The correlates of after-school sedentary behavior among children aged 5-18 years: a systematic review

BACKGROUND: Children and adolescents spend a large proportion of the after-school period in sedentary behaviors (SB). Identifying context-specific correlates is important for informing strategies to reduce these behaviors. This paper systematically reviews the correlates of children's and adolescents' after-school SB.

METHODS: A computerized literature search was performed in October 2015 for peer-reviewed original research journal articles published in English before October 2015. Eligibility criteria included: 1) sample aged 5-18 years; 2) quantified the amount of SB or component of this that the children/adolescents were performing after school; 3) a measure of SB as the dependent outcome; and 4) the association between potential correlates and after-school SB.

RESULTS: Data were synthesized in October 2015. Thirty-one studies met the eligibility criteria: 22 studies among children (≤ 12 years), six among adolescents (>12 years), two had a combined sample of children and adolescents and one cohort followed children from childhood to adolescence. Findings were separated by after-school location i.e. after-school programs (n = 4 studies) and unidentified locations (n = 27). There was insufficient evidence to draw conclusions on all but two of the 58 potential correlates: sex and age. Among children at unidentified locations there was a null association between sex (male) and overall after-school SB, a null association between sex (male) and after-school TV viewing, a positive association between age and overall after-school SB and an inconsistent association between age and after-school TV viewing. No correlates of after-school sedentary behaviour while at after-school programs were identified.

CONCLUSIONS: Only two correlates have been investigated frequently enough to determine an overall association; neither correlate is modifiable. Due to the lack of consistent investigation of potential correlates, further evidence is required to accurately identify potential intervention targets.

Family-based interventions for reducing sedentary time in youth: a systematic review of randomized controlled trials

Family involvement in interventions to reduce sedentary time may help foster appropriate long-term screen-based habits in children. This review systematically synthesized evidence from randomized controlled trials of interventions with a family component that targeted reduction of sedentary time, including TV viewing, video games and computer use, in children. MEDLINE, PubMed, PsycInfo, CINAHL and Embase were searched from inception through March 2012. Seventeen articles were considered eligible and included in the review. Studies were judged to be at low-to-moderate risk of bias. Despite inconsistent study results, level of parental involvement, rather than the setting itself, appeared an important determinant of intervention success. Studies including a parental component of medium-to-high intensity were consistently associated with statistically significant changes in sedentary behaviours. Participant age was also identified as a determinant of intervention outcomes; all three studies conducted in pre-school children demonstrated significant decreases in sedentary time. Finally, TV exposure appeared to be related to changes in energy intake rather than physical activity. Future studies should assess the effects of greater parental involvement and child age on success of sedentary behaviour interventions. More research is required to better understand the relationship between screen time and health behaviours, particularly energy intake.

The non-advertising effects of screen-based sedentary activities on acute eating behaviours in children, adolescents, and young adults. A systematic review.

Sedentary screen time may be an important determinant of childhood obesity. A number of potential mechanisms to explain the link between screen time and increased bodyweight have been proposed; however, the relationship appears to be best explained by the effects on dietary intake, which is attributed to either food advertising or effects independent of food advertising. Technological advances have allowed for greater accessibility and exposure to advertisement-free screen-based media. This review was conducted to systematically synthesise the evidence from laboratory based studies which have investigated the non-advertising effects of screen time (TV viewing, sedentary video games, and computer use) on dietary intake in children, adolescents, and young adults. MEDLINE, PubMed, PsychInfo, CINAHL, and Embase were searched from inception through 5 July 2013. Ten trials met the inclusion criteria and were included in the review. Risk of study bias was judged to range from low to high. Screen time in the absence of food advertising was consistently found to be associated with increased dietary intake compared with non-screen behaviours. Suggested explanations for this relationship included: distraction, interruption of physiologic food regulation, screen time as a conditioned cue to eat, disruption of memory formation, and the effects of the stress-induced reward system. Due to the limited number of high-quality studies available for this review, our findings are preliminary. More work is required to better establish the link between dietary intake and advertisement-free screen time and assess whether differences exist between the different screen-based activities.

