Screen-time Weight-loss Intervention Targeting Children at Home (SWITCH): A randomized controlled trial study protocol Intervening to Reduce Sedentary Behaviors and Childhood Obesity among School-Age Youth: A Systematic Review of Randomized Trials Effectiveness of parent‐centred interventions for the prevention and treatment of childhood overweight and obesity in community settings: a systematic review Depressive symptoms in adolescence: the association with multiple health risk behaviors. Screen-Time Weight-loss Intervention Targeting Children at Home (SWITCH): a randomized controlled trial Protocol for systematic reviews of determinants/correlates of obesity-related dietary and physical activity behaviors in young children (preschool 0 to 6 years): evidence mapping and syntheses Associations Between Screen-Based Sedentary Behavior and Cardiovascular Disease Risk Factors in Korean Youth Breaking up Sedentary Time in Overweight/Obese Adults on Work Days and Non-Work Days: Results from a Feasibility Study What are the most effective behaviour change techniques to promote physical activity and/or reduce sedentary behaviour in inactive adults? A systematic review protocol Sedentariness, small-screen recreation, and fitness in youth. Family, community and clinic collaboration to treat overweight and obese children: Stanford GOALS-A randomized controlled trial of a three-year, multi-component, multi-level, multi-setting intervention. Executive function mediates prospective relationships between sleep duration and sedentary behavior in children. Changes in sedentary behavior among adolescent girls: a 2.5-year prospective cohort study. Longitudinal sedentary behavior changes in adolescents in Ho Chi Minh City. Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. The Healthy Home Offerings via the Mealtime Environment (HOME) Plus study: design and methods. Rationale and study protocol for the 'active teen leaders avoiding screen-time' (ATLAS) group randomized controlled trial: an obesity prevention intervention for adolescent boys from schools in low-income communities. Energy balance-related behaviours associated with overweight and obesity in preschool children: a systematic review of prospective studies. Hip-Hop to Health Jr. Obesity Prevention Effectiveness Trial: postintervention results. Physical activity, sedentary behaviors and dietary habits among Saudi adolescents relative to age, gender and region Exploring changes in physical activity, sedentary behaviors and hypothesized mediators in the NEAT girls group randomized controlled trial. Evaluation of a multiple ecological level child obesity prevention program: Switch® what you Do, View, and Chew Healthy families study: design of a childhood obesity prevention trial for Hispanic families.
Background Approximately one third of New Zeal and children and young people are overweight or obese . A similar proportion ( 33 % ) do not meet recommendations for physical activity , and 70 % do not meet recommendations for screen time . Increased time being sedentary is positively associated with being overweight . There are few family-based interventions aim ed at reducing sedentary behavior in children . The aim of this trial is to determine the effects of a 24 week home-based , family oriented intervention to reduce sedentary screen time  on children 's body composition , sedentary behavior , physical activity , and diet . Methods / Design The study design is a pragmatic two-arm parallel r and omized controlled trial . Two hundred and seventy overweight children aged 9 - 12 years and primary caregivers are being recruited . Participants are r and omized to intervention ( family-based screen time intervention ) or control ( no change ) . At the end of the study , the control group is offered the intervention content . Data collection is undertaken at baseline and 24 weeks . The primary trial outcome is child body mass index ( BMI ) and st and ardized body mass index ( z BMI ) . Secondary outcomes are change from baseline to 24 weeks in child percentage body fat ; waist circumference ; self-reported average daily time spent in physical and sedentary activities ; dietary intake ; and enjoyment of physical activity and sedentary behavior . Secondary outcomes for the primary caregiver include change in BMI and self-reported physical activity . Discussion This study provides an excellent example of a theory-based , pragmatic , community-based trial targeting sedentary behavior in overweight children . The study has been specifically design ed to allow for estimation of the consistency of effects on body composition for Māori ( indigenous ) , Pacific and non-Māori/non-Pacific ethnic groups . If effective , this intervention is imminently scalable and could be integrated within existing weight management programs . Trial Registration Objective . To assess the effectiveness of interventions that focus on reducing  sedentary behavior ( SB ) among school-age youth and to identify elements associated with interventions ' potential for translation into practice setting s. Methods . A comprehensive literature search was conducted using 4 data bases for peer- review ed studies published between 1980 and April 2011 . R and omized trials , which lasted at least 12 weeks , aim ed at decreasing  SB among children aged 6 to 19 years were identified . Results . Twelve studies were included ; 3 focused only on SB , 1 focused on  physical activity ( PA )  , 6 were combined SB and PA interventions , and 2 studies targeted SB , PA , and diet .  