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Screen time interventions for children

Health Factors: Diet & Exercise
Decision Makers: Community Members Educators Local Government State Government Nonprofit Leaders
Evidence Rating: Scientifically Supported
Population Reach: 20-49% of WI's population
Impact on Disparities: No impact on disparities likely

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Description

Screen time interventions encourage children to spend time away from TV and other stationary screen media (e.g., computers and video games); such interventions typically do not address use of mobile screens (e.g., smartphones and tablets). Screen time interventions teach self-management skills to initiate or maintain behavior change using tracking and monitoring, classroom-based education, counseling sessions, and/or family-based or peer social support. Screen time interventions can also include physical activity and/or healthy diet components (CG-Obesity). Children and adolescents spend an average of 6 and 8 hours per day, respectively, in sedentary behaviors (ALR-Lou 2014). Although parent-reported average TV viewing time has decreased in recent years among preschoolers and children ages 6-11 (Loprinzi 2016), overall screen time averages have increased and are substantially more than the recommended limit of 2 hours per day (ALR-Lou 2014, AAP-Media, CG-Obesity).

Expected Beneficial Outcomes

Reduced sedentary screen time
Increased physical activity
Improved dietary habits
Improved weight status

Evidence of Effectiveness

There is strong evidence that screen time interventions reduce sedentary screen time among children under 14 (CG-ObesityBiddle 2014Marsh 2014). Interventions that include nutrition and physical activity components have also been shown to increase physical activity and improve dietary habits and weight-related outcomes for participating children (CG-ObesityBiddle 2014Friedrich 2014). Overall, screen time interventions have small but significant effects on stationary screen use with or without nutrition and physical activity components (CG-ObesityBiddle 2014Friedrich 2014); additional evidence is needed to confirm effects on mobile device use.

Screen time interventions may be especially effective for children under the age of 6 (Biddle 2014Marsh 2014). Such interventions can benefit children in urban and suburban settings, children from a variety of socio-economic and racial and ethnic backgrounds, and children who are of healthy weight, overweight, and obese (CG-Obesity).

In many cases, children who participate in screen time interventions with nutrition and physical activity components reduce their body mass index (BMI). Such interventions can also decrease the number of participating children who are obese (CG-Obesity). High levels of TV viewing are associated with higher BMIs as early as age 2 (Wen 2014).

Family and parental support significantly increase the effectiveness of screen time interventions, reducing sedentary behavior and fostering long-term healthy screen time habits (CG-ObesityMarsh 2014, Xu 2015). Screen time interventions that include family-based social support and electronic monitoring devices (e.g., low cost apps for mobile devices or time limits for TV or e-readers) reduce sedentary screen time (CG-ObesityBiddle 2014). Parents can increase the effectiveness of such interventions by enforcing consistent rules about media use with a family media plan, being a role model balancing screen time and other activities, and fostering family communication about media use (Chassiakos 2016, Xu 2015). Parental reductions in personal screen time can also decrease children’s screen time (Xu 2015).

In schools, screen time interventions can be incorporated into existing curricula. Teacher training may increase effectiveness of these interventions (CG-Obesity). In child care settings, higher levels of education for care providers is associated with lower levels of screen time for children; screen availability and attending home-based child care are associated with higher levels of screen time (Vanderloo 2014).

Implementation

United States

States and cities can regulate screen time in various settings, especially child care centers and home-based child care settings, as in Maryland (NCSL-ECE) and New York City (Nonas 2014). State health agencies often provide information, resources, and technical assistance to support the implementation of screen time interventions (ASTHO-Screen time).

There are several school-based screen time interventions that include physical activity and nutrition components. Many public middle schools in Massachusetts, for example, implement the Planet Health curriculum (CDC PRC-Planet health). Several elementary schools in Maplewood, New Jersey implement a week or year-long TV Turnoff Challenge (TV Turnoff).

The 5-2-1-0 childhood obesity prevention program is an example of a multi-component intervention for reducing screen time, improving diet, and increasing physical activity; the program encourages developing daily habits that include 5 servings of fruits and vegetables, 2 hours or less of screen time, 1 hour or more of physical activity, 0 sugary drinks, and increased water consumption. The 5-2-1-0 program started in Maine (MMC-5210), and has expanded to cities and states across the country, for example Florida (FL DOH-5210); Kentucky (KY DPH-5210); New Hampshire (FHC-5210); Baton Rouge, LA (MHCI-5210 plus 10); Chesterfield County, VA (CCHD-5210 everyday); and Palo Alto, CA (PAMF-5210 resources).

Families can also regulate screen time; for example, through family media plans, media free meals, media “curfews”, or designating one day/evening a week cell phone free for family fun time (CSE-Families, AAP-Media). 

Wisconsin

The Wisconsin Department of Health Services is one organization that provides guides and toolkits to help early child care and education professionals, community coalitions, government agencies, and others implementing or encouraging the use of screen time interventions with nutrition and physical activity components (WI DHS-Active early 2011).