Children and television watching: a qualitative study of New Zealand parents' perceptions and views

BACKGROUND: Television (TV) viewing is one of the most pervasive sedentary pursuits among children and adolescents. Research studies have shown that higher TV viewing hours are associated with a number of negative effects such as being overweight and obese, attention and behavioural problems, and impaired academic performance. Most interventions to reduce time spent watching TV have been school-based and little is known about the strategies that families use to control TV watching time. METHODS: Six focus groups with Māori, Pacific and non-Māori non-Pacific parents were conducted to examine New Zealand parents' perceptions of their children's TV watching. Focus groups explored attitudes towards TV viewing, strategies used to reduce viewing, and opinion on two different electronic monitors that can be used to restrict TV viewing. Focus group discussions were transcribed and a content analysis was conducted. RESULTS: Parents described TV as playing a dominant role in their family's lives, and highlighted several barriers to reducing children's TV viewing, such as parents not willing to reduce their own TV watching, a lack of safe alternatives to TV and the need to use TV as a babysitting tool. Limiting access to TV, making TV viewing a reward and finding alternative activities were current strategies parents employed to limit TV viewing; however, the barriers highlighted by parents make implementing such strategies difficult. Attitudes towards electronic monitor use to reduce TV viewing were mixed, but suggest further investigation of these devices is needed. CONCLUSIONS: Electronic devices that restrict the amount and content of TV viewing have some potential to support interventions and merit further investigation. It is imperative for interventions aimed at reducing TV viewing to consider the role TV plays within a family context, ensuring parental perceptions around the benefits and barriers of reducing TV are accounted for.

Effect of electronic time monitors on children's television watching: pilot trial of a home-based intervention

OBJECTIVES: This pilot study evaluated the feasibility (recruitment, retention, and acceptability) and preliminary efficacy of a six-week home-based electronic time monitor intervention on New Zealand children's television watching in 2008. METHODS: Twenty-nine children aged 9 to 12 years who watched more than 20 h of television per week (62% male, mean age 10.4 years) were randomised to either the intervention or the control group. The intervention group received an electronic TV time monitor for 6 weeks and advice to restrict TV watching to 1 h per day or less. The control group was given verbal advice to restrict TV watching. RESULTS: Participant retention at 6 weeks was 93%. Semi-structured interviews with intervention families confirmed moderate acceptability of TV time monitors and several perceived benefits including better awareness of household TV viewing and improved time planning. Drawbacks reported included disruption to parents' TV watching and increased sibling conflict. Time spent watching television decreased by 4.2 h (mean change [SD]: -254 [536] min) per week in the intervention group compared with no change in the control group (-3 [241] min), but the difference between groups was not statistically significant, p=0.77. Both groups reported decreases in energy intake from snacks and total screen time and increases in physical activity measured by pedometer and between-group differences were not statistically significant. CONCLUSIONS: Electronic TV time monitors are feasible to use for home-based TV watching interventions although acceptability varies between families. Preliminary findings from this pilot suggest that such devices have potential to decrease children's TV watching but a larger trial is needed to confirm effectiveness. Future research should be family-orientated; take account of other screen time activities; and employ TV time monitors as just one of a range of strategies to decrease sedentary behaviour.

A systematic review of the prevalence of sedentary behavior during the after-school period among children aged 5-18 years

BACKGROUND: Independent of physical activity levels, youth sedentary behaviors (SB) have negative health outcomes. SB prevalence estimates during discretionary periods of the day (e.g., after-school), inform the need for targeted period-specific interventions. This systematic review aimed to determine children's and adolescents' SB prevalence during the after-school period.

METHODS: A computerized search was conducted in October 2015 (analysed November 2015). Inclusion criteria were: published in a peer-reviewed English journal; participants aged 5-18 years; measured overall after-school sedentary time (ST) objectively, and/or specific after-school SBs (e.g., TV viewing) objectively or subjectively; and provided the percentage of the after-school period spent in ST/SB or duration of behavior and period to calculate this. Where possible, findings were analyzed by location (e.g., after-school care/'other' locations). The PRISMA guidelines were followed.