The majority of the studies were conducted in a school setting , while others were conducted in such setting s as clinics , community centers , and libraries . Conclusions . Overall , interventions that focused on decreasing SB were associated with reduction in time spent on SB and /or improvements in anthropometric measurements related to childhood obesity . Several of the studies did consider elements related to the intervention 's potential for translation into practice setting Background Worldwide in 2000 , 10 % of children aged five to 17 years were reported as being overweight with an additional 2‐3 % being obese . Overweight and obesity in childhood can adversely impact on both physical and psychological health . The rise in the prevalence of childhood obesity is a complex issue but widely recognised contributors include increased energy intake , decreased levels of physical activity and greater time spent in sedentary pursuits . A large number of environmental and cultural factors have also been identified as contributing to the problem . Evidence to support an optimal approach to treating childhood obesity is limited with many studies showing only modest results at best in the long‐term . However , the importance of family‐based treatment that combines diet , physical activity and behavioral components has been acknowledged in a recent Cochrane Systematic Review . It has also been suggested that interventions offered in the community setting may help overcome barriers to participation , by making programs more accessible and allowing the targeting of specific sub‐groups of the population . Objectives The objective of this review was to identify the effectiveness of parent‐centred interventions implemented in the community setting in modifying eating and physical activity behaviors or weight‐related outcomes of children . Inclusion criteria Types of participants This review considered studies that included free‐living children of pre‐school , primary and secondary school age and /or their parents/guardians aged > 18 years . Types of intervention(s)/phenomena of interest Intervention programs were required to have a parental component , to target eating and /or exercise behaviors for the prevention or treatment of obesity , and child weight status reported . Types of studies All intervention studies were included in the review including : r and omized controlled trials ( RCTs ) ; non‐r and omized controlled trials , longitudinal studies , cohort ( both retrospective and prospect i ve ) , case control and time series studies which had been conducted in a community setting . Types of outcomes This review considered studies that included overweight/obesity related outcomes , eating behavior outcomes , physical activity behaviour outcomes , and sedentary behavior outcomes and constructs . Search strategy A literature search of community‐based parent‐centred intervention studies to promote nutrition and physical activity for the prevention and treatment and of childhood overweight and obesity was performed in eight electronic data bases dating from 1975 to April 2009 . Method ological quality Studies were critically appraised for method ological quality using st and ardized tools . Data collection Data was extracted by one review er using a st and ardized data extraction form developed by the research ers and checked for accuracy and consistency by a second review er . Data synthesis Data in relation to setting , methodology , intervention components and effect on weight , dietary intake and physical activity was extracted , and described in a narrative synthesis . Where possible a meta‐ analysis was undertaken . Results Of the home‐based interventions , five of nine studies reported statistically significant changes in anthropometric outcomes post intervention . Of the 10 studies in the before and after school care setting , seven reported a significant decrease in a weight‐related outcome post intervention , with only one reporting an increase . Conclusions Results from the review support the after‐school setting as the most promising for community intervention setting for targeting parents as agents of change within child obesity prevention and treatment programs . Implication s for practice At this stage , interventions to support parents should target the after‐school environment as opposed to being conducted in the home , summer camps , leisure centers or churches . Targeting a decrease in energy intake and sweetened beverages in parallel with increasing number of daily steps and decreasing screen time use . Implication s for research Future studies of high quality are needed across the full range of community setting s. Given that currently most of the higher quality RCTs and the studies showing positive impacts of weight change are in the after‐school setting , further studies in this area using similar method ologies to those already published will facilitate future meta‐analyses in this area OBJECTIVE Although multiple studies of adolescents have examined the association of depression with individual health risk behaviors such as obesity or smoking , this is one of the few studies that examined the association between depression and multiple risk behaviors . METHODS A brief mail question naire , which screened for age , gender , weight , height , sedentary behaviors , physical activity , perception of general health , functional impairment and depressive symptoms , was completed by a sample of 2291 youth ( 60.7 % response rate ) aged 13 - 17 enrolled in a health care plan . A subset of youth who screened positive on the two-item depression screen and a r and om sample of those screening negative were approached to participate in a telephone interview with more in-depth information obtained on smoking and at-risk behaviors associated with drug and alcohol use . RESULTS Youth screening positive for high levels of depressive symptoms compared to those with few or no depressive symptoms were significantly more likely to meet criteria for obesity , had a poorer perception of health , spent more time on the computer , got along less well with parents and friends , had more problems completing school work and were more likely to have experimented with smoking and a wide array of behaviors associated with drug and alcohol use . CONCLUSIONS Because many adverse health behaviors that develop in adolescence continue into adulthood , the association of depressive symptoms with multiple risk behaviors and poor functioning suggest that early interventions are needed at an individual , school , community and primary care level Background Screen-based activities , such as watching television ( TV ) , playing video games , and using computers , are common sedentary behaviors among young people and have been linked with increased energy intake and overweight . Previous home-based sedentary behaviour interventions have been limited by focusing primarily on the child , small sample sizes , and short follow-up periods . The SWITCH ( Screen-Time Weight-loss Intervention Targeting Children at Home ) study aim ed to determine the effect of a home-based , family-delivered intervention to reduce screen-based sedentary behaviour on body composition , sedentary behaviour , physical activity , and diet over 24 weeks in overweight and obese children . Methods A two-arm , parallel , r and omized controlled trial was conducted . Children and their primary caregiver living in Auckl and , New Zeal and were recruited via schools , community centres , and word of mouth . The intervention , delivered over 20 weeks , consisted of a face-to-face meeting with the parent/caregiver and the child to deliver intervention content , which focused on training and educating them to use a wide range of strategies design ed to reduce their child ’s screen time . Families were given Time Machine TV monitoring devices to assist with allocating screen time , activity packages to promote alternative activities , online support via a website , and monthly newsletters . Control participants were given the intervention material on completion of follow-up . The primary outcome was change in children ’s BMI z-score from baseline to 24 weeks . Results Children ( n = 251 ) aged 9 - 12 years and their primary caregiver were r and omized to receive the SWITCH intervention ( n = 127 ) or no intervention ( controls ; n = 124 ) . There was no significant difference in change of z BMI between the intervention and control groups , although a favorable trend was observed ( -0.016 ; 95 % CI : -0.084 , 0.051 ; p = 0.64 ) . There were also no significant differences on secondary outcomes , except for a trend towards increased children ’s moderate intensity physical activity in the intervention group ( 24.3 min/d ; 95 % CI : -0.94 , 49.51 ; p = 0.06 ) . Conclusions A home-based , family-delivered intervention to reduce all leisure-time screen use had no significant effect on screen-time or on BMI at 24 weeks in overweight and obese children aged 9 - 12 years . Trial registration Australian New Zeal and Clinical Trials RegistryWebsite : http://www.anzctr.org.auTrial registration number : Background The aim of these review s is to inform the design and content of interventions to reduce obesity in young children . The behaviors that are associated with obesity/overweight have been studied extensively ; however , the factors associated with these behaviors in young children ( 0 to 6 years ) have not been systematic ally review ed . Over the past few years the focus of obesity prevention has shifted to preschool children because of the high prevalence of obesity at school entry and recognition that habits formed in early life could track into adulthood . In order to develop effective interventions and change behavior , it is important to underst and the factors that are associated with those behaviors . For example , we need to underst and whether it would be more important to target the family , childcare setting s or the wider environment and identify the most effective way of changing these energy balance related behaviors . Methods / Design Quantitative ( intervention and observational ) and qualitative literature on determinants/correlates of fruit and vegetable intake , sugar sweetened beverage and other unhealthy diet intake , and physical activity and sedentary behaviors in young children will be systematic ally identified , mapped and review ed . A common search strategy ( no language or period restrictions ) will be used to identify papers from eight electronic data bases and this will be supplemented by h and - search ing . Next , studies in developed countries that examine the factors associated with these behaviors in children aged 0 to 6 years ( at baseline ) will be screened and mapped descriptively followed by in-depth data extraction , quality assessment and synthesis . Data from quantitative studies will be summarized using either forest plots or harvest plots and narrative synthesis , and qualitative studies using thematic analysis . Qualitative evidence will be integrated with the quantitative evidence , using a parallel synthesis approach , to provide a deeper underst and ing of effective strategies to influence these energy balance related behaviors . Discussion In addition to updating and mapping current research , these review s will be the first to comprehensively synthesize and integrate both the quantitative and qualitative evidence pertaining to determinants/correlates/barriers/facilitators of obesity related behaviors in this young age group ( 0 to 6 years ) with the aim of informing future interventions . Systematic review registration International Prospect i ve Register for Systematic Review s ( PROSPERO ) Registration number : The purpose s of this study were to : 1 ) describe the patterns of screen-based sedentary behaviors  , and 2 ) examine the association between  screen-based sedentary behavior and cardiovascular disease ( CVD ) risk factors in representative Korean children and adolescents , aged 12 to 18 yr , in the Korean National Health and Nutrition Examination Survey .  Screen-based sedentary behavior  was measured using self-report question naires that included items for time spent watching TV and playing PC/video games . Physical activity  was measured using items for frequency and duration of moderate-to-vigorous physical activity ( MVPA )  . CVD risk factors such as body mass index ( BMI ) , waist circumference , LDL cholesterol , HDL cholesterol , total cholesterol , triglycerides , glucose , systolic blood pressure , and diastolic blood pressure were measured . Boys spent more time playing PC/video games , and girls spent more time watching TV . After adjusting for age , gender , annual household income , and MVPA , an additional hour of watching TV was significantly associated with the risk of overweight ( OR 1.17 [ 95 % CI 1.03 - 1.33 ] ) , high abdominal adiposity ( OR 1.27 [ 1.06 - 1.51 ] ) , and low HDL cholesterol ( OR 1.27 [ 1.10 - 1.47 ] ) . An additional hour spent playing PC/video games  also increased the risk of high abdominal adiposity ( OR 1.20 [ 1.03 - 1.40 ] ) . Prospect i ve observations and interventions are needed to determine causal relationships between  screen-based sedentary behavior  and CVD risk profiles in Korean youth Office workers are vulnerable to the adverse health effects of sedentary behavior ( i.e. , sitting time ) . Increasing physical activity and preventing time