School-based intervention on healthy behaviour among Ecuadorian adolescents: effect of a cluster-randomized controlled trial on screen-time

Abstract

BackgroundEffective interventions on screen-time behaviours (television, video games and computer time) are needed to prevent non-communicable diseases in low- and middle-income countries. The present manuscript investigates the effect of a school-based health promotion intervention on screen-time behaviour among 12- to 15-year-old adolescents. We report the effect of the trial on screen-time after two stages of implementation.MethodsWe performed a cluster-randomised pair matched trial in urban schools in Cuenca-Ecuador. Participants were adolescents of grade eight and nine (mean age 12.8 ± 0.8 years, n = 1370, control group n = 684) from 20 schools (control group n = 10). The intervention included an individual and environmental component tailored to the local context and resources. The first intervention stage focused on diet, physical activity and screen-time behaviour, while the second stage focused only on diet and physical activity. Screen-time behaviours, primary outcome, were assessed at baseline, after the first (18 months) and second stage (28 months). Mixed linear models were used to analyse the data.ResultsAfter the first stage (data from n = 1224 adolescents; control group n = 608), the intervention group had a lower increase in TV-time on a week day (β = −15.7 min; P = 0.003) and weekend day (β = −18.9 min; P = 0.005), in total screen-time on a weekday (β = −25.9 min; P = 0.03) and in the proportion of adolescents that did not meet the screen-time recommendation (β = −4 percentage point; P = 0.01), compared to the control group. After the second stage (data from n = 1078 adolescents; control group n = 531), the TV-time on a weekday (β = 13.1 min; P = 0.02), and total screen-time on a weekday (β = 21.4 min; P = 0.03) increased more in adolescents from the intervention group. No adverse effects were reported.Discussion and ConclusionA multicomponent school-based intervention was only able to mitigate the increase in adolescents’ television time and total screen-time after the first stage of the intervention or in other words, when the intervention included specific components or activities that focused on reducing screen-time. After the second stage of the intervention, which only included components and activities related to improve healthy diet and physical activity and not to decrease the screen-time, the adolescents increased their screen-time again. Our findings might imply that reducing screen-time is only possible when the intervention focuses specifically on reducing screen-time.Trial registrationClinicaltrials.gov identifier NCT01004367.

The Role of Recreational Online Activities in School-Based Screen Time Sedentary Behaviour Interventions for Adolescents: A Systematic and Critical Literature Review

“…The search resulted in 2583 items (see flow diagram in Fig. 1), and identified 30 published papers analysing 15 intervention studies (12 registered RCTs, three pre-post designs) that met the criteria for inclusion in the review (Aittasalo et al 2019;Andrade et al 2014Andrade et al , 2015Babic et al 2016;Babic et al 2015;Bagherniya et al 2018;Barbosa Filho et al 2019;Barbosa Filho et al 2016;Barbosa Filho et al 2015;Cui et al 2012;Foley et al 2017;Hamulka et al 2018;Hankonen et al 2016Hankonen et al , 2017Jussila et al 2015;Leme et al 2016;Leme and Philippi 2015;Lubans et al 2016a;Lubans et al 2016b;Majumdar et al 2013;Singh et al 2006Singh et al , 2009Singh et al , 2007Smith et al 2017;Smith et al 2014aSmith et al , 2014bTarro et al 2017, Tarro et al 2019Vik et al 2015;Wadolowska et al 2019). Out of the 15 studies, eight were analysed in more than one paper, presenting a separate rationale/study protocol or protocol and baseline results and additional effectiveness of RCT papers ( Table 1).…”

“…The age of the samples ranged from 10 to 19 years, and sample sizes varied from n = 172 (Bagherniya et al 2018) to n = 3147 (Vik et al 2015). The duration of the interventions lasted from three sessions (Aittasalo et al 2019) to 28 months (Andrade et al 2015) with two (pre-post intervention) to four assessment periods. Assessment included objective (i.e.…”

“…accelerometer-based), selfreport measures, and process evaluations. In terms of effectiveness, four studies were effective in reducing ST (Bagherniya et al 2018;Barbosa Filho et al 2019;Cui et al 2012;Smith et al 2014aSmith et al , 2014b, eight studies presented with mixed findings with part reduction in ST (reduction in one specific assessment period, weekend/weekdays or gender-based) (Aittasalo et al 2019;Andrade et al 2015;Babic et al 2016;Foley et al 2017;Leme et al 2016;Singh et al 2009;Tarro et al 2017), and three studies did not find significant intervention effects in reducing ST (Majumdar et al 2013;Vik et al 2015;Wadolowska et al 2019). Hankonen et al (2016) reported good participation, response and acceptability of protocol.…”

Üniversite Öğrencilerinde Sağlıklı Yaşam Becerileri Ölçeği'nin Geliştirilmesi

“…Günlük yaşamda ergenlerin sağlıklı yaşam becerilerinin önemini kavraması, geliştirmesi ve sürdürmesi bu dönemde büyük önem taşımaktadır. Aksi takdirde, birey bu dönemde kendilerine olduğu kadar çevrelerini de olumsuz etkileyebilecek sağlıksız davranışları kazanabilirler 5,13,14 . Bu nedenle, bu çalışmada, üniversite düzeyindeki öğrencilerin sağlıklı yaşam becerilerini ölçmeye yönelik bir ölçme aracının geliştirilmesi amaçlanmıştır.…”

“…KMO ve Bartlett's testi değerleri olarak kabul edilerek gerekli analizler yapıldı ve ortaya çıkan faktör yapısının açıklanabilirliğinin güç olması nedeniyle Eigen değeri 2 olarak değiştirildi ve analizler tekrarlandı. Varimax dik döndürme tekniği uygulandığında ise faktör yük değerleri 0.30'dan az olan maddeler(9,11,14,15,16,19,20,22,27,30,31,32,33,35,36) ölçekten çıkarıldı ve ölçek 21 madde ile son halini aldı ve analizler yenilendi. Ölçek en son 4 alt faktör ile biçimlendi.…”