RESULTS: Twenty-nine studies were included: 24 included children (≤12 years), four assessed adolescents (>12 years) and one included both; 20 assessed ST and nine assessed SB. On average, children spent 41% and 51% of the after-school period in ST when at after-school care and other locations respectively. Adolescents spent 57% of the after-school period in ST. SBs that children and adolescents perform include: TV viewing (20% of the period), non-screen based SB (including homework; 20%), screen-based SB (including TV viewing; 18%), homework/academics (13%), motorised transport (12%), social SB (9%), and screen-based SB (excluding TV viewing; 6%).

CONCLUSION: Children spent up to half of the after-school period in ST and this is higher among adolescents. A variety of screen- and non-screen based SBs are performed after school, providing key targets for interventions.

Socio-demographic correlates of prolonged television viewing time in Australian men and women : the AusDiab study

Background: Sedentary behaviors, particularly television viewing (TV) time, are associated with adverse health outcomes in adults, independent of physical activity levels. These associations are stronger and more consistent for women than for men. Methods: Multivariate regression models examined the sociodemographic correlates of 2 categories of TV time (≥2 hours/day and ≥4 hours/day); in a large, population-based sample of Australian adults (4950 men, 6001 women; mean age 48.1 years, range 25-91) who participated in the 1999/2000 Australian Diabetes, Obesity, and Lifestyle (AusDiab) study. Results: Some 46% of men and 40% of women watched ≥ 2 hours TV/day; 9% and 6% respectively watched ≥ 4 hours/day. For both men and women, ≥2 hours TV/day was associated with less than tertiary education, living outside of state capital cities, and having no paid employment. For women, mid and older age (45-64 and 65+) were also significant correlates of ≥2 hours TV/day. Similar patterns of association were observed in those viewing ≥4 hours/day. Conclusions: Prolonged TV time is associated with indices of social disadvantage and older age. These findings can inform the understanding of potential contextual influences and guide preventive initiatives.

Viewing The Biggest Loser : modes of reception and reflexivity among obese people

This article builds on previous reception research and scholarship on makeover TV through an analysis of obese people's views of The Biggest Loser (TBL). TBL involves obese people competing to lose weight as personal trainers push them through dietary and physical activity regimes. We articulate four themes characterizing responses to TBL: “That's not reality,” “Public ownership and judgment of the fat body,” “The lure of the transformation,” and “A guilty pleasure.” We consider how these themes are reflected in participants' movement between mediated, discursive, transparent, and referential modes of reception. While some were adamant in their rejection of the program, others were ambivalent in accepting and identifying with the desire for weight loss but questioning TBL's aesthetic dimensions and moralizing undertones. We argue that the reflexivity of viewers complicates appraisals of TBL as governing at a distance and offer some alternative readings of the impact and appeal of the program.

Park availability and physical activity, TV time, and overweight and obesity among women: findings from Australia and the United States

This study examined relationships between three measures of park availability and self-reported physical activity (PA), television viewing (TV) time, and overweight/obesity among women from Australia and the United States. Having more parks near home was the only measure of park availability associated with an outcome. Australian women (n=1848) with more parks near home had higher odds of meeting PA recommendations and lower odds of being overweight/obese. In the US sample (n=489), women with more parks near home had lower odds of watching >4h TV per day. A greater number of parks near home was associated with lower BMI among both Australian and US women. Evidence across diverse contexts provides support to improve park availability to promote PA and other health behaviors.

Children's television viewing and objectively measured physical activity: associations with family circumstances

Background: The contribution of family circumstance to physical activity and television viewing has not been widely investigated in pre-adolescents, and available information is inconsistent. This study examines whether television viewing and objectively measured physical activity vary by different indicators of family circumstance.
Methods: Data from the 2001 Children's Leisure Activity Study and the 2002/3 Health, Eating and Play Study, involving Australian children in Grades Prep (mean age 6y) and 5–6 (mean age 11y), were combined. Children wore accelerometers for six consecutive 24 hour periods. Average min/day in low-intensity activity (1.0–1.9 METs) and moderate-to-vigorous-intensity activity (≥3 METs) were calculated. Parents reported children's television viewing and family circumstance. Linear regression analyses were conducted separately for young girls, young boys, older girls and older boys. Results: Complete data were available for 2458 children. Parental education and, to a lesser extent, employment level were inversely associated with television viewing. Children in single-parent families, those whose fathers were not in paid employment, and those without siblings tended to spend more time in low-intensity activity than their peers. Children with siblings spent more time in moderate-to-vigorous-intensity activity; associations were stronger for girls. Maternal education was positively associated with moderate-to-vigorous-intensity activity for younger children. Maternal employment was positively associated with moderate-to-vigorous-intensity activity for older children. Multivariable models did not demonstrate a cumulative explanatory effect.
Conclusion:  Individual measures of family circumstance were differentially associated with television, low-intensity activity and moderate-to-vigorous-intensity activity and associations were often not consistent across age-by-gender groups. Interventions may need to be tailored accordingly.