spent sitting is an occupational health priority . This r and omized crossover design study compared the short-term ( 3-days ) effects of hourly interruptions of sedentary time with 5-min micrrobouts of activity for 9 hours ( MICRO ) to a sedentary control condition ( SED ) and a duration -matched continuous single bout of physical activity ( 45-min/d , ONE ) condition on inclinometer-derived sitting-time on work and non-work days in sedentary overweight/obese adults . Differences in sitting/lying , st and ing , stepping , number of sit/st and transitions , time spent in moderate and vigorous activity ( MVPA ) , energy expenditure , self-perceived vigor and fatigue , and insulin sensitivity were also examined . Twenty-two participants ( 10M/12F ; 31.7 ± 1.3 year old BMI 30.4 ± 0.5 kg/m2 ) completed all conditions . No between-condition effects were observed in sitting-time and sit/st and transitions . Both interventions increased daily steps , MVPA and energy expenditure with increases being greater in ONE than MICRO . Feelings of vigor and fasting insulin sensitivity were also improved . Participants reported less fatigue with MICRO than SED and ONE . Both interventions increase physical activity and energy expenditure in occupational and leisure-time context s. The sustainability of these effects over the long term and on health outcomes will need to be tested in future studies Introduction Large proportions of the population are not meeting recommended levels of physical activity and have increasingly sedentary lifestyles . Low levels of physical activity are predictive of poor health outcomes and time spent sedentary is related to a host of risk factors independently of physical activity levels . Building an evidence base of the best approaches to intervene in the lifestyles of inactive individuals is crucial in preventing long-term disease , disability and higher mortality rates . Methods and analysis Systematic search es will be conducted on all relevant data bases ( eg , PubMed , Scopus , CINAHL , PsycINFO ) . Studies will be included if they assess interventions aim ed at changing physical activity or sedentary behaviour levels in adults ( over 18 ) who are inactive and do not suffer from chronic conditions . Studies must also be r and omised controlled trials ( RCTs ) , have a primary outcome of physical activity or sedentary behaviour , and measure outcomes at least 6 months after intervention completion . Studies will be coded using the Behaviour Change Technique ( BCT ) taxonomy v1 and Template for Intervention Description and Replication ( TIDieR ) guidelines . 2 review ers will independently screen full-text articles and extract data on study characteristics , participants , BCTs , intervention features and outcome measures . Study quality will also be assessed independently by 2 review ers using the Cochrane risk of bias tool . A meta- analysis will be considered if there is sufficient homogeneity across outcomes . GRADE criteria will be used to assess quality of evidence . Dissemination This will be the first review to systematic ally appraise interventions aim ed at changing the physical activity or sedentary behaviour of inactive individuals using RCT design s with a 6-month follow-up post-intervention . This review will better inform intervention design ers targeting inactive population s and inform the design of a future complex intervention . Review registration number This protocol was registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) on 17 October 2014 ( registration number : CRD42014014321 ) BACKGROUND There are concerns that sedentariness among young people has increased and that this may be detrimental to their health . The purpose of this study was to examine the association between sedentary activities , including  small-screen recreation ( SSR : watching TV/DVDs/videos , recreational computer use ) and cardiorespiratory endurance ( CRE ) in children aged 11 - 15 years . METHODS A cross-sectional representative population survey was taken of New South Wales ( Australia ) school students in Grade s 6 , 8 , and 10 ( N=2750 ) in 2004 .  Sedentary activities and SSR were measured by a self-report question naire .  CRE was determined by the 20-meter multi-stage shuttle run test . The optimal cut point for time spent on SSR was determined by receiver operating characteristic analysis . RESULTS Time spent in sedentary activities was inversely associated with CRE among Grade 8 students ( p=0.01 ) and Grade 10 girls ( p=0.03 ) . CRE was lower among Grade 8 students ( p<0.001 ) and Grade 10 girls ( p<0.001 ) who spent > or=2 hours/day on SSR compared with students who spent < 2 hours/day . The 2-hour/day cut point for SSR had high sensitivity ( boys : 84 % , [ 95 % CI=79 % , 87 % ] ; girls : 79 % [ 95 % CI=74 % , 84 % ] ) and low specificity ( boys : 28 % [ 95 % CI=24 % , 32 % ] ; girls : 42 % [ 95 % CI=38 % , 46 % ] ) . CONCLUSIONS Cardiorespiratory endurance did not differ consistently across quintiles of sedentariness and SSR among boys ; however , among girls there was a consistent inverse association . If confirmed in prospect i ve studies , these findings have important implication s for risk of chronic disease OBJECTIVE To test the effects of a three-year , community-based , multi-component , multi-level , multi- setting ( MMM ) approach for treating overweight and obese children . DESIGN Two-arm , parallel group , r and omized controlled trial with measures at baseline , 12 , 24 , and 36 months after r and omization . PARTICIPANTS Seven through eleven year old , overweight and obese children ( BMI ≥ 85th percentile ) and their parents/caregivers recruited from community locations in low-income , primarily Latino neighborhoods in Northern California . INTERVENTIONS Families are r and omized to the MMM intervention versus a community health education active-placebo comparison intervention . Interventions last for three years for each participant . The MMM intervention includes a community-based after school team sports program design ed specifically for overweight and obese children , a home-based family intervention to reduce screen time , alter the home food/eating environment , and promote self-regulatory skills for eating and activity behavior change , and a primary care behavioral counseling intervention linked