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Tekeci Y, Torpil B, Altuntaş O. The Impact of Screen Exposure on Screen Addiction and Sensory Processing in Typically Developing Children Aged 6-10 Years. CHILDREN (BASEL, SWITZERLAND) 2024; 11:464. [PMID: 38671681 PMCID: PMC11049253 DOI: 10.3390/children11040464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
As technology continues to develop, children are spending more time in front of screens, which can lead to significant problems. For children aged 5 years and above, screen time of 2 or more hours per day on average is considered problematic. This study aimed to investigate the impact of screen exposure on screen addiction and sensory processing in typically developing children aged 6-10 years. The study analyzed 74 children who had a screen exposure time of 2 h or more and 71 children who had a screen exposure time of less than 2 h. The Dunn Sensory Profile was used to evaluate sensory processing skills, and the Problematic Media Use Scale was used to measure screen addiction. The group with high screen exposure showed statistically significant differences in screen addiction, distraction, and sedentary factors (p < 0.05). No significant differences were found in other parameters. Based on these findings, it has been determined that excessive screen exposure leads to a more sedentary lifestyle, increased screen addiction, and distraction in typically developing children aged 6-10 years. It is important to consider the duration of screen exposure in typically developing children aged 6-10 years and to conduct further studies on this topic.
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Affiliation(s)
- Yasin Tekeci
- Occupational Therapy Department, Faculty of Gülhane Health Sciences, University of Health Sciences Turkey, Ankara 06018, Turkey;
| | - Berkan Torpil
- Occupational Therapy Department, Faculty of Gülhane Health Sciences, University of Health Sciences Turkey, Ankara 06018, Turkey;
| | - Onur Altuntaş
- Occupational Therapy Department, Faculty of Health Sciences, Hacettepe University, Ankara 06018, Turkey;
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Burahmah E, Shanmugam S, Stansfield B. Full-Day Physical Activity and Sedentary Behaviour Levels of Typically Developing Children and Adolescents in the Middle East: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6940. [PMID: 37887678 PMCID: PMC10606092 DOI: 10.3390/ijerph20206940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/29/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023]
Abstract
Physical activity (PA) and sedentary behaviour (SB) are important components of physical behaviour associated with long-term health outcomes. Environmental and cultural factors may influence physical behaviour. To explore full day PA and SB in children and adolescents (2-18 years old) in the Middle East, a systematic literature review was performed including 183 journal articles. A wide range of PA and SB outcomes were reported, in some cases making synthesis of results difficult. As a consequence, results were generally reported narratively (MVPA time, total PA, SB time). Meta-regression of daily step count revealed females took 4600 fewer steps than males, with 3000 fewer steps on weekdays than weekends, and overweight individuals taking 2800 fewer steps/day. Steps decreased with age. Meta-regression for TV viewing time demonstrated an increase by 0.04 h per year of age. Even though environmental and cultural conditions may be different, PA and SB of children and adolescents in the Middle East were largely comparable to those of Europeans and North Americans. The wide range of data collection instruments used (both self-report questionnaire and body-worn devices) and heterogeneity of data made synthesis of reported data across studies very difficult, suggesting a need for greater standardisation of data collection methods.
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Affiliation(s)
| | | | - Ben Stansfield
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK; (E.B.); (S.S.)
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Chang RY, Chen TL, Yeh CC, Chen CH, Wang QW, Toung T, Liao CC. Risk of Obesity Among Children Aged 2-6 Years Who Had Prolonged Screen Time in Taiwan: A Nationwide Cross-Sectional Study. Clin Epidemiol 2023; 15:165-176. [PMID: 36817560 PMCID: PMC9936874 DOI: 10.2147/clep.s382956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/21/2023] [Indexed: 02/16/2023] Open
Abstract
Objective To evaluate the risk of obesity in preschool children with prolonged screen time in Taiwan. Methods Using a nationwide survey with random sampling, we collected information on 8378 preschool children aged 2-6 years among 206 preschools in Taiwan from 2016 to 2019. Socioeconomic data, body mass index, and lifestyle of the preschool children and their caregivers were compared among the groups of preschool children who had moderate and prolonged daily screen time. We used multiple log-binomial regression models to calculate the adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) of obesity associated with prolonged screen time. Results The prevalence of obesity in the preschool children was 13.1%, and the average screen time was 104.6 minutes. Children's age, sleep hours, outdoor play time, sugar intake, snack eating before dinner, sleep disturbance, and obesity, as well as caregiver's sex, age, education, screen time, exercise time and parent obesity were factors related to high screen time for preschool children. Compared with children with moderate screen time, children with prolonged screen time had a higher risk of obesity (PR, 1.45; 95% CI, 1.18-1.79). With a 60-minute increase in screen time, the risk of obesity increased, with an PR of 1.10 (95% CI, 1.03-1.17). Conclusion Preschool children with prolonged screen time had an increased risk of obesity in Taiwan. Interventions may be needed for this very susceptible population.
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Affiliation(s)
- Rui-Yu Chang
- Department of Sport Promotion, National Taiwan Sport University, Taoyuan, Taiwan
| | - Ta-Liang Chen
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Surgery, University of Illinois, Chicago, IL, USA
| | - Ching-Hsiang Chen
- Physical Education Office, China Medical University, Taichung, Taiwan
| | - Qiao-Wen Wang
- Doctoral Program of Educational Leadership and Technology Management, Tamkang University, Taipei, Taiwan
| | - Thomas Toung
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Chien-Chang Liao
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan.,Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,School of Health Care Administration, Taipei Medical University, Taipei, Taiwan.,School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
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Ophir Y, Rosenberg H, Efrati Y, Tikochinski R. Mothers' Perceptions of Children's Screen Use During the COVID-19 Lockdown in Israel. JOURNAL OF CHILD AND FAMILY STUDIES 2022; 32:81-92. [PMID: 35991343 PMCID: PMC9382602 DOI: 10.1007/s10826-022-02399-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
The contemporary parenting challenge of regulating children's screen time became even more difficult during the coronavirus pandemic (COVID-19). The current research addresses the characteristics of this challenge and explores mothers' perceptions regarding their children's screen use, through two consecutive studies. Study 1 included 299 mothers of elementary school children, who were asked to complete questionnaires regarding their children's screen habits. Mothers were also asked about their own attitudes towards screens, as parents, and about their personal feelings of frustration and guilt. Study 2 replicated this procedure among a new sample of 283 mothers who also completed validated scales assessing their sense of parental competence and authority style. Retrospective reports of mothers indicated that, during the lockdown, entertainment use of screens increased by 73% among 4th-6th graders and by 108% among 1st-3rd graders. Educational use increased by 86% in both age groups. Mothers' guilt increased as well and was predicted by children's entertainment use (but not educational use), after accounting for demographic variables and mothers' attitudes. Other factors, such as parenting style and having at-least one child with a diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD), were associated with entertainment use (regardless of the COVID-19 lockdown). Factors that were found to moderate the lockdown effect were mothers' attitudes towards screens and parental confidence. The findings are discussed in the context of parents' efforts to regulate their children's screen use.
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Affiliation(s)
- Yaakov Ophir
- Technion—Israel Institute of Technology, Haifa, Israel
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Wang X, Wu Y, Yao C, Wu X, Ruan Y, Ye S. Correlates of preschoolers' screen time in China: parental factors. BMC Pediatr 2022; 22:417. [PMID: 35831817 PMCID: PMC9281098 DOI: 10.1186/s12887-022-03443-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 06/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background With the advent of the electronic age, the prolonged screen time (ST) of preschoolers in China is relatively high and is on the rise, which is likely to affect preschoolers’ physical and mental health. This study aimed to explore the factors influencing ST in preschoolers, especially the role of parental factors, and to provide a basis for the prevention, control, and intervention of ST in preschoolers in China. Methods A questionnaire was completed by the parents of 1,546 preschoolers from four kindergartens in Pinghu City, Zhejiang Province, China, and a multivariate logistic regression model was used to analyze the correlates of excessive ST in preschoolers. Results A total of 43.8% of preschoolers aged 3 to 6 years, of which 50.3% were boys and 49.7% were girls, had > 1 h/day of ST. Older preschoolers, greater screen accessibility, greater frequency of eating in front of a screen, longer ST of parents, and unclear rules of screen-based behavior were the risk factors for ST being > 1 h/day (P < 0.05). After additional adjusting of maternal correlates, the relationship between the ST of fathers and ST of preschoolers was still significant (P < 0.01), and the dose–effect relationship was also observed (P < 0.001). Conclusion Prolonged parental ST (especially of fathers) and lack of rules for screen behavior were independent risk factors for prolonged preschoolers’ ST in this study.
