pooled mean differences. Fourteen trials including 2238 participants were assessed. The pooled analysis suggested that interventions targeting screen time reduction had a significant effect on BMI reduction (-0.15 kg/m, P < 0.001, I = 0) and on screen time reduction (-4.63 h/w, P = 0.003, I = 94.6%). Subgroup analysis showed that a significant effect of screen time reduction was observed in studies in which the duration of intervention was <7 months and that the types of interventions in those studies were health promotion curricula or counseling. Interventions for screen time reduction might be effective in reducing screen time and preventing excess weight. Further rigorous investigations with larger samples and longer follow-up periods are still needed to evaluate the efficacy of screen time reduction both in children and in adults.

Effectiveness of intervention strategies exclusively targeting reductions in children's sedentary time: a systematic review of the literature

An increasing number of interventions targeting sedentary behaviour in children have emerged in recent years. Recently published reviews included sedentary behaviour and physical activity interventions. This review critically summarizes evidence on the effectiveness of intervention strategies that exclusively targeted reducing sedentary time in children and adolescents. We performed a systematic literature search in Pubmed, Embase and the Cochrane Library through November 2015. Two independent reviewers selected eligible studies, extracted relevant data and rated the methodological quality using the assessment tool for quantitative studies. We included 21 intervention studies, of which 8 studies scored moderate on methodological quality and 13 studies scored weak. Four out of eight moderate quality studies reported significant beneficial intervention effects.Although descriptions of intervention strategies were not always clearly reported, we identified encouragement of a TV turnoff week and implementing standing desks in classrooms as promising strategies. Due to a lack of high quality studies and inconsistent findings, we found no convincing evidence for the effectiveness of existing interventions targeting solely sedentary behaviour. We recommend that future studies apply mediation analyses to explore which strategies are most effective. Furthermore, to increase the effectiveness of interventions, knowledge of children's motives to engage in sedentary behavior is required, as well as their opinion on potentially effective intervention strategies.

Screen Time Weight-loss Intervention Targeting Children at Home (SWITCH): process evaluation of a randomised controlled trial intervention

BACKGROUND

The Screen Time Weight-loss Intervention Targeting Children at Home (SWITCH) trial tested a family intervention to reduce screen-based sedentary behaviour in overweight children. The trial found no significant effect of the intervention on children's screen-based sedentary behaviour. To explore these null findings, we conducted a pre-planned process evaluation, focussing on intervention delivery and uptake.

METHODS

SWITCH was a randomised controlled trial of a 6-month family intervention to reduce screen time in overweight children aged 9-12 years (n = 251). Community workers met with each child's primary caregiver to deliver the intervention content. Community workers underwent standard training and were monitored once by a member of the research team to assess intervention delivery. The primary caregiver implemented the intervention with their child, and self-reported intervention use at 3 and 6 months. An exploratory analysis determined whether child outcomes at 6 months varied by primary caregiver use of the intervention.

RESULTS

Monitoring indicated that community workers delivered all core intervention components to primary caregivers. However, two thirds of primary caregivers reported using any intervention component "sometimes" or less frequently at both time points, suggesting that intervention uptake was poor. Additionally, analyses indicated no effect of primary caregiver intervention use on child outcomes at 6 months, suggesting the intervention itself lacked efficacy.

CONCLUSIONS

Poor uptake, and the efficacy of the intervention itself, may have played a role in the null findings of the SWITCH trial on health behaviour and body composition.

TRIAL REGISTRATION

The trial was registered in the Australian and New Zealand Clinical Trials Registry (no. ACTRN12611000164998 ); registration date: 10/02/2011.

The evaluation of the impact of a stand-biased desk on energy expenditure and physical activity for elementary school students

Due to the increasing prevalence of childhood obesity, the association between classroom furniture and energy expenditure as well as physical activity was examined using a standing-desk intervention in three central-Texas elementary schools. Of the 480 students in the 24 classrooms randomly assigned to either a seated or stand-biased desk equipped classroom, 374 agreed to participate in a week-long data collection during the fall and spring semesters. Each participant’s data was collected using Sensewear^® armbands and was comprised of measures of energy expenditure (EE) and step count. A hierarchical linear mixed effects model showed that children in seated desk classrooms had significantly lower (EE) and fewer steps during the standardized lecture time than children in stand-biased classrooms after adjusting for grade, race, and gender. The use of a standing desk showed a significant higher mean energy expenditure by 0.16 kcal/min (p < 0.0001) in the fall semester, and a higher EE by 0.08 kcal/min (p = 0.0092) in the spring semester.