to the community and home interventions . The active-placebo comparison intervention includes semi-annual health education home visits , monthly health education newsletters for children and for parents/guardians , and a series of community-based health education events for families . MAIN OUTCOME MEASURE Body mass index trajectory over the three-year study . Secondary outcome measures include waist circumference , triceps skinfold thickness , accelerometer-measured physical activity , 24-hour dietary recalls , screen time and other sedentary behaviors , blood pressure , fasting lipids , glucose , insulin , hemoglobin A1c , C-reactive protein , alanine aminotransferase , and psychosocial measures . CONCLUSIONS The Stanford GOALS trial is testing the efficacy of a novel community-based multi-component , multi-level , multi- setting treatment for childhood overweight and obesity in low-income , Latino families Childhood sedentary behavior has been linked to increased obesity risk . Prior work has identified associations between sedentary behavior , executive function ( EF ) , and sleep . This study tested the hypothesis that reduced sleep duration may adversely impact EF and lead to increased childhood sedentary behavior . Southern California schoolchildren participating in the school-based health promotion program Pathways to Health ( N=709 ) were assessed annually from 4th through 6th grade s ( 2010 - 2013 ) on self-report measures of sedentary behavior , sleep duration , and executive function .  A series of path models were specified treating average nightly sleep duration and weekend wake/bed-time shift at 4th grade as predictors of 6th grade sedentary behavior . Four EF subdomains were tested as potential mediators of longitudinal associations at 5th grade . Significant associations between average nightly sleep duration , EF and sedentary behavior were identified ( p<0.05 ) , adjusting for participant gender , physical activity , SES , ethnicity , program group assignment , and the presence/absence of parental screen time rules . Fifth grade overall EF (p<0.05)- and in particular the subdomains of inhibitory control ( p<0.05 ) and organization of material s (p<0.01)-significantly mediated the relationship between 4th grade sleep duration and 6th grade sedentary behavior ( p<0.05 ) . Furthermore , delay of weekend bed- or wake-times relative to weekdays was prospect ively associated with decreased overall EF ( p<0.05 ) , but not increased sedentary behavior ( p=0.35 for bed-time delay ; p=0.64 for wake-time delay ) , irrespective of average nightly sleep duration . Findings suggest that sleep promotion efforts may reduce children 's sedentary behavior  both directly and indirectly through changes in EF PURPOSE To describe longitudinal changes in  leisure-time sedentary behavior  among girls , during early to mid-adolescence . METHODS A 2.5-year prospect i ve cohort study , comprising 5 data collection s , 6 months apart , between 2000 and 2002 . Girls aged 12 - 15 years ( n = 200 ) from 8 high schools located in Sydney , Australia , self-reported the usual time spent each week in a comprehensive range of sedentary behaviors . RESULTS Retention rate for the study was 82 % . Girls aged 12.8 years spent approximately 45 % of their discretionary time in sedentary behavior , which increased to 63 % at age 14.9 years .  Watching TV , videos , and playing video games ( small screen recreation ; SSR ) was the most popular sedentary pastime , accounting for 33 % of time spent in sedentariness , followed by homework and reading ( 25 % ) . Sedentary behavior increased 1.4 and 3.3 hours on week and weekend days , respectively . On weekdays , increased time was spent on hobbies ( 27 min/day ) and on weekend days , increased time was spent sitting around talking with friends ( 60 min/day ) , computer use ( 37 min/day ) , and television viewing ( 34 min/day ) . CONCLUSIONS Among girls , the transition between early and mid-adolescence was accompanied by a significant increase in leisure-time sedentary behavior . Interventions to reduce sedentariness among adolescent girls are best to focus on weekend behaviors . Studies seeking to examine the association between inactivity and the development of chronic health problems need to examine a diverse range of activities that comprehensively measure sedentariness . This information will provide a better underst and ing of inactivity patterns among adolescent girls BACKGROUND Sedentary behavior is associated with increased risk of chronic disease and sedentary behavior is increasing among adolescents . Data on changes in sedentary behavior in developing countries are limited . PURPOSE To describe 5-year longitudinal changes in nonschool sedentary hours among urban adolescents in Ho Chi Minh City , and to identify correlates with this change . METHODS This is a 5-year longitudinal cohort with systematic r and om sampling of 759 students from 18 junior high schools . All measures were taken annually between 2004 and 2009 .  Sedentary behavior  was assessed by self-report and accelerometry . Generalized linear latent and mixed models were used to analyze the data in 2011 . RESULTS Between 2004 and 2009 , self-reported time spent in nonschool sedentary behavior  increased from 498 to 603 minutes/day . In the 5th survey year , boys and girls ( aged 16 years ) were , respectively , 3.6 times ( 95 % CI=2.3 , 6.0 ) and 3.1 times ( 95 % CI= 1.8 , 5.0 ) more likely to spend ≥2 hours/day on screen time compared with baseline ( aged 12 years ) . Accelerometer data adjusted for wearing time revealed that boys and girls aged 16 years had , respectively , 78 minutes/day ( 95 % CI=48 , 104 ) and 69 minutes/day ( 95 % CI=34 , 95 ) more nonschool sedentary time than those at the first accelerometer assessment ( at age 13 years ) . Girls in the highest socioeconomic quartile spent an additional 90 minutes/day in sedentary behavior compared with girls in the lowest quartile ( 95 % CI=52 , 128 ) .  CONCLUSIONS Nonschool sedentary behavior  increased among Vietnamese adolescents with age . The largest increase was in recreational screen time ( 28 % ) , which would be the most obvious target for preventive health strategies CONTEXT Current public health campaigns to reduce obesity and type 2 diabetes have largely focused on increasing exercise , but have paid little attention to the reduction of sedentary behaviors . OBJECTIVE To examine the relationship between various sedentary behaviors , especially prolonged television ( TV ) watching , and risk of obesity and type 2 diabetes in women . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study conducted from 1992 to 1998 among women from 11 states in the Nurses ' Health Study . The obesity analysis included 50 277 women who had a body mass index ( BMI ) of less than 30 and were free from diagnosed cardiovascular disease , diabetes , or cancer and completed questions on physical activity and sedentary behaviors at baseline . The diabetes analysis included 68 497 women who at baseline were free from diagnosed diabetes mellitus , cardiovascular disease , or cancer . MAIN OUTCOME MEASURES Onset of obesity and type 2 diabetes mellitus . RESULTS During 6 years of follow-up , 3757 ( 7.5 % ) of 50 277 women who had a BMI of less than 30 in 1992 became obese ( BMI > or = 30 ) . Overall , we documented 1515 new cases of type 2 diabetes .  Time spent watching TV was positively associated with risk of obesity and type 2 diabetes . In the multivariate analyses adjusting for age , smoking , exercise levels , dietary factors , and other covariates , each 2-h/d increment in TV watching was associated with a 23 % ( 95 % confidence interval [ CI ] , 17%-30 % ) increase in obesity and a 14 % ( 95 % CI , 5%-23 % ) increase in risk of diabetes ; each 2-h/d increment in sitting at work was associated with a 5 % ( 95 % CI , 0%-10 % ) increase in obesity and a 7 % ( 95 % CI , 0%-16 % ) increase in diabetes . In contrast , st and ing or walking around at home ( 2 h/d ) was associated with a 9 % ( 95 % CI , 6%-12 % ) reduction in obesity and a 12 % ( 95 % CI , 7%-16 % ) reduction in diabetes . Each 1 hour per day of brisk walking was associated with a 24 % ( 95 % CI , 19%-29 % ) reduction in obesity and a 34 % ( 95 % CI , 27%-41 % ) reduction in diabetes . We estimated that in our cohort , 30 % ( 95 % CI , 24%-36 % ) of new cases of obesity and 43 % ( 95 % CI , 32%-52 % ) of new cases of diabetes could be prevented by adopting a relatively active lifestyle ( < 10 h/wk of TV watching and > or = 30 min/d of brisk walking ) . CONCLUSIONS Independent of exercise levels , sedentary behaviors , especially TV watching , were associated with significantly elevated risk of obesity and type 2 diabetes , whereas even light to moderate activity was associated with substantially lower risk . This study emphasizes the importance of reducing prolonged TV watching and other sedentary behaviors for preventing obesity and diabetes BACKGROUND Informed and engaged parents and healthful home environments are essential for the health of youth . Although research has shown health benefits associated with family meals , to date , no r and omized controlled trial ( RCT ) has been developed to examine the impact of a family meals intervention on behavioral and health outcomes . METHODS / DESIGN The Healthy Home Offerings via the Mealtime Environment ( HOME ) Plus study is a two-arm ( intervention versus attention-only control ) RCT being conducted in Minneapolis/St . Paul . Built on previous pilot research , HOME Plus aims to increase the frequency and healthfulness of family meals and snacks and reduce children 's sedentary behavior , particularly screen time , to promote healthier eating and activity behaviors and prevent obesity . HOME Plus is delivered to families in community setting s. The program includes 10 monthly sessions focused on nutrition and activity education , meal planning and preparation skill development . In addition , five motivational goal - setting phone calls are conducted with parents . The primary outcome measure is age- and gender-adjusted child BMI -z score at post-intervention by treatment group . Secondary household-level outcomes include family meal frequency , home availability of healthful foods ( fruits/vegetables ) and unhealthful foods ( high-fat/sugary snacks ) and beverages ( sugar-sweetened beverages ) , and the quality of foods served at meals and snacks . Secondary child outcomes include dietary intake of corresponding foods and beverages and screen time . CONCLUSIONS The HOME Plus RCT actively engages whole families of 8 - 12 year old children to promote healthier eating and activity behaviors and prevent obesity through promotion of family meals and snacks and limited media use INTRODUCTION The negative consequences of unhealthy weight gain and the high likelihood of pediatric obesity tracking into adulthood highlight the importance of targeting youth who are ' at risk ' of obesity . The aim of this paper is to report the rationale and study protocol for the ' Active Teen Leaders Avoiding Screen-time ' ( ATLAS ) obesity prevention intervention  for adolescent boys living in low-income communities . METHODS / DESIGN The ATLAS intervention will be evaluated using a cluster r and omized controlled trial in 14 secondary schools in the state of New South Wales ( NSW ) , Australia ( 2012 to 2014 ) .  ATLAS is an 8-month multi-component , school-based program informed by self-determination theory and social cognitive theory . The intervention consists of teacher professional development , enhanced school-sport sessions , research er-led seminars , lunch-time physical activity mentoring sessions , pedometers for self-monitoring , provision of equipment to schools , parental newsletters , and a smartphone application and website . Assessment s were conducted at baseline and will be completed again at 9- and 18-months from baseline . Primary outcomes are body mass index ( BMI ) and waist circumference . Secondary outcomes include BMI z-scores , body fat ( bioelectrical impedance analysis ) , physical activity ( accelerometers ) , muscular fitness ( grip strength and push-ups ) , screen-time , sugar-sweetened beverage consumption , resistance training skill competency , daytime sleepiness , subjective well-being , physical self-perception , pathological video gaming , and aggression . Hypothesized mediators of behavior change will also be explored . DISCUSSION ATLAS is an innovative school-based intervention design ed to improve the health behaviors and related outcomes of adolescent males in low-income communities The current review aim ed to systematic