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Affiliation(s)
- Xinyao Wang
- Department of Preschool Education, Pinghu Normal College, Jiaxing University, No. 888, Hongjian Road, Pinghu, 314001, Jiaxing, China
| | - Yan Wu
- Department of Preschool Education, Pinghu Normal College, Jiaxing University, No. 888, Hongjian Road, Pinghu, 314001, Jiaxing, China
| | - Chunhua Yao
- Pinghu Kindergarten in Economic Development Zone, Jiaxing, 314201, China
| | - Xiangting Wu
- Department of Preschool Education, Pinghu Normal College, Jiaxing University, No. 888, Hongjian Road, Pinghu, 314001, Jiaxing, China
| | - Yuqian Ruan
- Department of Preschool Education, Pinghu Normal College, Jiaxing University, No. 888, Hongjian Road, Pinghu, 314001, Jiaxing, China
| | - Sunyue Ye
- Department of Preschool Education, Pinghu Normal College, Jiaxing University, No. 888, Hongjian Road, Pinghu, 314001, Jiaxing, China.
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Raj D, Ahmad N, Mohd Zulkefli NA, Lim PY. ‘Stop & Play’ digital health education intervention in reducing excessive screen time among preschoolers from low socioeconomic families in Malaysia: A Cluster Randomized Control Trial (Preprint). J Med Internet Res 2022; 25:e40955. [PMID: 37140970 DOI: 10.2196/40955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 01/09/2023] [Accepted: 03/15/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND High prevalence of excessive screen time among preschool children is attributable to certain parental factors such as lack of knowledge, false perception about screen time, and inadequate skills. Lack of strategies to implement screen time guidelines, in addition to multiple commitments that may hinder parents from face-to-face interventions, demands the need to develop a technology-based parent-friendly screen time reduction intervention. OBJECTIVE This study aims to develop, implement, and evaluate the effectiveness of Stop and Play, a digital parental health education intervention to reduce excessive screen time among preschoolers from low socioeconomic families in Malaysia. METHODS A single-blind, 2-arm cluster randomized controlled trial was conducted among 360 mother-child dyads attending government preschools in the Petaling district, who were randomly allocated into the intervention and waitlist control groups between March 2021 and December 2021. This 4-week intervention, developed using whiteboard animation videos, infographics, and a problem-solving session, was delivered via WhatsApp (WhatsApp Inc). Primary outcome was the child's screen time, whereas secondary outcomes included mother's screen time knowledge, perception about the influence of screen time on the child's well-being, self-efficacy to reduce the child's screen time and increase physical activity, mother's screen time, and presence of screen device in the child's bedroom. Validated self-administered questionnaires were administered at baseline, immediately after the intervention, and 3 months after the intervention. The intervention's effectiveness was evaluated using generalized linear mixed models. RESULTS A total of 352 dyads completed the study, giving an attrition rate of 2.2% (8/360). At 3 months after the intervention, the intervention group showed significantly reduced child's screen time compared with the control group (β=-202.29, 95% CI -224.48 to -180.10; P<.001). Parental outcome scores also improved in the intervention group as compared with that in the control group. Mother's knowledge significantly increased (β=6.88, 95% CI 6.11-7.65; P<.001), whereas perception about the influence of screen time on the child's well-being reduced (β=-.86, 95% CI -0.98 to -0.73; P<.001). There was also an increase in the mother's self-efficacy to reduce screen time (β=1.59, 95% CI 1.48-1.70; P<.001) and increase physical activity (β=.07, 95% CI 0.06-0.09; P<.001), along with reduction in mother's screen time (β=-70.43, 95% CI -91.51 to -49.35; P<.001). CONCLUSIONS The Stop and Play intervention was effective in reducing screen time among preschool children from low socioeconomic families, while improving the associated parental factors. Therefore, integration into primary health care and preschool education programs is recommended. Mediation analysis is suggested to investigate the extent to which secondary outcomes are attributable to the child's screen time, and long follow-up could evaluate the sustainability of this digital intervention. TRIAL REGISTRATION Thai Clinical Trial Registry (TCTR) TCTR20201010002; https://tinyurl.com/5frpma4b.
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Affiliation(s)
- Diana Raj
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Norliza Ahmad
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Nor Afiah Mohd Zulkefli
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Poh Ying Lim
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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Ramirez A, Tovar A, Garcia G, Nieri T, Hernandez S, Sastre M, Cheney AM. Involvement of Non-Parental Caregivers in Obesity Prevention Interventions among 0-3-Year-Old Children: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084910. [PMID: 35457780 PMCID: PMC9031125 DOI: 10.3390/ijerph19084910] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION We examined the scope of literature including non-parental caregiver involvement in child obesity prevention interventions. METHODS We conducted a scoping review following the Arksey and O'Malley framework, including only studies reporting the effect of an intervention on growth, weight, or early childhood obesity risk among children ages 0 to three years, published between 2000 and 2021. Interventions that did not include non-parental caregivers (adults regularly involved in childcare other than parents) were excluded. RESULTS Of the 14 studies that met the inclusion criteria, all were published between 2013 and 2020, and most interventions (n = 9) were implemented in the United States. Eight of the 14 interventions purposefully included other non-parental caregivers: five included both parents and non-parental caregivers, and the remaining three included only non-parental caregivers. Most interventions (n = 9) showed no significant impact on anthropometric outcomes. All interventions found improvements in at least one behavioral outcome (e.g., food groups intake (n = 5), parental feeding practices (n = 3), and screen time (n = 2)). This review can inform future interventions that plan to involve non-parental caregivers, which may be beneficial in shaping early health behaviors and preventing obesity early in life.
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Affiliation(s)
- Andrea Ramirez
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI 02881, USA;
| | - Alison Tovar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02903, USA;
| | - Gretel Garcia
- Graduate School of Education, University of California Riverside, Riverside, CA 92521, USA;
| | - Tanya Nieri
- Department of Sociology, University of California Riverside, Riverside, CA 92521, USA; (T.N.); (M.S.)
| | - Stephanie Hernandez
- School of Public Policy, University of California Riverside, Riverside, CA 92507, USA;
| | - Myrna Sastre
- Department of Sociology, University of California Riverside, Riverside, CA 92521, USA; (T.N.); (M.S.)
| | - Ann M. Cheney
- Department of Social Medicine, Population and Public Health, School of Medicine, University of California Riverside, Riverside, CA 92521, USA
- Correspondence:
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Effect of screen time intervention on obesity among children and adolescent: A meta-analysis of randomized controlled studies. Prev Med 2022; 157:107014. [PMID: 35248682 DOI: 10.1016/j.ypmed.2022.107014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 01/04/2022] [Accepted: 02/28/2022] [Indexed: 11/23/2022]
Abstract
Several studies have investigated the effect of screen time interventions on obesity in children and adolescents, but the existing results were controversial. This study aimed to analyze the effect of screen time intervention on obesity in children and adolescents. PubMed, Cochrane, Web of Science, Embase databases were searched through December 2020 to identify publications meeting a priori inclusion criteria and references in the published articles were also reviewed. Finally, 14 randomized controlled trials and 1894 subjects were included in this meta-analysis. The results showed that interventions targeting screen time are effective in reducing total screen time (MD: -6.90 h/week, 95% CI: [-9.19 to -4.60], p < 0.001) and television time (MD: -6.17 h/week, 95% CI: [-10.70 to -1.65], p < 0.001) in children and adolescents. However, there was no significant difference between the intervention and control groups in body mass index and body mass index-z score. In conclusion, there is no evidence that screen time interventions alone can decrease obesity risk in children and adolescents, though they can effectively reduce screen time.