Screen-Time Weight-loss Intervention Targeting Children at Home (SWITCH): a randomized controlled trial

BACKGROUND

Screen-based activities, such as watching television (TV), playing video games, and using computers, are common sedentary behaviors among young people and have been linked with increased energy intake and overweight. Previous home-based sedentary behaviour interventions have been limited by focusing primarily on the child, small sample sizes, and short follow-up periods. The SWITCH (Screen-Time Weight-loss Intervention Targeting Children at Home) study aimed to determine the effect of a home-based, family-delivered intervention to reduce screen-based sedentary behaviour on body composition, sedentary behaviour, physical activity, and diet over 24 weeks in overweight and obese children.

METHODS

A two-arm, parallel, randomized controlled trial was conducted. Children and their primary caregiver living in Auckland, New Zealand were recruited via schools, community centres, and word of mouth. The intervention, delivered over 20 weeks, consisted of a face-to-face meeting with the parent/caregiver and the child to deliver intervention content, which focused on training and educating them to use a wide range of strategies designed to reduce their child's screen time. Families were given Time Machine TV monitoring devices to assist with allocating screen time, activity packages to promote alternative activities, online support via a website, and monthly newsletters. Control participants were given the intervention material on completion of follow-up. The primary outcome was change in children's BMI z-score from baseline to 24 weeks.

RESULTS

Children (n = 251) aged 9-12 years and their primary caregiver were randomized to receive the SWITCH intervention (n = 127) or no intervention (controls; n = 124). There was no significant difference in change of zBMI between the intervention and control groups, although a favorable trend was observed (-0.016; 95% CI: -0.084, 0.051; p = 0.64). There were also no significant differences on secondary outcomes, except for a trend towards increased children's moderate intensity physical activity in the intervention group (24.3 min/d; 95% CI: -0.94, 49.51; p = 0.06).

CONCLUSIONS

A home-based, family-delivered intervention to reduce all leisure-time screen use had no significant effect on screen-time or on BMI at 24 weeks in overweight and obese children aged 9-12 years.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials RegistryWebsite: http://www.anzctr.org.au

TRIAL REGISTRATION NUMBER

ACTRN12611000164998.

Associations of social and environmental supports with sedentary behavior, light and moderate-to-vigorous physical activity in obese underserved adolescents

Background

Evidence to support differential health impacts of sedentary behavior (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) is building. However, few studies have examined individual, social, and environmental supports across the full range of sedentary and physical activities, including key influences such as self-efficacy, parenting factors, and home and neighborhood resources. This may be particularly important in underserved (low-income, minority), overweight/obese adolescents due to the social and environmental challenges (lack of resources, etc.) associated with increasing MVPA. This study evaluated a range of bioecological factors including individual (self-efficacy), parental (parental support, monitoring, limit-setting, and nurturance), and environmental (perceived home resources for PA and neighborhood support for PA) predictors of SB, LPA and MVPA in overweight/obese adolescents.

Methods

Overweight/obese and predominantly minority adolescents and caregivers (n = 181) completed measures in 2010 in the US including surveys assessing self-efficacy for PA, parenting variables related to PA and home and neighborhood supports for PA. Outcomes included 7-day accelerometer estimates of SB, LPA, and MVPA.

Results

Regression analyses showed parental social support and neighborhood support were significantly associated with LPA. No significant associations were found for SB or MVPA.

Conclusions

Results emphasized the importance of examining a range of sedentary and PA intensities and highlighted the role of parental and neighborhood social supports for LPA. These results have important implications that suggest that health promotion efforts should target social and environmental supports for increasing LPA in youth who are overweight/obese.

Associations between sedentary behaviour and physical activity in children and adolescents: a meta-analysis

Physical activity and sedentary behaviour are associated with metabolic and mental health during childhood and adolescence. Understanding the inter-relationships between these behaviours will help to inform intervention design. This systematic review and meta-analysis synthesized evidence from observational studies describing the association between sedentary behaviour and physical activity in young people (<18 years). English-language publications up to August 2013 were located through electronic and manual searches. Included studies presented statistical associations between at least one measure of sedentary behaviour and one measure of physical activity. One hundred sixty-three papers were included in the meta-analysis, from which data on 254 independent samples was extracted. In the summary meta-analytic model (k = 230), a small, but significant, negative association between sedentary behaviour and physical activity was observed (r = -0.108, 95% confidence interval [CI] = -0.128, -0.087). In moderator analyses, studies that recruited smaller samples (n < 100, r = -0.193, 95% CI = -0.276, -0.109) employed objective methods of measurement (objectively measured physical activity; r = -0.233, 95% CI = -0.330, -0.137) or were assessed to be of higher methodological quality (r = -0.176, 95% CI = -0.215, -0.138) reported stronger associations, although effect sizes remained small. The association between sedentary behaviour and physical activity in young people is negative, but small, suggesting that these behaviours do not directly displace one another.