ally identify dietary , physical activity and sedentary behaviours in preschool children ( 4 - 6 years of age ) that are prospect ively related to overweight or obesity later in childhood . Prospect i ve studies published between January 1990 and June 2010 were selected from search es in PubMed , EMBASE , PsycINFO , CINAHL and Cochrane Library . Studies examining the prospect i ve association between at least one relevant behaviour measured during preschool period ( children aged 4 - 6 years at baseline ) in relation to at least one anthropometric measurement at follow-up ( age < 18 years ) were included . Harvest plots were used to summarize the results and draw conclusions from the evidence . Of the 8,718 retrieved papers , 23 papers reporting on 15 different study sample s were included in this review . Strong evidence was found for an inverse association between total physical activity and overweight . Moderate evidence was observed for a positive association between television viewing and overweight . Because of the heterogeneity in the assessed dietary behaviours , insufficient evidence was found for an association between  dietary intake or specific dietary behaviours and overweight . These results suggest that interventions aim ing to prevent overweight among preschool children should focus on promotion of total physical activity and limitation of screen time and that further research is needed to establish whether and which dietary behaviours are important for obesity prevention in this age group . However , despite the lack of evidence for dietary behaviours from the present review , future interventions may already target specific dietary behaviours that are highly prevalent and for which there a clear rationale as well as preliminary evidence that these behaviours are associated with overweight The preschool years offer an opportunity to interrupt the trajectory toward obesity in black children . The Hip-Hop to Health Jr. Obesity Prevention Effectiveness Trial was a group-r and omized controlled trial assessing the feasibility and effectiveness of a teacher-delivered weight control intervention for black preschool children . The 618 participating children were enrolled in 18 schools administered by the Chicago Public Schools . Children enrolled in the nine schools r and omized to the intervention group received a 14-week weight control intervention delivered by their classroom teachers . Children in the nine control schools received a general health intervention .  Height and weight , physical activity , screen time , and diet data were collected at baseline and postintervention . At postintervention , children in the intervention schools engaged in more moderate-to-vigorous physical activity ( MVPA ) than children in the control schools ( difference between adjusted group means = 7.46 min/day , P = 0.02 ) . Also , children in the intervention group had less total screen time ( -27.8 min/day , P = 0.05 ) . There were no significant differences in BMI , BMI Z score , or dietary intake . It is feasible to adapt an obesity prevention program to be taught by classroom teachers . The intervention showed positive influences on physical activity and screen time , but not on diet . Measuring diet and physical activity in preschool children remains a challenge , and interventions delivered by classroom teachers require both intensive initial training and ongoing individualized supervision Background Few lifestyle factors have been simultaneously studied and reported for Saudi adolescents . Therefore , the purpose of the present study was to report on the prevalence of physical activity , sedentary behaviors and dietary habits among Saudi adolescents and to examine the interrelationships among these factors using representative sample s drawn from three major cities in Saudi Arabia . Methods This school-based cross-sectional study was conducted during the years 2009 - 2010 in three cities : Al-Khobar , Jeddah and Riyadh . The participants were 2908 secondary -school males ( 1401 ) and females ( 1507 ) aged 14 - 19 years , r and omly selected using a multistage stratified sampling technique . Measurements included weight , height , sedentary behaviors (  TV viewing  , playing video games and computer use ) , physical activity using a vali date d question naire and dietary habits . Results A very high proportion ( 84 % for males and 91.2 % for females ) of Saudi adolescents spent more than 2 hours on screen time daily and almost half of the males and three-quarters of the females did not meet daily physical activity guidelines . The majority of adolescents did not have a daily intake of breakfast , fruit , vegetables and milk . Females were significantly ( p < 0.05 ) more sedentary , much less physically active , especially with vigorous physical activity , and there were fewer days per week when they consumed breakfast , fruit , milk and diary products , sugar-sweetened drinks , fast foods and energy drinks than did males . However , the females ' intake of  French fries and potato chips , cakes and donuts , and c and y and chocolate was significantly ( p < 0.05 ) higher than the males ' . Screen time was significantly ( p < 0.05 ) correlated inversely with the intake of breakfast , vegetables and fruit .  Physical activity had a significant ( p < 0.05 ) positive relationship with fruit and vegetable intake but not with sedentary behaviors . Conclusions The high prevalence of sedentary behaviors , physical inactivity and unhealthy dietary habits among Saudi adolescents is a major public health concern . There is an urgent need for national policy promoting active living and healthy eating and reducing sedentary behaviors among children and adolescents in Saudi Arabia OBJECTIVE To evaluate the impact of a 12-month school-based multi-component program on adolescent girls '  physical activity and sedentary behaviors , and hypothesized mediators of physical activity behavior change . DESIGN Group r and omized controlled trial with 12-month follow-up . METHODS The intervention , guided by Social Cognitive Theory , involved 357 adolescent girls ( 13.2 ± 0.5 years ) from 12 secondary schools ( 6 intervention schools , 6 control schools ) in low-income communities in the Hunter and Central Coast regions of New South Wales , Australia . The intervention