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Krafft H, Boehm K, Schwarz S, Eichinger M, Büssing A, Martin D. Media Awareness and Screen Time Reduction in Children, Youth or Families: A Systematic Literature Review. Child Psychiatry Hum Dev 2021; 54:815-825. [PMID: 34855040 PMCID: PMC10140095 DOI: 10.1007/s10578-021-01281-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
Excessive use of screen media is a global public health issue and especially extensive screen exposure during very early childhood. This review was conducted in order to update previous reviews on the effectiveness of interventions to reduce screen time. An electronic literature search was carried out in MEDLINE, COCHRANE LIBRARY and CINAHL for articles indexed from June 2011 until October 2019. The search identified 933 publications of which 11 publications were included in this review. There are studies showing interventions with a positive influence on reduction of screen time and the participants' awareness and behavior concerning the use of screen media, as well as studies without such effects. No intervention was identified to be superior. This warrants further investigation of potentially effective combinations of intervention components and long-term follow-up.
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Affiliation(s)
- Hanno Krafft
- Chair of Medical Theory, Integrative and Anthroposophic Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Katja Boehm
- Chair of Medical Theory, Integrative and Anthroposophic Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Silke Schwarz
- Chair of Medical Theory, Integrative and Anthroposophic Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Michael Eichinger
- Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Arndt Büssing
- Chair of Medical Theory, Integrative and Anthroposophic Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - David Martin
- Chair of Medical Theory, Integrative and Anthroposophic Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany. .,Department of Pediatrics, Tübingen University, Tübingen, Germany.
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Yalçin SS, Tezol Ö, Çaylan N, Erat Nergiz M, Yildiz D, Çiçek Ş, Oflu A. Evaluation of problematic screen exposure in pre-schoolers using a unique tool called "seven-in-seven screen exposure questionnaire": cross-sectional study. BMC Pediatr 2021; 21:472. [PMID: 34696746 PMCID: PMC8546938 DOI: 10.1186/s12887-021-02939-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Screen media exposure has been increasing in the preschool years. Risky aspects of screen exposure have many potential negative effects on children’s health. We aimed to evaluate problematic screen exposure in Turkish preschool children by using a unique tool called the “Seven-in-Seven Screen Exposure Questionnaire” and to investigate factors associated with problematic screen exposure. Methods A questionnaire form was designed including general descriptive questions in the first part. In the second part, a questionnaire we designed called the “Seven-in-Seven Screen Exposure Questionnaire” was conducted to evaluate problematic screen exposure characteristics. The questionnaire included seven items: daily screen time, viewing with parent(s), setting screen limits, screen exposure during meals and in the hour before bedtime, age of onset of screen exposure, and viewing low-quality content. The total problematic screen exposure score (range 0–13) was generated by summing scores from the seven items. Total scores are classified into two categories: low (< 7) and high (≥ 7). Logistic regression was performed to search for independent parameters associated with problematic screen exposure. Results One thousand two hundred forty-five mother-child pairs participated in this study. The median age of the children was 3.9 (IQR: 2.9–4.7) years and 51% were males. Overall, 280 children (22.5%) had a problematic screen exposure score of ≥7 (high). The median problematic screen exposure score was 4 (IQR: 3–6). Maternal age of < 30 years; paternal age of ≥30 years; maternal educational level of ≤12 years; the age of 24–48 months; home-based daycare; postponing eating, toileting, or sleeping while using a screen; and using touchscreen devices were found to be associated with an increased risk of having a high problematic screen exposure score. Conclusion Developing national scales to monitor problematic screen use in children would be more effective than monitoring screen time alone. All of the screen use characteristics not recommended in children would be evaluated using problematic screen exposure scales. The “Seven-in-Seven Screen Exposure Questionnaire” may serve as an example for further studies.
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Affiliation(s)
- S Songül Yalçin
- Department of Pediatrics, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
| | - Özlem Tezol
- Department of Pediatrics, Mersin University, Faculty of Medicine, Mersin, Turkey
| | - Nilgün Çaylan
- Department of Child and Adolescents Health, Ministry of Health, Ankara, Turkey
| | - Meryem Erat Nergiz
- Department of Pediatrics, Yıldırım Beyazıt University, Yenimahalle Research Hospital, Ankara, Turkey
| | - Deniz Yildiz
- Department of Pediatrics, Dr. Sami Ulus Child Hospital, Ankara, Turkey
| | - Şeyma Çiçek
- Department of Pediatrics, Etimesgut Şehit Sait Ertürk Hospital, Ankara, Turkey
| | - Ayşe Oflu
- Department of Pediatrics, Afyon Health Sciences University, Faculty of Medicine, Afyon, Turkey
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11
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Akçay D, Barış N. Evaluating the effectiveness of interventions to reducing screen time in children: meta-analysis of randomized controlled trials. JOURNAL OF PUBLIC MENTAL HEALTH 2021. [DOI: 10.1108/jpmh-03-2021-0039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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12
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Choi Y, Lee DY, Lee S, Park EJ, Yoo HJ, Shin Y. Association Between Screen Overuse and Behavioral and Emotional Problems in Elementary School Children. Soa Chongsonyon Chongsin Uihak 2021; 32:154-160. [PMID: 34671188 PMCID: PMC8499035 DOI: 10.5765/jkacap.210015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/04/2021] [Accepted: 08/18/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study identified the association between excessive exposure to screen media and behavioral and emotional problems in elementary school students. METHODS A total of 331 parents of children aged 7-10 years were recruited from "The Kids Cohort for Understanding of Internet Addiction Risk Factors in Early Childhood (K-CURE)" study. Children's demographics, household media ownership, screen time, and behavioral/emotional problems were assessed using a parental questionnaire. Children's behavior/emotional problems were measured using the Korean version the of Child Behavior Checklist (K-CBCL) score. RESULTS The total K-CBCL score in the screen overuse group was 51.18±9.55, significantly higher than 47.28±10.09 in the control group (t=2.14, p=0.05). For each subscale, the externalization score (51.65±10.14, 48.33±8.97, respectively; t=2.02, p<0.05), social problem score (55.41±6.11, 53.24±5.19, respectively; t=2.27, p<0.05), and rule breaking behavior score (55.71±6.11, 53.24±5.19, respectively; t=2.27, p<0.05) were significantly higher in the screen overuse group than in the control group. In addition, the screen overuse group also had a significantly higher usage rate than the control group, even if limited to smartphones, not only on weekdays (3.56±2.08, 1.87±2.02, respectively; t=-4.597, p<0.001) but also weekends (1.62±0.74, 1.19±0.83, respectively; t=-3.14, p=0.003). CONCLUSION The study suggested that screen media overuse patterns in children in Korea are particularly relevant to the excessive use of smartphones and are related to higher risks of emotional and behavioral problems.
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Affiliation(s)
- Yeonkyu Choi
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Korea
| | - Dong Yun Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Sangha Lee
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Korea
| | - Eun-Jin Park
- Department of Psychiatry, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Hee Jeong Yoo
- Department of Psychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yunmi Shin
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Korea
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Byrne R, Terranova CO, Trost SG. Measurement of screen time among young children aged 0-6 years: A systematic review. Obes Rev 2021; 22:e13260. [PMID: 33960616 PMCID: PMC8365769 DOI: 10.1111/obr.13260] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 12/16/2022]
Abstract
The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.