Television viewing habits associated with obesity risk factors: a survey of Melbourne schoolchildren.

Objectives: To examine whether children’s television viewing may be a useful indicator of risk of obesity-promoting versus healthy eating behaviours, low-level physical activity (PA) and overweight or obesity among children of primary school entry and exit ages. Design: Cross-sectional study, stratified by area-level socioeconomic status. Participants and setting: 1560 children (613 aged 5–6 years [50% boys], and 947 aged 10–12 years [46% boys]) from 24 primary schools in Melbourne, Australia, randomly selected proportionate to school size between 1 November 2002 and 30 December 2003 . Main outcome measures: Parents’ reports of the time their child spends watching television, their participation in organised physical activities (PA), and their food intake; each child’s measured height and weight and their PA levels as assessed by accelerometry for one week. Results: After adjusting for the age and sex of child, the parents’ level of education, clustering by school, and all other health behaviour variables, children who watched television for > 2 h/day were significantly more likely than children who watched television for ≤ 2 h/day to: to have one or more serves/day of high energy drinks (adjusted odds ratio [AOR], 2.31; 95% CI, 1.61–3.32), and to have one or more serves/day of savoury snacks (AOR, 1.50; 95% CI, 1.04–2.17). They were also less likely to have two or more serves/day of fruit (AOR, 0.58; 95% CI, 0.46–0.74), or to participate in any organised PA (AOR, 0.52; 95% CI, 0.34–0.80). Conclusions: Health practitioners in the primary care setting may find that asking whether a child watches television for more than 2 hours daily can be a useful indicator of a child’s risk of poor diet and low physical activity level.

Indonesian masculinities : images of men in Indonesian TV advertising

This article examines images of men in Indonesian popular culture, focussing on TV advertising in particular.  Extending previous feminist scholarship on gendered representations in the Indonesian media, this article suggests that on the surface, Indonesian TV commercials reinforce and streobrthen male dominance in Indonesian society, promoting the notion that a man's primary roles are public ones, and a woman's primary roles are domestic ones. However, this investigation also suggests that so-called 'domesticated' women are also represented as actors in the public sphere, in roles as earners and spenders. This observation correlates with the argument that from the late New Order period, in media representation - and in some small sections of society, even in practice - women and men in Indonesia were becoming increasingly more equal (Sen, 1994, 2002). But is the pendulum of gender relations now swinging the other way? By examining Indonesian popular culture from the perspective of what it reveals about men and masculinity, this paper argues that a significant number of TV commercials may point towards another emergent trend in contemporary Indonesian popular culture: the rise of misandry, which is defined as a negative or contemptuous attitude towards men, 'the sexist counterpart of misogyny' (Nathanson and Young 2001, ix).

Relationship marketing and pay TV: satisfaction, complaining behavior, service recovery, and repurchase

The aims of this research included demonstrating the detenninants of Pay TV subscriber satisfaction, and displaying the relationships between key aspects of relationship marketing, such as perceptions of value, satisfaction, customer complaint behavior and service recovery, and the intention to repurchase. A survey of 171 Australian respondents suggested that the perceived quality of the variety of the programs available and the perceived quality of the monthly program guide were major contributors to value, and that value was the main driver of overall satisfaction, which in tum was the main driver of the likelihood of disconnection from the Pay TV service. Those respondents who reported having a problem but not complaining directly about it were significantly more likely to have the intention to disconnect in the future, but they were not significantly different in tenns of their value perceptions or overall satisfaction.