Dance and reducing television viewing to prevent weight gain in African-American girls: the Stanford GEMS pilot study. Team sports for overweight children: the Stanford Sports to Prevent Obesity Randomized Trial (SPORT). Decreasing sedentary behaviors in treating pediatric obesity. Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. Reducing children's television viewing to prevent obesity: a randomized controlled trial. Role of behaviour modification in the treatment of childhood obesity with the parents as the exclusive agents of change ICAPS: a multilevel program to improve physical activity in adolescents. Effects of Open-Loop Feedback on Physical Activity and Television Viewing in Overweight and Obese Children: A Randomized, Controlled Trial Short- and Long-Term Beneficial Effects of a Combined Dietary–Behavioral–Physical Activity Intervention for the Treatment of Childhood Obesity Why did soft drink consumption decrease but screen time not? Mediating mechanisms in a school-based obesity prevention program Time Well Spent? Relating Television Use to Children's Free-Time Activities Increasing physical activity and decreasing sedentary activity in adolescent girls – The Incorporating More Physical Activity and Calcium in Teens (IMPACT) study A Policy-Based School Intervention to Prevent Overweight and Obesity Short-term effectiveness of anticipatory guidance to reduce early childhood risks for subsequent violence. Impact of a school-based interdisciplinary intervention on diet and physical activity among urban primary school children: eat well and keep moving. Do we fatten our children at the television set? Obesity and television viewing in children and adolescents. Influence of a health education intervention on physical activity and screen time in primary school children: 'Switch Off--Get Active'. A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children. Randomised controlled trial adapting US school obesity prevention to England Primary care interventions to reduce television viewing in African-American children. Effects of decreasing sedentary behavior and increasing activity on weight change in obese children. Effects of contingent television on physical activity and television viewing in obese children. Healthy steps in an integrated delivery system: child and parent outcomes at 30 months. An intervention to reduce television viewing by preschool children. Statistical considerations. Outcomes of a group-randomized trial to prevent excess weight gain, reduce screen behaviours and promote physical activity in 10-year-old children: Switch-Play Television exposure and overweight risk in preschoolers. Television exposure as a risk factor for aggressive behavior among 3-year-old children.
OBJECTIVE To test the feasibility , acceptability , and potential efficacy of after-school dance classes and a family-based intervention to reduce television viewing , thereby reducing weight gain , among African-American girls . DESIGN Twelve-week , 2-arm parallel group , r and omized controlled trial . SETTING Low-income neighborhoods . PARTICIPANTS Sixty-one 8 - 10-year-old African-American girls and their parents/guardians . INTERVENTIONS The treatment intervention consisted of after-school dance classes at 3 community centers , and a 5-lesson intervention , delivered in participants ' homes , and design ed to reduce television , videotape , and video game use . The active control intervention consisted of disseminating newsletters and delivering health education lectures . MAIN OUTCOME MEASURES Implementation and process measures , body mass index , waist circumference , physical activity measured by accelerometry , self-reported media use , and meals eaten with TV . RESULTS Recruitment and retention goals were exceeded . High rates of participation were achieved for assessment s and intervention activities , except where transportation was lacking . All interventions received high satisfaction ratings . At follow up , girls in the treatment group , as compared to the control group , exhibited trends toward lower body mass index ( adjusted difference = -.32 kg/m2 , 95 % confidence interval [ CI ] -.77 , .12 ; Cohen 's d = .38 st and ard deviation units ) and waist circumference ( adjusted difference = -.63 cm , 95 % CI -1.92 , .67 ; d = .25 ) ; increased after-school physical activity ( adjusted difference = 55.1 counts/minute , 95 % CI -115.6 , 225.8 ; d = .21 ) ; and reduced television , videotape , and video game use ( adjusted difference = -4.96 hours/week , 95 % CI -11.41 , 1.49 ; d = .40 ) . The treatment group reported significantly reduced household television viewing ( d = .73 , P = .007 ) and fewer dinners eaten while watching TV ( adjusted difference = -1.60 meals/week , 95 % CI -2.99 , -.21 ; d = .59 ; P = .03 ) . Treatment group girls also reported less concern about weight ( d = .60 ; P = .03 ) , and a trend toward improved school grade s ( d = .51 ; P = .07 ) . CONCLUSIONS This study confirmed the feasibility , acceptability , and potential efficacy of using dance classes and a family-based intervention to reduce television viewing , thereby reducing weight gain , in African-American girls OBJECTIVE To evaluate the feasibility , acceptability , and efficacy of an after-school team sports program for reducing weight gain in low-income overweight children . DESIGN Six-month , 2-arm , parallel-group , pilot r and omized controlled trial . SETTING Low-income , racial/ethnic minority community . PARTICIPANTS Twenty-one children in grade s 4 and 5 with a body mass index at or above the 85th percentile . INTERVENTIONS The treatment intervention consisted of an after-school soccer program . The " active placebo " control intervention consisted of an after-school health education program . MAIN OUTCOME MEASURES Implementation , acceptability , body mass index , physical activity measured using accelerometers , reported television and other screen time , self-esteem , depressive symptoms , and weight concerns . RESULTS All 21 children completed the study . Compared with children receiving health education , children in the soccer group had significant decreases in body mass index z scores at 3 and 6 months and significant increases in total daily , moderate , and vigorous physical activity at 3 months . CONCLUSION An after-school team soccer program for overweight children can be a feasible , acceptable , and efficacious intervention for weight control BACKGROUND Epidemiological studies have shown television watching to be a risk factor for the development of obesity in children . The effect of reducing television watching and other sedentary behaviors as a component of a comprehensive obesity treatment program has not been thoroughly tested . OBJECTIVE To compare the influence of targeting decreases in sedentary behavior vs. increases in physical activity in the comprehensive treatment of obesity in 8- to 12-year-old children . DESIGN R and omized , controlled outcome study . SETTING Childhood obesity research clinic . DESIGN Ninety families