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Affiliation(s)
- Rebecca Byrne
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
| | - Caroline O. Terranova
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
| | - Stewart G. Trost
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
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Vaidyanathan S, Manohar H, Chandrasekaran V, Kandasamy P. Screen Time Exposure in Preschool Children with ADHD: A Cross-Sectional Exploratory Study from South India. Indian J Psychol Med 2021; 43:125-129. [PMID: 34376887 PMCID: PMC8313458 DOI: 10.1177/0253717620939782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Concern is mounting regarding screen exposure among young children and its association with mental health. Children with attention deficit hyperactivity disorder (ADHD) may be more vulnerable to its effects such as increased externalizing behaviors and problems with language and cognitive development and biological functions such as sleep. We aimed to assess screen exposure in preschool children with ADHD and to study the correlation of screen time with the severity of ADHD and parental stress levels. METHODS Children of age 2.5-6 years, diagnosed with ADHD (n = 56) were included, and details of the total duration of screen exposure, maximum continuous screen exposure time, and types of screen-based devices used, reasons for screen exposure were collected from primary caregivers. ADHD symptom severity was assessed on Conner's Abbreviated Rating Scale. Family interview for stress and coping, adapted for ADHD, was used to measure parental stress. RESULTS Total screen exposure time in preschool children with ADHD was more than the recommended standards in 80.4% of children, with a median of 140.00 minutes (range: 20-500 minutes). The most commonly used modality was television (98.2%), followed by mobile phones (87.3%), tablets (17.9%), and laptops (10.7%). The severity of ADHD (r = 0.29, P = 0.02) and parent stress levels (r = 0.29, P = 0.03) were positively correlated to increased screen time exposure in the child. CONCLUSIONS Preschool children with ADHD have screen exposure above the recommended duration of one hour/day. Structured parent training programs for children with preschool ADHD and providing developmentally appropriate interventions are essential in curtailing screen time exposure and also to address parental stress.
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Affiliation(s)
- Sivapriya Vaidyanathan
- Dept. of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Harshini Manohar
- Dept. of Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro-Sciences, Bangalore, Karnataka, India
| | - Venkatesh Chandrasekaran
- Dept. of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Preeti Kandasamy
- Dept. of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Lin YM, Kuo SY, Chang YK, Lin PC, Lin YK, Lee PH, Lin PH, Chen SR. Effects of Parental Education on Screen Time, Sleep Disturbances, and Psychosocial Adaptation Among Asian Preschoolers: A Randomized Controlled Study. J Pediatr Nurs 2021; 56:e27-e34. [PMID: 32703680 DOI: 10.1016/j.pedn.2020.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/10/2020] [Accepted: 07/10/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE A recent increase in screen time during early childhood has adversely affected the sleep and psychosocial health of children; however, limited information is available regarding effective interventions to reduce the screen time among them. This study aimed to investigate the effect of a parental educational program on screen use, sleep quality, and psychosocial adaptation among preschoolers. DESIGN AND METHODS A clustered randomized controlled study with a parallel-group design was conducted. Preschoolers with a screen time of ≥2 h/day and their parents were recruited. In total, 14 kindergartens containing 129 parent-child dyads were randomly allocated to either the experimental group (receiving parental education, N = 63 dyads) or the control group (daily activities, N = 66 dyads). Data were collected before and after the intervention. A screen time questionnaire, the Children's Sleep Habits Questionnaire, and the Pediatric Symptom checklist-17 were provided to the participants. A linear mixed-model analysis was performed to examine the efficacy of the intervention. RESULTS After the intervention, the screen time of children in the experimental group was significantly reduced (effect size: 0.83, p < .001), and they presented improved sleep quality (effect size: 0.57, p = .01) and attention score (effect size: 0.77, p = .02) for psychosocial adaptation. CONCLUSIONS Parental education is an effective intervention for reducing screen time and improving sleep quality and attention among preschoolers. PRACTICE IMPLICATIONS Healthcare professionals should consider implementing parental educational programs to reduce screen time, and thus improve the sleep quality and psychosocial health of preschoolers.
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Affiliation(s)
- Yen-Miao Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taiwan.
| | - Shu-Yu Kuo
- School of Nursing, College of Nursing, Taipei Medical University, Taiwan.
| | - Yu-Kai Chang
- Department of Physical Education and Institute for Research Excellence in Learning Science, National Taiwan Normal University, Republic of China (Taiwan).
| | - Pi-Chu Lin
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taiwan.
| | - Yen-Kuang Lin
- Biostatistics Center, Taipei Medical University, Taiwan.
| | - Pi-Hsia Lee
- School of Nursing, College of Nursing, Taipei Medical University, Taiwan.
| | - Pu-Hung Lin
- Department of Nursing, Taipei Municipal Wan Fang Hospital, Taiwan.
| | - Su-Ru Chen
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taiwan.
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Landgren K, Quaye AA, Hallström E, Tiberg I. Family-based prevention of overweight and obesity in children aged 2–6 years: a systematic review and narrative analysis of randomized controlled trials. CHILD AND ADOLESCENT OBESITY 2020. [DOI: 10.1080/2574254x.2020.1752596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Kajsa Landgren
- Department of Health Science, Faculty of Medicine, Lund University, Lund, Sweden
| | - Angela A. Quaye
- Department of Health Science, Faculty of Medicine, Lund University, Lund, Sweden
| | - Elinor Hallström
- Research Institute of Sweden, Department of Agriculture and Food, Lund, Sweden
| | - Irén Tiberg
- Department of Health Science, Faculty of Medicine, Lund University, Lund, Sweden
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Blackburn NE, Wilson JJ, McMullan II, Caserotti P, Giné-Garriga M, Wirth K, Coll-Planas L, Alias SB, Roqué M, Deidda M, Kunzmann AT, Dallmeier D, Tully MA. The effectiveness and complexity of interventions targeting sedentary behaviour across the lifespan: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2020; 17:53. [PMID: 32334631 PMCID: PMC7183680 DOI: 10.1186/s12966-020-00957-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/13/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Evidence suggests that sedentary behaviour (SB) is associated with poor health outcomes. SB at any age may have significant consequences for health and well-being and interventions targeting SB are accumulating. Therefore, the need to review the effects of multicomponent, complex interventions that incorporate effective strategies to reduce SB are essential. METHODS A systematic review and meta-analysis were conducted investigating the impact of interventions targeting SB across the lifespan. Six databases were searched and two review authors independently screened studies for eligibility, completed data extraction and assessed the risk of bias and complexity of each of the included studies. RESULTS A total of 77 adult studies (n=62, RCTs) and 84 studies (n=62, RCTs) in children were included. The findings demonstrated that interventions in adults when compared to active controls resulted in non-significant reductions in SB, although when compared to inactive controls significant reductions were found in both the short (MD -56.86; 95%CI -74.10, -39.63; n=4632; I2 83%) and medium-to-long term (MD -20.14; 95%CI -34.13, -6.16; n=4537; I2 65%). The findings demonstrated that interventions in children when compared to active controls may lead to relevant reductions in daily sedentary time in the short-term (MD -59.90; 95%CI -102.16, -17.65; n=267; I2 86%), while interventions in children when compared to inactive controls may lead to relevant reductions in the short-term (MD -25.86; 95%CI -40.77, -10.96; n=9480; I2 98%) and medium-to-long term (MD -14.02; 95%CI -19.49, -8.55; n=41,138; I2 98%). The assessment of complexity suggested that interventions may need to be suitably complex to address the challenges of a complex behaviour such as SB, but demonstrated that a higher complexity score is not necessarily associated with better outcomes in terms of sustained long-term changes. CONCLUSIONS Interventions targeting reductions in SB have been shown to be successful, especially environmental interventions in both children and adults. More needs to be known about how best to optimise intervention effects. Future intervention studies should apply more rigorous methods to improve research quality, considering larger sample sizes, randomised controlled designs and valid and reliable measures of SB.