Implementation Resources

AAP-Media - American Academy of Pediatrics (AAP). Media and children communication toolkit: AAP recommendations and resources for parents. Accessed on March 8, 2017
ChangeLab-Model childcare statute - National Policy & Legal Analysis Network to Prevent Childhood Obesity (NPLAN). Model childcare licensing statute for obesity prevention. Oakland: ChangeLab Solutions; 2013. Accessed on March 9, 2017
HOST-PA - Healthy Out-of-School Time (HOST) Coalition. Resources: Physical activity (PA). Accessed on May 9, 2017
MN DOH-Screen time - Minnesota Department of Health (MN DOH). Television/screen time and health: TV/screen time obesity report. Accessed on March 13, 2017
USDA-Screen time - US Department of Agriculture (USDA), Team Nutrition Healthy Meals Resource System (HMRS). Electronic media use/screen time. Accessed on March 16, 2017
UW CPHN-Resources - University of Washington Center for Public Health Nutrition (UW CPHN). Early care and education: Trainings, tools, and resources. Accessed on March 9, 2017

Citations - Description

AAP-Media - American Academy of Pediatrics (AAP). Media and children communication toolkit: AAP recommendations and resources for parents. Accessed on March 8, 2017
ALR-Lou 2014 - Lou DW. Research review: Sedentary behaviors and youth: Current trends and the impact on health. Active Living Research (ALR); 2014. Accessed on March 9, 2017
CG-Obesity - The Guide to Community Preventive Services (The Community Guide). Obesity. Accessed on March 9, 2017
Loprinzi 2016* - Loprinzi PD, Davis RE. Secular trends in parent-reported television viewing among children in the United States, 2001-2012. Child: Care, Health and Development. 2016;42(2):288-291. Accessed on March 9, 2017

Citations - Evidence

Biddle 2014* - Biddle SJH, Petrolini I, Pearson N. Interventions designed to reduce sedentary behaviours in young people: A review of reviews. British Journal of Sports Medicine. 2014;48:182-186. Accessed on March 9, 2017
CG-Obesity - The Guide to Community Preventive Services (The Community Guide). Obesity. Accessed on March 9, 2017
Chassiakos 2016 - Chassiakos YR, Radesky J, Christakis D, Moreno MA, Cross C. Children and adolescents and digital media. Pediatrics. 2016;138(5):e20162593. Accessed on March 8, 2017
Friedrich 2014* - Friedrich RR, Polet JP, Schuch I, Wagner MB. Effect of intervention programs in schools to reduce screen time: A meta-analysis. Jornal de Pediatria. 2014;90(3):232-241. Accessed on March 9, 2017
Marsh 2014* - Marsh S, Foley LS, Wilks DC, Maddison R. Family-based interventions for reducing sedentary time in youth: A systematic review of randomized controlled trials. Obesity Reviews. 2014;15:117-133. Accessed on March 9, 2017
Vanderloo 2014 - Vanderloo L. Screen-viewing among preschoolers in childcare: A systematic review. BMC Pediatrics. 2014;14:205. Accessed on March 9, 2017
Wen 2014 - Wen LM, Baur LA, Rissel C, Xu H, Simpson JM. Correlates of body mass index and overweight and obesity of children aged 2 years: Findings from the healthy beginnings trial. Obesity. 2014;22(7):1723-1730. Accessed on March 9, 2017
Xu 2015 - Xu H, Wen LM, Rissel C. Associations of parental influences with physical activity and screen time among young children: A systematic review. Journal of Obesity. 2015;2015:546925. Accessed on March 9, 2017

Citations - Implementation

AAP-Media - American Academy of Pediatrics (AAP). Media and children communication toolkit: AAP recommendations and resources for parents. Accessed on March 8, 2017
ASTHO-Screen time - Association of State and Territorial Health Officials (ASTHO). Action sheet: Preventing obesity through reduced screen time interventions. Accessed on March 9, 2017
CCHD-5210 everyday - Chesterfield County Health Department (CCHD). 5-2-1-0 Everyday! Chesterfield County's Coalition for Active Children (COACH) promotes 5-2-1-0 message to help prevent childhood obesity. Accessed on March 9, 2017
CDC PRC-Planet health - Centers for Disease Control and Prevention (CDC), Prevention Research Centers (PRC). Reading, writing, and reducing obesity: The middle school curriculum Planet health. Accessed on March 9, 2017
CSE-Families - Common Sense Education (CSE), Common Sense Media. Connecting families: Our family toolbox. Accessed on March 8, 2017
FHC-5210 - Foundation for Healthy Communities (FHC). 5-2-1-0 Healthy NH. Accessed on March 9, 2017
FL DOH-5210 - Florida Department of Health (FL DOH), FloridaHealth Lee County. The 5-2-1-0 plan for a healthier active lifestyle. Accessed on March 9, 2017
KY DPH-5210 - Kentucky Cabinet for Health and Family Services Department for Public Health (KY DPH). 5-2-1-0: Kentucky has the prescription for significantly reducing childhood obesity. Accessed on March 9, 2017
MHCI-5210 plus 10 - Mayor's Healthy City Initiative (MHCI). Healthy Baton Rouge: 5-2-1-0+10: Numbers for your children's health! Accessed on March 9, 2017
MMC-5210 - Maine Medical Center (MMC), Healthy Maine Partnerships (HMP). 5-2-1-0 Let's go! Accessed on March 9, 2017
NCSL-ECE - National Conference of State Legislatures (NCSL). Early care and education (ECE) 2014 legislative action. Accessed on March 9, 2017
Nonas 2014 - Nonas C, Silver LD, Khan LK, Leviton L. Rationale for New York City’s regulations on nutrition, physical activity, and screen time in early child care centers. Preventing Chronic Disease. 2014;11:E182. Accessed on March 9, 2017
PAMF-5210 resources - Sutter Health Palo Alto Medical Foundation (PAMF). 5-2-1-0 Resources. Accessed on March 9, 2017
TV Turnoff - TVturnoff.net. Ultimate TV turnoff challenge: Program outline. Accessed on March 9, 2017
WI DHS-Active early 2011 - Wisconsin Department of Health Services (WI DHS), Wisconsin Department of Public Instruction (WI DPI), Wisconsin Department of Children and Families (WI DCF). Active early: A Wisconsin guide for improving childhood physical activity. 2011. Accessed on March 9, 2017

Page Last Updated

March 8, 2017

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