Parental monitoring of children's media consumption: the long-term influences on body mass index in children

IMPORTANCE

Although children's media consumption has been one of the most robust risk factors for childhood obesity, effects of specific parenting influences, such as parental media monitoring, have not been effectively investigated.

OBJECTIVES

To examine the potential influences of maternal and paternal monitoring of child media exposure and children's general activities on body mass index (BMI) in middle childhood.

DESIGN, SETTING, AND PARTICIPANTS

A longitudinal study, taken from a subsample of the Three Generational Study, a predominantly white, Pacific Northwest community sample (overall participation rate, 89.6%), included assessments performed from June 1998 to September 2012. Analyses included 112 mothers, 103 fathers, and their 213 children (55.4% girls) at age 5, 7, and/or 9 years. Participation rates ranged from 66.7% to 72.0% of all eligible Three Generational Study children across the 3 assessments.

EXPOSURES

Parents reported on their general monitoring of their children (whereabouts and activities), specific monitoring of child media exposure, children's participation in sports and recreational activities, children's media time (hours per week), annual income, and educational level. Parental BMI was recorded.

MAIN OUTCOMES AND MEASURES

Predictions to level and change in child BMI z scores were tested.

RESULTS

Linear mixed-effects modeling indicated that more maternal, but not paternal, monitoring of child media exposure predicted lower child BMI z scores at age 7 years (95% CI, -0.39 to -0.07) and less steeply increasing child BMI z scores from 5 to 9 years (95% CI, -0.11 to -0.01). These effects held when more general parental monitoring, and parent BMI, annual income, and educational level were controlled for. The significant negative effect of maternal media monitoring on children's BMI z scores at age 7 years was marginally accounted for by the effect of child media time. The maternal media monitoring effect on children's BMI z score slopes remained significant after adjustment for children's media time and sports and recreational activity.

CONCLUSIONS AND RELEVANCE

These findings suggest that parental behaviors related to children's media consumption may have long-term effects on children's BMI in middle childhood. They underscore the importance of targeting parental media monitoring in efforts to prevent childhood obesity.

Family-based interventions for reducing sedentary time in youth: a systematic review of randomized controlled trials

Family involvement in interventions to reduce sedentary time may help foster appropriate long-term screen-based habits in children. This review systematically synthesized evidence from randomized controlled trials of interventions with a family component that targeted reduction of sedentary time, including TV viewing, video games and computer use, in children. MEDLINE, PubMed, PsycInfo, CINAHL and Embase were searched from inception through March 2012. Seventeen articles were considered eligible and included in the review. Studies were judged to be at low-to-moderate risk of bias. Despite inconsistent study results, level of parental involvement, rather than the setting itself, appeared an important determinant of intervention success. Studies including a parental component of medium-to-high intensity were consistently associated with statistically significant changes in sedentary behaviours. Participant age was also identified as a determinant of intervention outcomes; all three studies conducted in pre-school children demonstrated significant decreases in sedentary time. Finally, TV exposure appeared to be related to changes in energy intake rather than physical activity. Future studies should assess the effects of greater parental involvement and child age on success of sedentary behaviour interventions. More research is required to better understand the relationship between screen time and health behaviours, particularly energy intake.

Interventions designed to reduce sedentary behaviours in young people: a review of reviews

BACKGROUND

Leisure time is increasingly spent in sedentary pursuits such as screen-viewing (eg, television/DVD viewing and computer use), motorised travel, school/work and sitting-based socialising (eg, social media and chatting). Sedentary screen time, particularly TV, appears to play an important role in the aetiology of obesity due to its co-occurrence with other unhealthy behaviours such as snacking on energy-dense foods, low levels of physical activity and inadequate sleep. More information is needed on how to reduce sedentary behaviours. Most interventions have focused on young people and a number of systematic reviews exist on this topic.