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Affiliation(s)
- Nicole E Blackburn
- Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, School of Health Sciences, Ulster University, Newtownabbey, United Kingdom.
| | - Jason J Wilson
- Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, School of Health Sciences, Ulster University, Newtownabbey, United Kingdom
| | - Ilona I McMullan
- Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, School of Health Sciences, Ulster University, Newtownabbey, United Kingdom
| | - Paolo Caserotti
- Department of Sports Science and Clinical Biomechanics, Center for Active and Healthy Ageing (CAHA), Syddansk Universitet, Odense, Denmark
| | - Maria Giné-Garriga
- Department of Sport Sciences, Faculty of Psychology, Education and Sport Sciences Blanquerna, Universitat Ramon Llull, Barcelona, Spain
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Katharina Wirth
- Agaplesion Bethesda Clinic Ulm, Geriatric Centre Ulm/Alb-Donau, Ulm, Germany
- Department of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Laura Coll-Planas
- Fundació Salut i Envelliment-Universitat Autònoma de Barcelona, Barcelona, Spain
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Sergi Blancafort Alias
- Fundació Salut i Envelliment-Universitat Autònoma de Barcelona, Barcelona, Spain
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Marta Roqué
- Fundació Salut i Envelliment-Universitat Autònoma de Barcelona, Barcelona, Spain
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Manuela Deidda
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing (IHW), University of Glasgow, Glasgow, United Kingdom
| | - Andrew T Kunzmann
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Dhayana Dallmeier
- Agaplesion Bethesda Clinic Ulm, Geriatric Centre Ulm/Alb-Donau, Ulm, Germany
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Mark A Tully
- Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, School of Health Sciences, Ulster University, Newtownabbey, United Kingdom
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey, United Kingdom
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Robidoux H, Ellington E, Lauerer J. Screen Time: The Impact of Digital Technology on Children and Strategies in Care. J Psychosoc Nurs Ment Health Serv 2019; 57:15-20. [PMID: 31670830 DOI: 10.3928/02793695-20191016-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Media and digital devices are an integral part of the world today. Despite potential benefits of media time, excessive or inappropriate use of technology is having a significant impact on the development and health of children. There is a relationship between increased screen time and greater risk of physical health complications, mental health concerns, and negative outcomes on cognitive, language, social, and emotional development. Successful evidence-based interventions and screening initiatives are available for reducing unhealthy media use in children. Providers need to be aware of media-use guidelines, screen for at-risk media use, and provide parental education as well as recommend interventions when indicated. [Journal of Psychosocial Nursing and Mental Health Services, 57(11), 15-20.].
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Barnett TA, Kelly AS, Young DR, Perry CK, Pratt CA, Edwards NM, Rao G, Vos MB. Sedentary Behaviors in Today's Youth: Approaches to the Prevention and Management of Childhood Obesity: A Scientific Statement From the American Heart Association. Circulation 2019; 138:e142-e159. [PMID: 30354382 DOI: 10.1161/cir.0000000000000591] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This scientific statement is about sedentary behavior and its relationship to obesity and other cardiometabolic outcomes in youth. A deleterious effect of sedentary behavior on cardiometabolic health is most notable for screen-based behaviors and adiposity; however, this relation is less apparent for other cardiometabolic outcomes or when sedentary time is measured with objective movement counters or position monitors. Increasing trends of screen time are concerning; the portability of screen-based devices and abundant access to unlimited programming and online content may be leading to new patterns of consumption that are exposing youth to multiple pathways harmful to cardiometabolic health. This American Heart Association scientific statement provides an updated perspective on sedentary behaviors specific to modern youth and their impact on cardiometabolic health and obesity. As we reflect on implications for practice, research, and policy, what emerges is the importance of understanding the context in which sedentary behaviors occur. There is also a need to capture the nature of sedentary behavior more accurately, both quantitatively and qualitatively, especially with respect to recreational screen-based devices. Further evidence is required to better inform public health interventions and to establish detailed quantitative guidelines on specific sedentary behaviors in youth. In the meantime, we suggest that televisions and other recreational screen-based devices be removed from bedrooms and absent during meal times. Daily device-free social interactions and outdoor play should be encouraged. In addition, parents/guardians should be supported to devise and enforce appropriate screen time regulations and to model healthy screen-based behaviors.
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Akçay D, Emiroğlu ON. The Effect of Motivational Interviewing with Mothers on Media Interaction and Aggression Behaviours of Preschool-Aged Children. Compr Child Adolesc Nurs 2019; 43:217-232. [PMID: 31424967 DOI: 10.1080/24694193.2019.1651788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study evaluates the effect of motivational interviewing with mothers on media interaction and aggression of preschool-aged children. This study was conducted as a quasi-experimental/pre-experimental research in order to evaluate the effect of motivational interviewing with mothers on media interaction and aggression of preschool-aged children. The motivational interviews conducted with the mothers focused on the stages of change and were performed as two face-to-face sessions and two telephone call sessions. While the pre and post-intervention prosocial behavior sub-dimension scores of the children were shown to increase, the overt physical aggression and relational aggression sub-dimension scores were found to decrease. Motivational interviewing technique can be effective for mothers who need to increase control of their children and set limits on media interaction. Nurses in this field can apply the MI technique and help parents to develop behavioral changes.
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Affiliation(s)
- Duygu Akçay
- Public Health Nursing, National Defense Department , Ankara, Turkey
| | - Oya Nuran Emiroğlu
- Department of Public Health Nursing, Hacettepe University , Ankara, Turkey
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Brown T, Moore THM, Hooper L, Gao Y, Zayegh A, Ijaz S, Elwenspoek M, Foxen SC, Magee L, O'Malley C, Waters E, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2019; 7:CD001871. [PMID: 31332776 PMCID: PMC6646867 DOI: 10.1002/14651858.cd001871.pub4] [Citation(s) in RCA: 264] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies to prevent obesity is very large and is accumulating rapidly. This is an update of a previous review. OBJECTIVES To determine the effectiveness of a range of interventions that include diet or physical activity components, or both, designed to prevent obesity in children. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsychINFO and CINAHL in June 2015. We re-ran the search from June 2015 to January 2018 and included a search of trial registers. SELECTION CRITERIA Randomised controlled trials (RCTs) of diet or physical activity interventions, or combined diet and physical activity interventions, for preventing overweight or obesity in children (0-17 years) that reported outcomes at a minimum of 12 weeks from baseline. DATA COLLECTION AND ANALYSIS Two authors independently extracted data, assessed risk-of-bias and evaluated overall certainty of the evidence using GRADE. We extracted data on adiposity outcomes, sociodemographic characteristics, adverse events, intervention process and costs. We meta-analysed data as guided by the Cochrane Handbook for Systematic Reviews of Interventions and presented separate meta-analyses by age group for child 0 to 5 years, 6 to 12 years, and 13 to 18 years for zBMI and BMI. MAIN RESULTS We included 153 RCTs, mostly from the USA or Europe. Thirteen studies were based in upper-middle-income countries (UMIC: Brazil, Ecuador, Lebanon, Mexico, Thailand, Turkey, US-Mexico border), and one was based in a lower middle-income country (LMIC: Egypt). The majority (85) targeted children aged 6 to 12 years.Children aged 0-5 years: There is moderate-certainty evidence from 16 RCTs (n = 6261) that diet combined with physical activity interventions, compared with control, reduced BMI (mean difference (MD) -0.07 kg/m2, 95% confidence interval (CI) -0.14 to -0.01), and had a similar effect (11 RCTs, n = 5536) on zBMI (MD -0.11, 95% CI -0.21 to 0.01). Neither diet (moderate-certainty evidence) nor physical activity interventions alone (high-certainty evidence) compared with control reduced BMI (physical activity alone: MD -0.22 kg/m2, 95% CI -0.44 to 0.01) or zBMI (diet alone: MD -0.14, 95% CI -0.32 to 0.04; physical activity alone: MD 0.01, 95% CI -0.10 to 0.13) in children aged 0-5 years.Children aged 6 to 12 years: There is moderate-certainty evidence from 14 RCTs (n = 16,410) that physical activity interventions, compared with control, reduced BMI (MD -0.10 kg/m2, 95% CI -0.14 to -0.05). However, there is moderate-certainty evidence that they had little or no effect on zBMI (MD -0.02, 95% CI -0.06 to 0.02). There is low-certainty evidence from 20 RCTs (n = 24,043) that diet combined with physical activity interventions, compared with control, reduced zBMI (MD -0.05 kg/m2, 95% CI -0.10 to -0.01). There is high-certainty evidence that diet interventions, compared with control, had little impact on zBMI (MD -0.03, 95% CI -0.06 to 0.01) or BMI (-0.02 kg/m2, 95% CI -0.11 to 0.06).Children aged 13 to 18 years: There is very low-certainty evidence that physical activity interventions, compared with control reduced BMI (MD -1.53 kg/m2, 95% CI -2.67 to -0.39; 4 RCTs; n = 720); and low-certainty evidence for a reduction in zBMI (MD -0.2, 95% CI -0.3 to -0.1; 1 RCT; n = 100). There is low-certainty evidence from eight RCTs (n = 16,583) that diet combined with physical activity interventions, compared with control, had no effect on BMI (MD -0.02 kg/m2, 95% CI -0.10 to 0.05); or zBMI (MD 0.01, 95% CI -0.05 to 0.07; 6 RCTs; n = 16,543). Evidence from two RCTs (low-certainty evidence; n = 294) found no effect of diet interventions on BMI.Direct comparisons of interventions: Two RCTs reported data directly comparing diet with either physical activity or diet combined with physical activity interventions for children aged 6 to 12 years and reported no differences.Heterogeneity was apparent in the results from all three age groups, which could not be entirely explained by setting or duration of the interventions. Where reported, interventions did not appear to result in adverse effects (16 RCTs) or increase health inequalities (gender: 30 RCTs; socioeconomic status: 18 RCTs), although relatively few studies examined these factors.Re-running the searches in January 2018 identified 315 records with potential relevance to this review, which will be synthesised in the next update. AUTHORS' CONCLUSIONS Interventions that include diet combined with physical activity interventions can reduce the risk of obesity (zBMI and BMI) in young children aged 0 to 5 years. There is weaker evidence from a single study that dietary interventions may be beneficial.However, interventions that focus only on physical activity do not appear to be effective in children of this age. In contrast, interventions that only focus on physical activity can reduce the risk of obesity (BMI) in children aged 6 to 12 years, and adolescents aged 13 to 18 years. In these age groups, there is no evidence that interventions that only focus on diet are effective, and some evidence that diet combined with physical activity interventions may be effective. Importantly, this updated review also suggests that interventions to prevent childhood obesity do not appear to result in adverse effects or health inequalities.The review will not be updated in its current form. To manage the growth in RCTs of child obesity prevention interventions, in future, this review will be split into three separate reviews based on child age.