with obese 8- to 12-year-old children were r and omly assigned to groups that were provided a comprehensive family-based behavioral weight control program that included dietary , and behavior change information but differed in whether sedentary or physically active behaviors were targeted and the degree of behavior change required . RESULTS Results during 2 years showed that targeting either decreased sedentary behaviors or increased physical activity was associated with significant decreases in percent overweight and body fat and improved aerobic fitness . Self-reported activity minutes increased and targeted sedentary time decreased during treatment . Children substituted nontargeted sedentary behaviors for some of their targeted sedentary behaviors . CONCLUSION These results support reducing sedentary behaviors as an adjunct in the treatment of pediatric obesity OBJECTIVE To evaluate the impact of a school-based health behavior intervention known as Planet Health on obesity among boys and girls in grade s 6 to 8 . DESIGN R and omized , controlled field trial with 5 intervention and 5 control schools . Outcomes were assessed using preintervention ( fall 1995 ) and follow-up measures ( spring 1997 ) , including prevalence , incidence , and remission of obesity . PARTICIPANTS A group of 1295 ethnically diverse grade 6 and 7 students from public schools in 4 Massachusetts communities . INTERVENTION Students participated in a school-based interdisciplinary intervention over 2 school years . Planet Health sessions were included within existing curricula using classroom teachers in 4 major subjects and physical education . Sessions focused on decreasing television viewing , decreasing consumption of high-fat foods , increasing fruit and vegetable intake , and increasing moderate and vigorous physical activity . MAIN OUTCOME MEASURES Obesity was defined as a composite indicator based on both a body mass index and a triceps skinfold value greater than or equal to age- and sex-specific 85th percentiles . Because schools were r and omized , rather than students , the generalized estimating equation method was used to adjust for individual-level covariates under cluster r and omization . RESULTS The prevalence of obesity among girls in intervention schools was reduced compared with controls , controlling for baseline obesity ( odds ratio , 0.47 ; 95 % confidence interval , 0.24 - 0.93 ; P = .03 ) , with no differences found among boys . There was greater remission of obesity among intervention girls vs. control girls ( odds ratio , 2.16 ; 95 % confidence interval , 1.07 - 4.35 ; P = .04 ) . The intervention reduced television hours among both girls and boys , and increased fruit and vegetable consumption and result ed in a smaller increment in total energy intake among girls . Reductions in television viewing predicted obesity change and mediated the intervention effect . Among girls , each hour of reduction in television viewing predicted reduced obesity prevalence ( odds ratio , 0.85 ; 95 % confidence interval , 0.75 - 0.97 ; P = .02 ) . CONCLUSION Planet Health decreased obesity among female students , indicating a promising school-based approach to reducing obesity among youth CONTEXT Some observational studies have found an association between television viewing and child and adolescent adiposity .  OBJECTIVE To assess the effects of reducing television , videotape , and video game use on changes in adiposity , physical activity , and dietary intake . DESIGN R and omized controlled school-based trial conducted from September 1996 to April 1997 . SETTING Two sociodemographically and scholastically matched public elementary schools in San Jose , Calif. PARTICIPANTS Of 198 third- and fourth- grade students , who were given parental consent to participate , 192 students ( mean age , 8.9 years ) completed the study . INTERVENTION Children in 1 elementary school received an 18-lesson , 6-month classroom curriculum to reduce television , videotape , and video game use . MAIN OUTCOME MEASURES Changes in measures of height , weight , triceps skinfold thickness , waist and hip circumferences , and cardiorespiratory fitness ; self-reported media use , physical activity , and dietary behaviors ; and parental report of child and family behaviors . The primary outcome measure was body mass index , calculated as weight in kilograms divided by the square of height in meters . RESULTS Compared with controls , children in the intervention group had statistically significant relative decreases in body mass index ( intervention vs control change : 18.38 to 18.67 kg/m2 vs 18.10 to 18.81 kg/m2 , respectively ; adjusted difference -0.45 kg/m2 [ 95 % confidence interval [ CI ] , -0.73 to -0.17 ] ; P = .002 ) , triceps skinfold thickness ( intervention vs control change : 14.55 to 15.47 mm vs 13.97 to 16.46 mm , respectively ; adjusted difference , -1.47 mm [ 95 % CI , -2.41 to -0.54 ] ; P=.002 ) , waist circumference ( intervention vs control change : 60.48 to 63.57 cm vs 59.51 to 64.73 cm , respectively ; adjusted difference , -2.30 cm [ 95 % CI , -3.27 to -1.33 ] ; P<.001 ) , and waist-to-hip ratio ( intervention vs control change : 0.83 to 0.83 vs 0.82 to 0.84 , respectively ; adjusted difference , -0.02 [ 95 % CI , -0.03 to -0.01 ] ; P<.001 ) . Relative to controls , intervention group changes were accompanied by statistically significant decreases in children 's reported television viewing and meals eaten in front of the television . There were no statistically significant differences between groups for changes in high-fat food intake , moderate-to-vigorous physical activity , and cardiorespiratory fitness . CONCLUSIONS Reducing television , videotape , and video game use may be a promising , population -based approach to prevent childhood obesity OBJECTIVE : This study examined the reduction in overweight and changes in eating-related behaviours in obese children treated with a  family-based approach  , in which the parents were the exclusive agents of change . Results were compared to the conventional approach in which children are responsible for their own weight loss . DESIGN : A one-year longitudinal prospect i ve design was used . Participants were r and omly allocated for the experimental ( parents as the agents of change ) or the conventional ( children as the agents of change ) intervention . METHODS : Sixty obese children ( 20 % over ideal weight for age , height and gender ) aged 6–11 y ( mean±s.d . 