OBJECTIVE

To synthesise systematic reviews and meta-analyses of interventions aimed at decreasing sedentary behaviours among children and adolescents.

METHODS

Papers were located from computerised and manual searches. Included articles were English language systematic reviews or meta-analyses of interventions aiming at reducing sedentary behaviour in children (<11 years) and adolescents (12-18 years).

RESULTS

Ten papers met the inclusion criteria and were analysed. All reviews concluded some level of effectiveness in reducing time spent in sedentary behaviour. When an effect size was reported, there was a small but significant reduction in sedentary time (highest effect size=-0.29; CI -0.35 to -0.22). Moderator analyses showed a trend favouring interventions with children younger than 6 years. Effective strategies include the involvement of family, behavioural interventions and electronic TV monitoring devices.

CONCLUSIONS

Results from systematic reviews and meta-analyses show that interventions to reduce children's sedentary behaviour have a small but significant effect. Future research should expand these findings examining interventions targeting different types of sedentary behaviours and the effectiveness of specific behaviour change techniques across different contexts and settings.

Longitudinal sedentary behavior changes in adolescents in Ho Chi Minh City

BACKGROUND

Sedentary behavior is associated with increased risk of chronic disease and sedentary behavior is increasing among adolescents. Data on changes in sedentary behavior in developing countries are limited.

PURPOSE

To describe 5-year longitudinal changes in nonschool sedentary hours among urban adolescents in Ho Chi Minh City, and to identify correlates with this change.

METHODS

This is a 5-year longitudinal cohort with systematic random sampling of 759 students from 18 junior high schools. All measures were taken annually between 2004 and 2009. Sedentary behavior was assessed by self-report and accelerometry. Generalized linear latent and mixed models were used to analyze the data in 2011.

RESULTS

Between 2004 and 2009, self-reported time spent in nonschool sedentary behavior increased from 498 to 603 minutes/day. In the 5th survey year, boys and girls (aged 16 years) were, respectively, 3.6 times (95% CI=2.3, 6.0) and 3.1 times (95% CI= 1.8, 5.0) more likely to spend ≥2 hours/day on screen time compared with baseline (aged 12 years). Accelerometer data adjusted for wearing time revealed that boys and girls aged 16 years had, respectively, 78 minutes/day (95% CI=48, 104) and 69 minutes/day (95% CI=34, 95) more nonschool sedentary time than those at the first accelerometer assessment (at age 13 years). Girls in the highest socioeconomic quartile spent an additional 90 minutes/day in sedentary behavior compared with girls in the lowest quartile (95% CI=52, 128).

CONCLUSIONS

Nonschool sedentary behavior increased among Vietnamese adolescents with age. The largest increase was in recreational screen time (28%), which would be the most obvious target for preventive health strategies.

Primary prevention of overweight in children and adolescents: a meta-analysis of the effectiveness of interventions aiming to decrease sedentary behaviour

The objectives of this meta-analysis were to provide an overview of the evidence regarding the effects of interventions, implemented in the school- and general population setting, aiming to prevent excessive sedentary behaviour in children and adolescents on (1) the amount of sedentary behaviour and (2) BMI. Differences in effects on sedentary behaviour and BMI between single health behaviour interventions (sedentary behaviour only) and multiple health behaviour interventions were explored.

A literature search was conducted in PubMed, EMBASE, Web of Science, PsycINFO and Cochrane Database of Systematic Reviews. Thirty-four (R)CT studies evaluating 33 general population interventions, published between 1990 and April 2011, aiming to decrease sedentary behaviour in normal weight children or adolescents (0–18 years) were included. Intervention duration ranged from 7 days to 4 years. Mean change in sedentary behaviour and BMI from baseline to post-intervention was calculated using a random effects model.

Results showed significant decreases for the amount of sedentary behaviour and BMI. For sedentary behaviour the post-intervention mean difference was −17.95 min/day (95%CI:-26.61;–9.28); the change-from-baseline mean difference was −20.44 min/day (95%CI:-30.69;–10.20). For BMI the post-intervention mean difference was −0.25 kg/m² (95%CI:-0.40;–0.09); the change-from-baseline mean difference was −0.14 kg/m² (95%CI:-0.23;–0.05). No differences were found between single and multiple health behaviour interventions.

Interventions in the school- and general population setting aiming to reduce only sedentary behaviour and interventions targeting multiple health behaviours can result in significant decreases in sedentary behaviour. Studies need to increase follow-up time to estimate the sustainability of the intervention effects found.