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Affiliation(s)
- Tamara Brown
- Durham UniversityDepartment of Sport and Exercise SciencesDurhamUK
- Fuse, the NIHR Centre for Translational Research in Public HealthDurhamUK
| | - Theresa HM Moore
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge HallBristolUKBS8 2PS
- NIHR CLAHRC West at University Hospitals Bristol NHS Foundation TrustBristol‐ None ‐UKBS1 2NT
| | - Lee Hooper
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
| | - Yang Gao
- Hong Kong Baptist UniversityDepartment of Sport and Physical EducationKowloonHong Kong
| | - Amir Zayegh
- The Royal Children's HospitalGeneral MedicineMelbourneVictoriaAustralia3052
| | - Sharea Ijaz
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge HallBristolUKBS8 2PS
- NIHR CLAHRC West at University Hospitals Bristol NHS Foundation TrustBristol‐ None ‐UKBS1 2NT
| | - Martha Elwenspoek
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge HallBristolUKBS8 2PS
- NIHR CLAHRC West at University Hospitals Bristol NHS Foundation TrustBristol‐ None ‐UKBS1 2NT
| | - Sophie C Foxen
- Royal Air Force High WycombeDefence Medical ServicesNaphillBucksUKHP14 4UE
| | - Lucia Magee
- Royal United HospitalMedical DepartmentBathUK
| | - Claire O'Malley
- Durham UniversityDepartment of Sport and Exercise SciencesDurhamUK
- Fuse, the NIHR Centre for Translational Research in Public HealthDurhamUK
| | | | - Carolyn D Summerbell
- Durham UniversityDepartment of Sport and Exercise SciencesDurhamUK
- Fuse, the NIHR Centre for Translational Research in Public HealthDurhamUK
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Effect of educational interventions on health in childhood: a meta-analysis of randomized controlled trials. Public Health 2018; 164:134-147. [PMID: 30321761 DOI: 10.1016/j.puhe.2018.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/22/2018] [Accepted: 04/19/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The purpose of this study was to summarize the findings of randomized controlled trials (RCTs) investigating any potential effects of educational interventions on health in childhood. STUDY DESIGN Meta-analysis. METHODS PubMed, Embase, and the Cochrane Library databases were searched to identify all RCTs that fit our analysis through May 2016. Weighted mean difference (WMD) was used to measure the effect of educational interventions in childhood by using a random effects model. RESULTS Thirty RCTs reporting data on 35,296 children were included in the meta-analysis. The summary WMD indicated that children who received educational interventions had lower levels of body mass index (BMI) (WMD: -0.15; 95% CI: -0.24 to -0.05; P = 0.003), BMI z-score (WMD: -0.03; 95% CI: -0.05 to -0.02; P < 0.001), waist circumference (WMD: -0.97; 95% CI: -1.95 to -0.00; P = 0.050), triceps skinfold (WMD: -1.39; 95% CI: -2.41 to -0.37; P = 0.008), systolic blood pressure (WMD: -1.13; 95% CI: -2.20 to -0.07; P = 0.037), total cholesterol (WMD: -4.04; 95% CI: -7.18 to -0.90; P = 0.012), and triglyceride (WMD: -2.62; 95% CI: -4.33 to -0.90; P = 0.003). However, educational interventions were found to have little or no significant impact on the waist-to-hip ratio, diastolic blood pressure, high-density lipoprotein, and low-density lipoprotein. CONCLUSIONS The study findings prove the positive effects of educational interventions on BMI, BMI z-score, waist circumference, triceps skinfold, systolic blood pressure, total cholesterol, and triglyceride.
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MacArthur G, Caldwell DM, Redmore J, Watkins SH, Kipping R, White J, Chittleborough C, Langford R, Er V, Lingam R, Pasch K, Gunnell D, Hickman M, Campbell R. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018; 10:CD009927. [PMID: 30288738 PMCID: PMC6517301 DOI: 10.1002/14651858.cd009927.pub2] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Engagement in multiple risk behaviours can have adverse consequences for health during childhood, during adolescence, and later in life, yet little is known about the impact of different types of interventions that target multiple risk behaviours in children and young people, or the differential impact of universal versus targeted approaches. Findings from systematic reviews have been mixed, and effects of these interventions have not been quantitatively estimated. OBJECTIVES To examine the effects of interventions implemented up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. SEARCH METHODS We searched 11 databases (Australian Education Index; British Education Index; Campbell Library; Cumulative Index to Nursing and Allied Health Literature (CINAHL); Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; Embase; Education Resource Information Center (ERIC); International Bibliography of the Social Sciences; MEDLINE; PsycINFO; and Sociological Abstracts) on three occasions (2012, 2015, and 14 November 2016)). We conducted handsearches of reference lists, contacted experts in the field, conducted citation searches, and searched websites of relevant organisations. SELECTION CRITERIA We included randomised controlled trials (RCTs), including cluster RCTs, which aimed to address at least two risk behaviours. Participants were children and young people up to 18 years of age and/or parents, guardians, or carers, as long as the intervention aimed to address involvement in multiple risk behaviours among children and young people up to 18 years of age. However, studies could include outcome data on children > 18 years of age at the time of follow-up. Specifically,we included studies with outcomes collected from those eight to 25 years of age. Further, we included only studies with a combined intervention and follow-up period of six months or longer. We excluded interventions aimed at individuals with clinically diagnosed disorders along with clinical interventions. We categorised interventions according to whether they were conducted at the individual level; the family level; or the school level. DATA COLLECTION AND ANALYSIS We identified a total of 34,680 titles, screened 27,691 articles and assessed 424 full-text articles for eligibility. Two or more review authors independently assessed studies for inclusion in the review, extracted data, and assessed risk of bias.We pooled data in meta-analyses using a random-effects (DerSimonian and Laird) model in RevMan 5.3. For each outcome, we included subgroups related to study type (individual, family, or school level, and universal or targeted approach) and examined effectiveness at up to 12 months' follow-up and over the longer term (> 12 months). We assessed the quality and certainty of evidence using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS We included in the review a total of 70 eligible studies, of which a substantial proportion were universal school-based studies (n = 28; 40%). Most studies were conducted in the USA (n = 55; 79%). On average, studies aimed to prevent four of the primary behaviours. Behaviours that were most frequently addressed included alcohol use (n = 55), drug use (n = 53), and/or antisocial behaviour (n = 53), followed by tobacco use (n = 42). No studies aimed to prevent self-harm or gambling alongside other behaviours.Evidence suggests that for multiple risk behaviours, universal school-based interventions were beneficial in relation to tobacco use (odds ratio (OR) 0.77, 95% confidence interval (CI) 0.60 to 0.97; n = 9 studies; 15,354 participants) and alcohol use (OR 0.72, 95% CI 0.56 to 0.92; n = 8 studies; 8751 participants; both moderate-quality evidence) compared to a comparator, and that such interventions may be effective in preventing illicit drug use (OR 0.74, 95% CI 0.55 to 1.00; n = 5 studies; 11,058 participants; low-quality evidence) and engagement in any antisocial behaviour (OR 0.81, 95% CI 0.66 to 0.98; n = 13 studies; 20,756 participants; very low-quality evidence) at up to 12 months' follow-up, although there was evidence of moderate to substantial heterogeneity (I² = 49% to 69%). Moderate-quality evidence also showed that multiple risk behaviour universal school-based interventions improved the odds of physical activity (OR 1.32, 95% CI 1.16 to 1.50; I² = 0%; n = 4 studies; 6441 participants). We considered observed effects to be of public health importance when applied at the population level. Evidence was less certain for the effects of such multiple risk behaviour interventions for cannabis use (OR 0.79, 95% CI 0.62 to 1.01; P = 0.06; n = 5 studies; 4140 participants; I² = 0%; moderate-quality evidence), sexual risk behaviours (OR 0.83, 95% CI 0.61 to 1.12; P = 0.22; n = 6 studies; 12,633 participants; I² = 77%; low-quality evidence), and unhealthy diet (OR 0.82, 95% CI 0.64 to 1.06; P = 0.13; n = 3 studies; 6441 participants; I² = 49%; moderate-quality evidence). It is important to note that some evidence supported the positive effects of universal school-level interventions on three or more risk behaviours.For most outcomes of individual- and family-level targeted and universal interventions, moderate- or low-quality evidence suggests little or no effect, although caution is warranted in interpretation because few of these studies were available for comparison (n ≤ 4 studies for each outcome).Seven studies reported adverse effects, which involved evidence suggestive of increased involvement in a risk behaviour among participants receiving the intervention compared to participants given control interventions.We judged the quality of evidence to be moderate or low for most outcomes, primarily owing to concerns around selection, performance, and detection bias and heterogeneity between studies. AUTHORS' CONCLUSIONS Available evidence is strongest for universal school-based interventions that target multiple- risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family- or individual-level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high-quality multiple- risk behaviour intervention studies to further strengthen the evidence base in this field.