9.2±1.0 y ) were included in the study . Anthropometric measurements and biochemical tests were performed on the children and their parents before and after the programme , and both parents completed a sociodemographic and a family eating and activity habits question naire . Hour-long support/educational sessions were conducted by a clinical dietitian–14 sessions for the parents in the experimental intervention and 30 for the children in the conventional intervention . Individual sessions were held for members of both groups , when necessary . RESULTS : Significant differences were found between the two groups in the reduction of exposure to food stimuli and changes in eating habits ( eating while st and ing , watching TV , reading or doing homework , eating following stress and eating between meals ) . Mean weight reduction ( by percentile ) was significantly greater in the experimental intervention group ( parent-only treatment ) in comparison to the conventional intervention group ( child-only treatment ) . CONCLUSIONS : Treatment of childhood obesity with the parents as the exclusive agents of change , induces more behavioural changes as well as greater weight loss , than the conventional approach OBJECTIVES ICAPS ( Intervention Centred on Adolescents ' Physical activity and Sedentary behaviour ) is aim ed at preventing excessive weight gain and cardiovascular risk in adolescents by promoting physical activity ( PA ) with an emphasis on recreational and daily-life PA , with a lifelong perspective . DESIGN R and omized study design ed to last for four years . Study cohort constituted of 954 first-level students ( 91 % of eligible pupils ) , aged 11.7 + /- 0.6 y ( mean + /- SD ) from four pairs of schools r and omly selected in eastern France , after sociogeographical stratification . In each pair , intervention status was r and omised at school-level . The program , not limited to school setting s , involves multiple partners with three objectives : 1 ) changing attitudes through debates and access to attractive activities during breaks and after-school hours , 2 ) encouraging social support , 3 ) providing environmental conditions that enable PA . Adapted times and places , open participation , emphasis on fun , meeting with others and absence of competitive aspects are used to reduce usual barriers to PA .  Accessibility and safety are permanent concerns . RESULTS Prevalence of overweight was 23.7 % . High participation rates were attained ( 50 % participated in at least one weekly activity ) . At six-month , the proportion of intervention adolescents  not performing supervised PA out of academic PA  was reduced by half ( 36 % to 17 % vs 42 % to 42 % in controls P < 10 - 4 ) ; the proportion of those spending > 3 h/day in sedentary occupations decreased ( 34 % to 28 % vs 27 % to 36 % ; P < 10 - 4 ) . CONCLUSION These data demonstrate the feasibility of implementing a multilevel PA intervention program in adolescents . Six-month results document increased PA  and decreased sedentary behaviour OBJECTIVES . Television viewing and physical inactivity increase the risk of obesity in youth . Thus , identifying new interventions that increase physical activity and reduce television viewing would be helpful in the prevention and treatment of pediatric obesity . This study evaluated the effects of open-loop feedback plus reinforcement versus open-loop feedback alone on  physical activity , targeted sedentary behavior , body composition , and energy intake in youth . METHODS . Thirty overweight or obese 8- to 12-year-old children were r and omly assigned to an  intervention ( n = 14 ) or control group ( n = 16 ) . Participants wore accelerometers every day for 8 weeks and attended biweekly meetings to download the activity monitors . For children in the open-loop feedback plus reinforcement ( intervention ) group , accumulating 400 counts of physical activity on pedometers earned 1 hour of television/VCR/DVD time , which was controlled by a Token TV electronic device . Open-loop feedback control subjects wore activity monitors but had free access to targeted sedentary behavior . RESULTS . Compared with controls , the open-loop feedback plus reinforcement group demonstrated significantly greater increases in daily physical activity counts ( + 65 % vs + 16 % ) and minutes per day of moderate-to-vigorous physical activity ( + 9.4 vs + 0.3 ) and greater reductions in minutes per day spent in television viewing ( −116.1 vs + 14.3 ) . The intervention group also showed more favorable changes in body composition , dietary fat intake , and energy intake from snacks compared with controls . Reductions in sedentary behavior were directly related to reductions in BMI , fat intake , snack intake , and snack intake while watching television . CONCLUSIONS . Providing feedback of physical activity in combination with reinforcing physical activity with sedentary behavior is a simple method of modifying the home environment that may play an important role in treating and preventing child obesity Background . Obesity has become the most common pediatric chronic disease in the modern era . Early prevention and treatment of childhood and adolescent obesity is m and ated . Surprisingly , however , only a minor fraction of obese children participate in weight reduction interventions , and the longer-term effects of these weight-reduction interventions among children have not been eluci date d. Objective . To examine prospect ively the short- and long-term effects of a 3-month , combined dietary-behavioral-physical activity intervention on anthropometric measures , body composition , dietary and leisure-time habits , fitness , and lipid profiles among obese children . Methods . In this r and omized prospect i ve study , 24 obese subjects completed the 3-month intervention and were compared with 22 obese , age- and gender-matched , control subjects . Results . At 3 months , there were significant differences in changes in body weight ( −2.8 ± 2.3 kg vs 1.2 ± 2.2 kg ) , BMI ( −1.7 ± 1.1 kg/m2 vs −0.2 ± 1.0 kg/m2 ) , body fat percentage ( from skinfold tests ; −3.3 ± 2.6 % vs 1.4 ± 4.7 % ) , serum total cholesterol level ( −24.6 ± 15.1 mg/dL vs 0.8 ± 18.7 mg/dL ) , low-density lipoprotein cholesterol level ( −23.3 ± 15.2 mg/dL vs −3.7 ± 17.3 mg/dL ) , and fitness ( 215 ± 107 seconds vs 50 ± 116 seconds ) in the intervention group versus the control group . After a 1-year follow-up period , there were significant differences between the intervention group ( n = 20 ) and the control group ( n = 20 ) in body weight ( 0.6 ± 6.0 kg vs 5.3 ± 2.7 kg ) , BMI ( −1.7 ± 2.3 kg/m2 vs 0.6 ± 0.9 kg/m2 ) , and body fat percentage . There was a significant increase in leisure-time physical activity among the intervention participants , compared with a decrease among the control subjects . Conclusions . Our data demonstrate the short- and longer-term beneficial effects of a combined dietary-behavioral-physical activity intervention among obese children . These results highlight the importance of multidisciplinary programs for the treatment of childhood obesity and emphasize their encouraging long-term effects Objectives This paper aims to identify the mediating mechanisms of a school-based obesity prevention program ( DOiT ) . Methods The DOiT-program was implemented in Dutch prevocational secondary schools and evaluated using a controlled , cluster-r and omised trial ( September 2003 to May 2004 ) . We examined mediators of effects regarding ( 1 ) consumption of sugar containing beverages ( SCB ) ; ( 2 ) consumption of high caloric snacks ; ( 3 ) screen-viewing behaviour ; and ( 4 ) active commuting to school . To improve these behaviours the DOiT-program tried to influence the following potentially mediating variables : attitude , subjective norm , perceived behavioural control , and habit-strength . Results Both in boys ( n = 418 ) and girls ( n = 436 ) the DOiT-intervention  reduced SCB consumption ( between group difference in boys = -303.5 ml/day , 95 % CI : -502.4;-104.5 , between group difference in girls = -222.3 ml/day , 95 % CI : -371.3;-73.2 ) . The intervention did not affect the other examined behaviours . In girls , no intervention effect on hypothetical mediators was found nor evidence of any mediating mechanisms . Boys in intervention schools improved their attitude towards decreasing SCB consumption , while this behaviour became less of a habit . Indeed , attitude and habit strength were significant mediators of the DOiT-intervention 's effect ( 4.5 and 3.8 % , respectively ) on SCB consumption among boys . Conclusion Our findings imply that interventions aim ed at EBRB-change should be gender-specific . Future studies aim ed at reducing SCB consumption among boys should target attitude and habit strength as mediating mechanisms . Our study did not resolve the mediating mechanisms in girls . Trial registration International St and ard R and omised Controlled Trial Number Register IS RCT OBJECTIVES . This study assessed the cl aim that children 's television use interferes with time spent in more developmentally appropriate activities . METHODS . Data came from the first wave of the Child Development Supplement , a nationally representative sample of children aged 0 to 12 in 1997 ( N = 1712 ) . Twenty-four-hour time-use diaries from 1 r and omly chosen weekday and 1 r and omly chosen weekend day were used to assess children 's time spent watching television , time spent with parents , time spent with siblings , time spent reading ( or being read to ) , time spent doing homework , time spent in creative play , and time spent in active play . Ordinary least squares multiple regression was used to assess the relationship between children 's television use and time spent pursuing other activities . RESULTS . Results indicated that time spent watching television both with and without parents or siblings was negatively related to time spent with parents or siblings , respectively , in other activities . Television viewing also was negatively related to time spent doing homework for 7- to 12-year-olds and negatively related to creative play , especially among very young children ( younger than 5 years ) . There was no relationship between time spent watching television and time spent reading ( or being read to ) or to time spent in active play . CONCLUSIONS . The results of this study are among the first to provide empirical support for the assumptions made by the American Academy of Pediatrics in their screen time recommendations . Time spent viewing television both with and without parents and siblings present was strongly negatively related to time spent interacting with parents or siblings . Television viewing was associated with decreased homework time and decreased time in creative play . Conversely , there was no support for the widespread belief that television interferes with time spent reading or in active play Background Lack of regular physical activity and consequent sub-optimal bone mass acquisition in youth has been implicated as a primary cause of adult-onset osteoporosis . IMPACT was a behavioral theory-based 1 1/2 year r and omized controlled field study aim ed at increasing bone accretion in middle school girls . The objective of this study was to determine the intervention effects of the IMPACT program upon key physical and sedentary activity endpoints among schools that participated in the IMPACT study . Endpoints examined included weight bearing physical activity ( WBPA ) ; moderate to vigorous physical activity ( MVPA ) ; vigorous physical activity ( VPA ) ; MET ( metabolic equivalent ) – weighted WBPA and MVPA ; sedentary activity ; before/after-school physical activity ; and weekend physical activity . Methods Primary data analysis using a pretest-posttest control group design was conducted utilizing mixed model analysis of covariance . Data gathered from the IMPACT cohort from 2000–2002 were analyzed to determine baseline versus follow-up differences in activity endpoints . Confounders investigated included ethnicity , body mass index , menarcheal status , participation in 7th grade PE/athletics , friend/familial support and neighborhood safety . Results Follow-up means were higher for participating intervention schools relative to control schools for all physical activity variables but were statistically significant only for the following variables : daily minutes of vigorous physical activity ( mean difference between Intervention ( I ) and Control ( C ) = 6.00↑ minutes , 95 % CI = 5.82–6.18 , p = 0.05 ) , daily after school activity minutes ( mean difference between I and C = 8.95↑ minutes , 95 % CI = 8.69–9.21 , p = 0.04 ) , and daily weekend activity minutes ( mean difference between I and C = 19.00↑ minutes , 95 % CI = 18.40–19.60 , p = 0.05 ) . The intervention significantly reduced duration of student daily TV/Video watching ( mean difference between I and C = 12.11↓ minutes , 95 % CI = 11.74–12.48 , p = 0.05 ) and total daily sedentary activity minutes ( mean difference between I and C = 16.99↓ minutes , 95 % CI = 16.49–17.50 , p = 0.04 ) . Conclusion A well design ed and implemented school based health and physical activity intervention can result in a positive influence upon increasing physical activity levels and decreasing sedentary activity . Future interventions should consider a more structured intervention component to obtain significant changes in WBPA BACKGROUND . The prevalence and seriousness of childhood obesity has prompted calls for broad public health solutions that reach beyond clinic setting s. Schools are ideal setting s for population -based interventions to address obesity . OBJECTIVE . The purpose of this work was to examine the effects of a multicomponent , School Nutrition Policy Initiative on the prevention of overweight ( 85.0th to 94.9th percentile ) and obesity ( > 95.0th percentile ) among children in grade s 4 through 6 over a 2-year period . METHODS . Participants were 1349 students in grade s 4 through 6 from 10 schools in a US city in the Mid-Atlantic region with ≥50 % of students eligible for free or reduced-price meals .  