included enhanced school sport , lunchtime physical activity sessions , interactive seminars , student h and books , nutrition workshops , pedometers , parent newsletters and text messages to encourage physical activity and healthy eating , and a decrease in sedentary behavior . Outcomes were assessed at baseline and 12-months and included : physical activity ( accelerometers ) , sedentary behaviors ( question naire and accelerometers ) , and social-cognitive mediators of physical activity ( question naire ) . RESULTS There were significant between group differences in favor of the intervention group for self-reported recreational computer use ( -26.0 min ; 95 % CI , -46.9 to -5.1 ) , and sedentary activities summed ( -56.4 min ; 95 % CI , -110.1 to -2.7 ) , however objective sedentary behavior showed no differences . There were no group-by-time effects for any of the physical activity outcomes or hypothesized mediators . CONCLUSIONS A school-based intervention tailored for adolescent girls from schools located in low-income communities significantly reduced time spent in sedentary activities . However , improvements in physical activity and hypothesized mediators of physical activity behavior were not observed . Future studies are encouraged to explore alternative mechanisms of behavior change derived from integrated and socio-ecological theories Background Schools are the most frequent target for intervention programs aim ed at preventing child obesity ; however , the overall effectiveness of these programs has been limited . It has therefore been recommended that interventions target multiple ecological levels ( community , family , school and individual ) to have greater success in changing risk behaviors for obesity . This study examined the immediate and short-term , sustained effects of the Switch program , which targeted three behaviors ( decreasing children 's screen time , increasing fruit and vegetable consumption , and increasing physical activity ) at three ecological levels ( the family , school , and community ) . Methods Participants were 1,323 children and their parents from 10 schools in two states . Schools were matched and r and omly assigned to treatment and control . Measures of the key behaviors and body mass index were collected at baseline , immediately post-intervention , and 6 months post-intervention . Results The effect sizes of the differences between treatment and control groups ranged between small ( Cohen 's d = 0.15 for body mass index at 6 months post-intervention ) to large ( 1.38 ; parent report of screen time at 6 months post-intervention ) , controlling for baseline levels . There was a significant difference in parent-reported screen time at post-intervention in the experimental group , and this effect was maintained at 6 months post-intervention ( a difference of about 2 hours/week ) . The experimental group also showed a significant increase in parent-reported fruit and vegetable consumption while child-reported fruit and vegetable consumption was marginally significant . At the 6-month follow-up , parent-reported screen time was significantly lower , and parent and child-reported fruit and vegetable consumption was significantly increased . There were no significant effects on pedometer measures of physical activity or body mass index in the experimental group . The intervention effects were moderated by child sex ( for fruit and vegetable consumption , physical activity , and weight status ) , family involvement ( for fruit and vegetable consumption ) , and child body mass index ( for screen time ) . The perception of change among the experimental group was generally positive with 23 % to 62 % indicating positive changes in behaviors . Conclusion The results indicate that the Switch program yielded small-to-modest treatment effects for promoting children 's fruit and vegetable consumption and minimizing screen time . The Switch program offers promise for use in youth obesity prevention BACKGROUND The childhood obesity epidemic disproportionately affects Hispanics . This paper reports on the design of the ongoing Healthy Families Study , a r and omized controlled trial testing the efficacy of a community-based , behavioral family intervention to prevent excessive weight gain in Hispanic children using a community-based participatory research approach . METHODS The study will enroll 272 Hispanic families with children ages 5 - 7 residing in greater Nashville , Tennessee , United States . Families are r and omized to the active weight gain prevention intervention or an alternative intervention focused on oral health . Lay community health promoters implement the interventions primarily in Spanish in a community center . The active intervention was adapted from the We Can ! parent program to be culturally-targeted for Hispanic families and for younger children . This 12-month intervention promotes healthy eating behaviors , increased physical activity , and decreased sedentary behavior , with an emphasis on parental modeling and experiential learning for children . Families attend eight bi-monthly group sessions during four months then receive information and /or support by phone or mail each month for eight months . The primary outcome is change in children 's body mass index . Secondary outcomes are changes in children 's waist circumference , dietary behaviors , preferences for fruits and vegetables , physical activity , and screen time . RESULTS Enrollment and data collection are in progress . CONCLUSION This study will contribute valuable evidence on efficacy of a childhood obesity prevention intervention targeting Hispanic families with implication s for reducing disparities
Among children , these interventions demonstrated reduced screen time , increased physical activity , and improved diet- and weight-related outcomes .
CONTEXT Sedentary time spent with screen media is associated with obesity among children and adults .
Obesity has potentially serious health consequences , such as heart disease and diabetes .
This Community Guide systematic review examined the effectiveness and economic efficiency of behavioral interventions aim ed at reducing recreational ( i.e. , neither school- nor work-related ) sedentary screen time , as measured by screen time , physical activity , diet , and weight-related outcomes .