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Affiliation(s)
- Georgina MacArthur
- University of BristolPopulation Health Sciences, Bristol Medical School39 Whatley RoadBristolUKBS8 2PS
| | - Deborah M Caldwell
- University of BristolPopulation Health Sciences, Bristol Medical School39 Whatley RoadBristolUKBS8 2PS
| | - James Redmore
- University of BristolPopulation Health Sciences, Bristol Medical School39 Whatley RoadBristolUKBS8 2PS
| | - Sarah H Watkins
- University of BristolPopulation Health Sciences, Bristol Medical School39 Whatley RoadBristolUKBS8 2PS
| | - Ruth Kipping
- University of BristolPopulation Health Sciences, Bristol Medical School39 Whatley RoadBristolUKBS8 2PS
| | - James White
- School of Medicine, Cardiff UniversityDECIPHer (Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement), Centre for Trials Research4th Floor Neuadd MeirionnyddCardiffUKCF14 4YS
| | - Catherine Chittleborough
- University of AdelaideSchool of Public HealthLevel 7, 178 North Terrace, Mail Drop DX 650 550AdelaideSouth AustraliaAustralia5005
| | - Rebecca Langford
- University of BristolPopulation Health Sciences, Bristol Medical School39 Whatley RoadBristolUKBS8 2PS
| | - Vanessa Er
- University of BristolPopulation Health Sciences, Bristol Medical School39 Whatley RoadBristolUKBS8 2PS
| | - Raghu Lingam
- Newcastle UniversityInstitute of Health and SocietyBaddiley‐Clark Building, Richardson RoadNewcastle Upon TyneUKNE2 4AX
| | - Keryn Pasch
- University of TexasDepartment of Kinesiology and Health Education1 University Station, D3700AustinTexasUSA78712
| | - David Gunnell
- University of BristolPopulation Health Sciences, Bristol Medical School39 Whatley RoadBristolUKBS8 2PS
| | - Matthew Hickman
- University of BristolPopulation Health Sciences, Bristol Medical School39 Whatley RoadBristolUKBS8 2PS
| | - Rona Campbell
- University of BristolPopulation Health Sciences, Bristol Medical School39 Whatley RoadBristolUKBS8 2PS
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Wang X, Zhou G, Zeng J, Yang T, Chen J, Li T. Effect of educational interventions on health in childhood: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018; 97:e11849. [PMID: 30200070 PMCID: PMC6133573 DOI: 10.1097/md.0000000000011849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The purpose of this study was to summarize the evidences from randomized controlled trials (RCTs) investigating the effects of educational interventions in overweight/obesity childhood by using meta-analytic approach. METHODS PubMed, Embase, and the Cochrane Library databases were searched from the inception to April 2018. Weighted mean differences (WMDs) with corresponding 95% confidence intervals (CIs) were used to measure the effects of educational interventions during childhood in the random-effects models. RESULTS Thirty RCTs reporting data on 35,296 children were included in the meta-analysis. The summary WMD indicated that children received educational interventions had lower levels of body mass index (BMI) (WMD: -0.15; 95% CI: -0.24 to -0.05; P = .003), BMI z-score (WMD: -0.03; 95% CI: -0.05 to -0.02; P < .001), waist circumference (WMD: -0.97; 95% CI: -1.95 to -0.00; P = 0.050), triceps skinfold (WMD: -1.39; 95% CI: -2.41 to -0.37; P = .008), systolic blood pressure (WMD: -1.13; 95% CI: -2.20 to -0.07; P = .037), total cholesterol (WMD: -4.04; 95% CI: -7.18 to -0.90; P = .012), and triglyceride (WMD: -2.62; 95% CI: -4.33 to -0.90; P = .003). However, educational interventions were not associated with the levels of waist-to-hip ratio, diastolic blood pressure, high-density lipoprotein, and low-density lipoprotein. CONCLUSION The study findings elucidate the positive effects of educational interventions on BMI, BMI z-score, waist circumference, triceps skinfold, systolic blood pressure, total cholesterol, and triglyceride.
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Affiliation(s)
- Xuqin Wang
- Children's Nutrition Research Center
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing
- Third Affiliated Hospital of Zunyi Medical College, Guizhou, PR China
| | - Guoqi Zhou
- Third Affiliated Hospital of Zunyi Medical College, Guizhou, PR China
| | - Jiaying Zeng
- Children's Nutrition Research Center
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing
| | - Ting Yang
- Children's Nutrition Research Center
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing
| | - Jie Chen
- Children's Nutrition Research Center
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing
| | - Tingyu Li
- Children's Nutrition Research Center
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing
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Association between overweight/obesity and eating habits while watching television among primary-school children in the city of Shiraz, Iran. Public Health Nutr 2017; 21:571-579. [PMID: 29173231 DOI: 10.1017/s1368980017003251] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE It has been reported that television (TV) viewing is associated with childhood obesity in Western countries. The present study aimed to investigate the relationship between obesity and eating habits while watching TV among primary-school children in the Middle East. DESIGN Cross-sectional. SETTING Children were recruited from primary schools of four educational districts in Shiraz, Iran. Anthropometric indices of mass (kg) and height (m) were measured, and BMI (percentile) was calculated. Demographic characteristics, TV viewing behaviours and physical activity data were collected from parents during face-to-face interviews and a 3d dietary record was completed. Subject Children (n 607) aged 6-10 years. RESULTS Mean (sd) age of children was 8·16 (1·37) years, of whom 9·1 and 8·4 % were overweight and obese, respectively. Children who spent ≥2 h watching TV on weekdays (OR=1·99; 95 % CI 1·09, 3·60) and weekend days (OR=1·86; 95 % CI 1·01, 3·43) had higher odds of being obese, even after adjusting for physical activity. Children who ate breakfast while watching TV had higher odds of being overweight v. those who did not watch TV while eating breakfast (OR=2·70; 95 % CI 1·02, 7·60). There were no associations between TV viewing during other meals (lunch and dinner) and overweight/obesity. CONCLUSIONS TV viewing for ≥2 h daily increases the risk of being obese in Iranian children aged 6-10 years, independent of physical activity. Further, breakfast consumption while watching TV may increase the risk of overweight/obesity, independent of total TV viewing time.