Schools were matched on school size and type of food service and r and omly assigned to intervention or control . Students were assessed at baseline and again after 2 years . The School Nutrition Policy Initiative included the following components : school self- assessment , nutrition education , nutrition policy , social marketing , and parent outreach . RESULTS . The incidences of overweight and obesity after 2 years were primary outcomes . The prevalence and remission of overweight and obesity , BMI z score , total energy and fat intake , fruit and vegetable consumption , body dissatisfaction , and hours of activity and inactivity were secondary outcomes . The intervention result ed in a 50 % reduction in the incidence of overweight . Significantly fewer children in the intervention schools ( 7.5 % ) than in the control schools ( 14.9 % ) became overweight after 2 years . The prevalence of overweight was lower in the intervention schools . No differences were observed in the incidence or prevalence of obesity or in the remission of overweight or obesity at 2 years . CONCLUSION . A multicomponent school-based intervention can be effective in preventing the development of overweight among children in grade s 4 through 6 in urban public schools with a high proportion of children eligible for free and reduced-priced school meals OBJECTIVE To determine whether newly developed anticipatory guidance material s design ed to teach the use of time-outs and the importance of reductions in childhood television viewing would be recalled by parents and if their use would result in changes in self-reported parental behavior . SUBJECTS AND SETTING A total of 559 parents of children aged 14 months to 6 years recruited at the time of routine child health maintenance visits at 2 managed care pediatric departments in eastern Massachusetts . METHODS In-person parent interviews were conducted in the waiting room prior to office visits , with follow-up telephone calls 2 to 3 weeks after the visit . Two groups of families were enrolled : a control group who received usual anticipatory guidance and an intervention group who received written material s. Intervention group providers were trained to include study topics during the office visit and to introduce the written material s. RESULTS Provider training and the provision of written material s increased the parents ' specific recall of anticipatory guidance of at least 2 to 3 weeks following the office visit . This effect was specific to the areas of intervention and did not carry over to other commonly used topics of anticipatory guidance . Among parents who had never used a time-out prior to the office visit , there was a significant increase in the use of time-outs . Parents who received anticipatory guidance regarding the link between exposure to television violence and subsequent violence in children were somewhat more likely to report reductions in weekend television viewing than were parents in the control group , although this change was not statistically significant . CONCLUSIONS Certain parenting behaviors have been associated with subsequent violence . Brief , inexpensive anticipatory guidance in relevant areas , provided in the context of routine health supervision visits , appears to result in favorable short-term changes in parenting practice OBJECTIVE To evaluate the impact of a school-based interdisciplinary health behavior intervention on  diet  and  physical activity  among children in grade s 4 and 5 . DESIGN A quasiexperimental field trial with 6 intervention and 8 matched control schools . Outcomes were assessed longitudinally using preintervention ( fall 1995 ) and follow-up ( spring 1997 ) student survey food frequency and activity measures and follow-up 24-hour recall measures of diet and activity . Change was also assessed using yearly repeated cross-sectional surveys of all grade 5 students from 1995 through 1997 . PARTICIPANTS Longitudinal data were collected from 479 students initially in grade 4 in Baltimore , Md , public schools ; 91 % were African American . Repeated 24-hour recall measures in 1997 were collected for a r and om sub sample of 336 students . Cross-sectional survey data were collected from all grade 5 students in 1995,1996 , and 1997 ( n = 2103 ) . INTERVENTION The Eat Well and Keep Moving Program was taught by classroom teachers over 2 years in math , science , language arts , and social studies classes . Material s provided links to school food services and families and provided training and wellness programs for teachers and other staff members . Intervention material s focused on decreasing consumption of foods high in total and saturated fat and increasing fruit and vegetable intake , as well as reducing television viewing and increasing physical activity . MAIN OUTCOME MEASURES Dietary intake and physical activity measured via repeated 24-hour recall were primary end points , with additional food frequency and activity measures . RESULTS The 24-hour recall measures indicated that , after controlling for baseline covariates , the percentages of total energy from fat and saturated fat were reduced among students in intervention compared with control schools ( -1.4 % ; 95 % confidence interval [ CI ] , -2.8 to -0.04 ; P = .04 and -0.60 % ; 95 % CI , -1.2 to -0.01 ; P = .05 ) . There was an increase in fruit and vegetable intake ( 0.36 servings/4184 kJ ; 95 % CI , 0.10 - 0.62 ; P=.01 ) , in vitamin C intake ( 8.8 mg/4184 kJ ; 95 % CI , 2.0 - 16 ; P=.01 ) , and in fiber consumption ( 0.7 g/4184 kJ ; 95 % CI , 0.0 - 1.4 ; P=.05 ) . Television viewing was marginally reduced ( -0.55 h/d ; 95 % CI , -1.04 to 0.04 ; P=.06 ) . Analysis of longitudinal and repeated cross-sectional food frequency data indicated similar significant decreases in the percentages of total energy from fat and saturated fat . CONCLUSION Evaluation of the Eat Well and Keep Moving Program indicates effectiveness in improving dietary intake of students and reducing television viewing The association of television viewing and obesity in data collected during cycles II and III of the National Health Examination Survey was examined . Cycle II examined 6,965 children aged 6 to 11 years and cycle III examined 6,671 children aged 12 to 17 years . Included in the cycle III sample were 2,153 subjects previously studied during cycle II . These surveys , therefore , provided two cross-sectional sample s and one prospect i ve sample . In all three sample s , significant associations of the time spent watching television and the prevalence of obesity were observed . In 12- to 17-year-old adolescents , the prevalence of obesity increased by 2 % for each additional hour of television viewed . The associations persisted when controlled for prior obesity , region , season , population density , race , socioeconomic class , and a variety of other family variables . The consistency , temporal sequence , strength , and specificity of the associations suggest that television viewing may cause obesity in at least some children and adolescents . The potential effects of obesity on activity and the consumption of calorically dense foods are consistent with this hypothesis Low levels of physical activity coupled with high levels of television viewing have been linked with obesity in children . The objective of this study was to assess the efficacy of ' Switch Off-Get Active ' , a 16-week controlled health education intervention , in increasing physical activity and reducing screen time and BMI in primary school children . A secondary objective was to compare children with high and low screen time . Participants were 312 children aged 10.2+/-0.7 years , attending nine schools in areas of social disadvantage . The 10-lesson , teacher-led intervention , conducted in spring 2003 , emphasised self-monitoring , budgeting of time and selective viewing . Differences , adjusted for baseline values by ANCOVA , existed between intervention and control children at follow-up for self-reported physical activity ( intervention + 0.84 30 min blocks/day , 95%CI 0.11 - 1.57 , p<0.05 ) and self-efficacy for physical activity ( p<0.05 ) but not self-reported screen time ( intervention--0.41 blocks/day , 95%CI--0.93 - 0.12 , p=0.13 ) or BMI ( p=0.63 ) . Cross-sectional comparisons at baseline indicated lower physical activity , self-efficacy for physical activity and aerobic fitness and a higher BMI in children with high screen time . In conclusion , health education interventions can increase physical activity in primary school children but follow-ups of longer duration may be needed to demonstrate intervention effects on BMI OBJECTIVE To assess the effects of reducing television viewing and computer use on children 's  body mass index ( BMI ) as a risk factor for the development of overweight in young children . DESIGN R and omized controlled clinical trial . SETTING University children 's hospital . PARTICIPANTS Seventy children aged 4 to 7 years whose BMI was at or above the 75th BMI percentile for age and sex . INTERVENTIONS Children were r and omized to an intervention to reduce their television viewing and computer use by 50 % vs a monitoring control group that did not reduce television viewing or computer use . MAIN OUTCOME MEASURES Age- and sex-st and ardized BMI ( z BMI ) , television viewing , energy intake , and physical activity were monitored every 6 months during 2 years . RESULTS Children r and omized to the intervention group showed greater reductions in targeted sedentary behavior ( P < .001 ) , z BMI ( P < .05 ) , and energy intake ( P < .05 ) compared with the monitoring control group . Socioeconomic status moderated z BMI change ( P = .01 ) , with the experimental intervention working better among families of low socioeconomic status . Changes in targeted sedentary behavior mediated changes in z BMI ( P < .05 ) . The change in television viewing was related to the change in energy intake ( P < .001 ) but not to the change in physical activity ( P = .37 ) . CONCLUSIONS Reducing television viewing and computer use may have an important role in preventing obesity and in lowering  BMI in young children , and these changes may be related more to changes in energy intake than to changes in physical activity Objectives : To determine whether a  school obesity prevention project developed in the United States can be adapted for use in Engl and . Methods : A pilot cluster r and omised controlled trial and interviews with teachers were carried out in 19 primary schools in South West Engl and . Participants included 679 children in year 5 ( age 9–10 ) . Baseline and follow-up assessment s were completed for 323 children ( screen viewing ) and 472 children ( body mass index ) .  Sixteen lessons on healthy eating , physical activity and reducing TV viewing were taught over 5 months by teachers . Main outcome measures were hours of screen activities , body mass index , mode of transport to school and teachers ’ views of the intervention . Results : Children from intervention schools spent less time on screen-viewing activities after the intervention but these differences were imprecisely estimated : mean difference in minutes spent on screen viewing at the end of the intervention ( intervention schools minus control schools ) adjusted for baseline levels and clustering within schools was −11.6 ( 95 % CI −42.7 to 19.4 ) for a week day and was −15.4 ( 95 % CI −57.5 to 26.8 ) for a Saturday . There was no difference in mean body mass index or the odds of obesity . Conclusions : It is feasible to transfer this US school-based intervention to UK schools , and it may be effective in reducing the time children spend on screen-based activities . The study has provided information for a full-scale trial , which would require 50 schools ( ∼1250 pupils ) to detect effects on screen viewing and body mass index over 2 years of follow-up BACKGROUND Data are lacking on primary care interventions to reduce children 's television viewing .  Low-income African-American children watch greater amounts of television than their peers . DESIGN / METHODS A r and omized controlled pilot and feasibility trial was conducted . Twenty-eight families with 7- to 12-year-old African-American children receiving primary care at an urban community clinic serving a low-income population were r and omized to receive counseling alone or counseling plus a behavioral intervention that included an electronic television time manager . The main outcome was hours of children 's television , videotape , and video game use . Parents/guardians and children completed baseline and 4-week follow-up self-report surveys . Additional outcomes included overall household television use , time spent in organized physical activity and playing outside , and meals eaten by the child while watching television . RESULTS Both intervention groups reported similar decreases in children 's television , videotape , and video game use ( mean changes of -13.7 , SD=26.1 and -14.1 , SD=16.8 hours per week ) . The behavioral intervention group reported significantly greater increases in organized physical activity ( changes of + 2.5 , SD=5.9 and -3.6 , SD=4.7 hours per week ; p = 0.004 ) and nearly significant greater increases in playing outside ( changes of 1.0 , SD=5.9 and -4.7 , SD=9.4 hours per week ; p < 0.06 ) . Changes in overall household television use and meals eaten while watching television also appeared to favor the behavioral intervention , with small to medium effect sizes , but differences were not statistically significant . CONCLUSIONS This small pilot and feasibility study evaluated two promising primary care-based interventions to reduce television , videotape , and video game use among low-income African-American children . The effects on physical activity suggest that the behavioral intervention may be more effective Obese children 8 - 12 years old from 61 families were r and omized to treatment groups that targeted increased exercise , decreased sedentary behaviors , or both ( combined group ) to test the influence of reinforcing children to be more active or less sedentary on child weight change . Significant decreases in percentage overweight were observed after 4 months between the sedentary and the exercise groups ( -19.9 vs. -13.2 ) . At 1 year , the sedentary group had a greater decrease in percentage overweight than did the combined and the exercise groups ( -18.7 vs. -10.3 and -8.7 ) and greater decrease in percentage of body fat ( -4.7 vs. -1.3 ) . All groups improved fitness during treatment and follow-up . Children in the sedentary group increased their liking for high-intensity activity and reported lower caloric intake than did children in the exercise group . These results support the goal of reducing time spent in sedentary activities to improve weight loss OBJECTIVE Elevated television ( TV ) viewing and physical inactivity promote obesity in children . Thus , changes in physical activity and sedentary behavior seem critical to treating childhood obesity . PRESENT STUDY : Using a r and omized , 2-arm design , this pilot study tested the effects of contingent TV on physical activity and TV viewing in 10 obese children .  TV viewing was contingent on pedaling a stationary cycle ergometer for experimental participants but was not contingent on pedaling for control participants . The study was conducted over 12 weeks , including a 2-week baseline period . RESULTS Multivariate analyses indicated that the intervention significantly increased pedaling and reduced TV-viewing time . During the treatment phase , the experimental group pedaled 64.4 minutes per week on average , compared with 8.3 minutes by controls . The experimental group watched 1.6 hours of TV per week on average , compared with 21.0 hours per week on average by controls during this phase . Secondary analyses indicated that the experimental group showed significantly greater reductions in total body fat and percent leg fat . Total pedaling time during intervention correlated with greater reductions in percent body fat ( r = -0.68 ) . CONCLUSIONS Contingencies in the home environment can be arranged to modify physical activity and TV viewing and may have a role in treating childhood obesity . Contingent TV may be one method to help achieve this goal OBJECTIVE To test the effects of the Healthy Steps for Young Children program ( HS ) ( which supports parents managing children 's developmental and behavioral issues)-with  and without a prenatal component-on child health and development , parenting practice s , and parental well-being . DESIGN A concurrent comparison with clinic-level assignment to intervention or usual care status . Nested in the intervention arm , a r and omized trial compared HS with and without a prenatal component . SETTING Five primary care clinics in an integrated delivery system in the Pacific Northwest . PARTICIPANTS A consecutive sample of 439 pregnant women ( 80 % of eligible ) were enrolled . Follow-up data were obtained for 78 % when the child was 30 months old . Intervention Families in intervention clinics received HS services , including developmental and behavioral advice and risk factor screening . In addition , those r and omized to prenatal services received 3 home visits during pregnancy . MAIN OUTCOME MEASURES Assessed by telephone interview in the 3 domains of child health and development , parenting practice s , and parental well-being . RESULTS Intervention was associated with positive outcomes in timely well-child care , immunization rates , breastfeeding , television viewing , injury prevention , and discipline strategies . Prenatal initiation of services was associated with larger expressive vocabularies at age 24 months . Mothers who received the intervention reported more depressive symptoms , but there was no increase in the proportion with clinical ly significant depression . CONCLUSIONS For members of an integrated delivery system , the HS intervention was associated with positive effects on children 's health and parenting practice s. There was little evidence of any additional benefit of HS services initiated during the prenatal period BACKGROUND Television viewing has been associated with increased violence in play and higher rates of obesity . Although there are interventions to reduce television viewing by school-aged children , there are none for younger children . OBJECTIVE To develop and evaluate an intervention to reduce television viewing by preschool children . DESIGN R and omized controlled trial conducted in 16 preschool and /or day care centers in rural upstate New York . PATIENTS Children aged 2.6 through 5.5 years . INTERVENTION Children attending intervention centers received a 7-session program design ed to reduce television viewing as part of a health promotion curriculum , whereas children attending the control centers received a safety and injury prevention program . OUTCOME MEASUREMENTS Change in parent-reported child television/video viewing and measured growth variables . RESULTS Before the intervention , the intervention and control groups viewed 11.9 and 14.0 h/wk of television/videos , respectively . Afterward , children in the intervention group decreased their television/video viewing 3.1 h/wk , whereas children in the control group increased their viewing by 1.6 h/wk , for an adjusted difference between the groups of -4.7 h/wk ( 95 % confidence interval , -8.4 to -1.0 h/wk ; P = .02 ) . The percentage of children watching television/videos more than 2 h/d also decreased significantly from 33 % to 18 % among the intervention group , compared with an increase of 41 % to 47 % among the control group , for a difference of -21.5 % ( 95 % confidence interval , -42.5 % to -0.5 % ; P = .046 ) . There were no statistically significant differences in children 's growth between groups . CONCLUSIONS This study is the first to show that a preschool-based intervention can lead to reductions in  young children 's television/video viewing . Further research is needed to determine the long-term effects associated with reductions in young children 's television viewing The main goal of the study is to determine the benefit of higher dosage of indomethacin ( HDI ) compared with stopping treatment after the lower dosage ( SDI ) . The cascaded nature of the study , whereby patients only move to the higher dosing regimen if st and ard dosing does not close the PDA , complicates the analysis . The suggestion of potential selection bias is confirmed when we consider Table 1 in themanuscript where those onHDI have slightly lower gestational age ( 27.4 vs. 26.2 , p1⁄40.01 ) and birthweight ( 950 vs. 833 g , p1⁄40.05 ) . The overlapping group structure , SD vs. SDþHDI , leads to dependencies and therefore increased correlation that should also be considered in the analysis . We performed a supplementary analysis to estimate the potential effect of selection bias on the analysis results by using propensity scores to create a case control setting . The 52 patients receiving HDI were considered as the treatment group , and the control group donor pool was defined to be those patients receiving st and ard dosing , excluding those patients that subsequently move to the HDI group ( i.e. , 248–521⁄4196 patients ) . Wefitted a logisticmodelwith dependent variable the indicator of treatment ( SDI1⁄40 , HDI1⁄41 ) , and independent variables gender , birthweight and gestational age , to derive the score . We employed nearest neighbor 1:1matching using the “ MatchIt ” package in R to find similar patients to those in the HDI group . Figure S1 shows