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Poitras VJ, Gray CE, Janssen X, Aubert S, Carson V, Faulkner G, Goldfield GS, Reilly JJ, Sampson M, Tremblay MS. Systematic review of the relationships between sedentary behaviour and health indicators in the early years (0-4 years). BMC Public Health 2017; 17:868. [PMID: 29219092 PMCID: PMC5773886 DOI: 10.1186/s12889-017-4849-8] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background The purpose of this systematic review was to examine the relationships between sedentary behaviour (SB) and health indicators in children aged 0 to 4 years, and to determine what doses of SB (i.e., duration, patterns [frequency, interruptions], and type) were associated with health indicators. Methods Online databases were searched for peer-reviewed studies that met the a priori inclusion criteria: population (apparently healthy, 1 month to 4.99 years), intervention/exposure and comparator (durations, patterns, and types of SB), and outcome/health indicator (critical: adiposity, motor development, psychosocial health, cognitive development; important: bone and skeletal health, cardiometabolic health, fitness, risks/harm). The quality of the evidence was assessed by study design and outcome using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Results Due to heterogeneity, meta-analyses were not possible; instead, narrative syntheses were conducted, structured around the health indicator and type of SB. A total of 96 studies were included (195,430 participants from 33 countries). Study designs were: randomized controlled trial (n = 1), case-control (n = 3), longitudinal (n = 25), longitudinal with additional cross-sectional analyses (n = 5), and cross-sectional (n = 62). Evidence quality ranged from “very low” to “moderate”. Associations between objectively measured total sedentary time and indicators of adiposity and motor development were predominantly null. Associations between screen time and indicators of adiposity, motor or cognitive development, and psychosocial health were primarily unfavourable or null. Associations between reading/storytelling and indicators of cognitive development were favourable or null. Associations between time spent seated (e.g., in car seats or strollers) or in the supine position, and indicators of adiposity and motor development, were primarily unfavourable or null. Data were scarce for other outcomes. Conclusions These findings continue to support the importance of minimizing screen time for disease prevention and health promotion in the early years, but also highlight the potential cognitive benefits of interactive non-screen-based sedentary behaviours such as reading and storytelling. Additional high-quality research using valid and reliable measures is needed to more definitively establish the relationships between durations, patterns, and types of SB and health indicators, and to provide insight into the appropriate dose of SB for optimal health in the early years. Electronic supplementary material The online version of this article (10.1186/s12889-017-4849-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Veronica J Poitras
- Healthy Active Living and Obesity Research Group, RI #1, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
| | - Casey E Gray
- Healthy Active Living and Obesity Research Group, RI #1, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Xanne Janssen
- University of Strathclyde, School of Psychological Science and Health, G1 1QE, Glasgow, Scotland, UK
| | - Salome Aubert
- Healthy Active Living and Obesity Research Group, RI #1, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Valerie Carson
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, T6G 2H9, Canada
| | - Guy Faulkner
- School of Kinesiology, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Gary S Goldfield
- Healthy Active Living and Obesity Research Group, RI #1, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - John J Reilly
- University of Strathclyde, School of Psychological Science and Health, G1 1QE, Glasgow, Scotland, UK
| | - Margaret Sampson
- Healthy Active Living and Obesity Research Group, RI #1, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.,Library and Media Services, Children's Hospital of Eastern Ontario, Ottawa, ON, K1H 8L1, Canada
| | - Mark S Tremblay
- Healthy Active Living and Obesity Research Group, RI #1, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
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[Reduce sedentary behaviour among children - a systematic review]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59:1443-1451. [PMID: 27683079 DOI: 10.1007/s00103-016-2452-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
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.
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Downing KL, Hnatiuk JA, Hinkley T, Salmon J, Hesketh KD. Interventions to reduce sedentary behaviour in 0-5-year-olds: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med 2016; 52:314-321. [PMID: 29449219 PMCID: PMC5867408 DOI: 10.1136/bjsports-2016-096634] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 11/03/2022]
Abstract
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.
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Affiliation(s)
- Katherine L Downing
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Science, Geelong, Victoria, Australia
| | - Jill A Hnatiuk
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Science, Geelong, Victoria, Australia.,School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Trina Hinkley
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Science, Geelong, Victoria, Australia
| | - Jo Salmon
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Science, Geelong, Victoria, Australia
| | - Kylie D Hesketh
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Science, Geelong, Victoria, Australia
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Sim LA, Lebow J, Wang Z, Koball A, Murad MH. Brief Primary Care Obesity Interventions: A Meta-analysis. Pediatrics 2016; 138:peds.2016-0149. [PMID: 27621413 DOI: 10.1542/peds.2016-0149] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Although practice guidelines suggest that primary care providers working with children and adolescents incorporate BMI surveillance and counseling into routine practice, the evidence base for this practice is unclear. OBJECTIVE To determine the effect of brief, primary care interventions for pediatric weight management on BMI. DATA SOURCES Medline, CENTRAL, Embase, PsycInfo, and CINAHL were searched for relevant publications from January 1976 to March 2016 and cross-referenced with published studies. STUDY SELECTION Eligible studies were randomized controlled trials and quasi-experimental studies that compared the effect of office-based primary care weight management interventions to any control intervention on percent BMI or BMI z scores in children aged 2 to 18 years. DATA EXTRACTION Two reviewers independently screened sources, extracted data on participant, intervention, and study characteristics, z-BMI/percent BMI, harms, and study quality using the Cochrane and Newcastle-Ottawa risk of bias tools. RESULTS A random effects model was used to pool the effect size across eligible 10 randomized controlled trials and 2 quasi-experimental studies. Compared with usual care or control treatment, brief interventions feasible for primary care were associated with a significant but small reduction in BMI z score (-0.04, [95% confidence interval, -0.08 to -0.01]; P = .02) and a nonsignificant effect on body satisfaction (standardized mean difference 0.00, [95% confidence interval, -0.21 to 0.22]; P = .98). LIMITATIONS Studies had methodological limitations, follow-up was brief, and adverse effects were not commonly measured. CONCLUSIONS BMI surveillance and counseling has a marginal effect on BMI, highlighting the need for revised practice guidelines and the development of novel approaches for providers to address this problem.
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Affiliation(s)
| | - Jocelyn Lebow
- Departments of Psychiatry and Psychology, and.,Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Zhen Wang
- Evidence-Based Practice Center and Center for Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota
| | - Afton Koball
- Gundersen Lutheran Health System, Department of Behavioral Health, LaCrosse, Wisconsin
| | - M Hassan Murad
- Evidence-Based Practice Center and Center for Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota
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Wu L, Sun S, He Y, Jiang B. The effect of interventions targeting screen time reduction: A systematic review and meta-analysis. Medicine (Baltimore) 2016; 95:e4029. [PMID: 27399085 PMCID: PMC5058814 DOI: 10.1097/md.0000000000004029] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Lei Wu
- Department of Epidemiology, Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Samio Sun
- Department of Bioengineering, The University of Tokyo, Tokyo, Japan
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX
| | - Yao He
- Department of Epidemiology, Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, Chinese People's Liberation Army General Hospital, Beijing, China
- State Key Laboratory of Kidney Disease
- Correspondence: Yao He, Fuxing Road 28, Beijing 100853, China (e-mail: )
| | - Bin Jiang
- Department of Acupuncture, Chinese People's Liberation Army General Hospital, Beijing, China
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Effectiveness of intervention strategies exclusively targeting reductions in children's sedentary time: a systematic review of the literature. Int J Behav Nutr Phys Act 2016; 13:65. [PMID: 27276873 PMCID: PMC4899905 DOI: 10.1186/s12966-016-0387-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 06/01/2016] [Indexed: 01/08/2023] Open
Abstract
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.
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