the propensity scores of those matched compared with those unmatched ; we can determine a good match between those paired in terms of their propensity score . Following matching , in the control group ( SDI only ) there were 42/52 primary PDA closures compared with 32/52 in the HDI group ( 81 vs. 62 % , p1⁄40.05 ) . This supplementary analysis indicates a marginal trend toward the number of primary PDA closures being slightly higher in the st and ard dosing group compared with those receiving higher dosing ; there had been r and om allocation of patients to each of the arms . Although this trend is marginally significant , it does not conclusively contradict the conclusion of no difference between the closure rates stated in the text of the article ( section “ secondary outcome : efficacy of treatment ” ( 65.3 vs. 65.4 % , p1⁄40.9 ) . Supplementary Objectives : To evaluate the effectiveness of an intervention to prevent excess weight gain , reduce time spent in screen behaviours , promote participation in and enjoyment of physical activity ( PA ) , and improve fundamental movement skills among children . Participants : In 2002 , 311 children ( 78 % response ; 49 % boys ) , average age 10 years 8 months , were recruited from three government schools in low socioeconomic areas of Melbourne , Australia . Design : Group-r and omized controlled trial . Children were r and omized by class to one of the four conditions : a behavioural modification group ( BM ; n=66 ) ; a fundamental movement skills group ( FMS ; n=74 ) ; a combined BM/FMS group ( BM/FMS ; n=93 ) ; and a control ( usual curriculum ) group ( n=62 ) . Data were collected at baseline , post intervention , 6- and 12-month follow-up periods . Results :  BMI data were available for 295 children at baseline and 268 at 12-month follow-up . After adjusting for food intake and PA , there was a significant intervention effect from baseline to post intervention on age- and sex-adjusted BMI in the BM/FMS group compared with controls ( −1.88 kg m−2 , P<0.01 ) , which was maintained at 6- and 12-month follow-up periods ( −1.53 kg m−2 , P<0.05 ) . Children in the BM/FMS group were less likely than controls to be overweight/obese between baseline and post intervention ( adjusted odds ratio (AOR)=0.36 , P<0.05 ) ; also maintained at 12-month follow-up ( AOR=0.38 , P<0.05 ) . Compared with controls , FMS group children recorded higher levels and greater enjoyment of PA ; and BM children recorded higher levels of PA and TV viewing across all four time points . Gender moderated the intervention effects for participation in and enjoyment of PA , and fundamental movement skills . Conclusion : This programme represents a promising approach to preventing excess weight gain and promoting participation in and enjoyment of PA . Examination of the mediators of this intervention and further tailoring of the programme to suit both genders is required OBJECTIVE To test the independent effect of television exposure in preschool-aged children on  overweight risk . DESIGN Cross-sectional and longitudinal analysis of the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development . SETTING Ten US sites . PARTICIPANTS One thous and sixteen children selected via conditional r and om sampling . MAIN EXPOSURE Being awake in the room with the television on for 2 hours or more per day , by maternal report at age 36 months . MAIN OUTCOME MEASURES Child overweight ( body mass index [ calculated as weight in kilograms divided by the square of height in meters ] > or = 95th percentile ) calculated from measured anthropometrics at ages 36 and 54 months . Covariates tested included child sex and race ; maternal marital status , education , age , and depressive symptoms ; income-needs ratio , child behavior problems ; Home Observation for Measurement of the Environment total score ; hours per week in nonparental care ; and proportion of television exposure that was educational . RESULTS At age 36 months , 5.8 % of children were overweight ; at age 54 months , 10.0 % were overweight . Exposure to 2 or more hours of television per day was associated with an increased risk of overweight at both age 36 months ( odds ratio , 2.92 ; 95 % confidence interval , 1.36 - 6.24 ) and age 54 months ( odds ratio , 1.71 ; 95 % confidence interval , 1.03 - 2.83 ) in unadjusted analyses . Only maternal age altered the concurrent relationship , and the effect of television remained significant ( odds ratio , 2.61 ; 95 % confidence interval , 1.21 - 5.62 ) . Television exposure at age 36 months was no longer a significant predictor of overweight at age 54 months when controlling for covariates . CONCLUSION Excessive  television exposure is a risk factor for overweight in preschoolers independent of a number of potential confounders associated with the quality of the home environment OBJECTIVE To examine associations of  child television ( TV ) exposure and household TV use with  aggressive behavior among 3-year-old children while controlling for demographic characteristics and risk and protective factors for aggression . DESIGN The Fragile Families and Child Wellbeing Study , a prospect i ve cohort study . SETTING Data collected at home and by telephone from parents of children born from 1998 to 2000 from 20 cities . PARTICIPANTS Mothers who completed a 36-month in-home survey and met inclusion criteria ( n = 3128 ) . MAIN EXPOSURE Direct child TV exposure and household TV use were the primary explanatory variables . Additional risk factors included neighborhood disorder and maternal factors like depression . OUTCOME MEASURES Childhood aggression was assessed with the Child Behavior Checklist/2 - 3 . Multivariate linear regression models were used to examine associations between TV measures , additional risk factors , and childhood aggression . RESULTS Children who were spanked in the past month ( beta = 1.24 , P < .001 ) , lived in a disorderly neighborhood ( beta = 2.07 , P < .001 ) , and had a mother reporting depression ( beta = 0.92 , P < .001 ) and parenting stress ( beta = 0.16 , P < .001 ) were significantly more likely to exhibit aggressive behavior .  Direct child TV exposure  ( beta = 0.16 , P < .001 ) and household TV use ( beta = 0.09 , P < .001 ) were also significantly associated with childhood aggression , even when controlling for other factors . CONCLUSIONS Three-year-old children exposed to more TV , both directly and indirectly , are at increased risk for exhibiting aggressive behavior . Further research is essential to determine whether pediatric recommendations concerning TV and children should include limits for general household TV use
BACKGROUND : Screen time , especially television viewing , is associated with risk of overweight and obesity in children .
Although several interventions have been developed to reduce children 's screen time , no systematic review of these interventions exists to date .
OBJECTIVE : This is a systematic review and meta- analysis of interventions targeting a reduction in children 's  screen time .