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

Susana Andrade, Maïté Verloigne, Greet Cardon, Patrick Kolsteren, Angelica Ochoa-Avilés, Roosmarijn Verstraeten, Silvana Donoso, Carl Lachat, Susana Andrade, Maïté Verloigne, Greet Cardon, Patrick Kolsteren, Angelica Ochoa-Avilés, Roosmarijn Verstraeten, Silvana Donoso, Carl Lachat

Abstract

Background: Effective 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.

Methods: We 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.

Results: After 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 conclusion: A 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 registration: Clinicaltrials.gov identifier NCT01004367.

References

    1. Tremblay MS, LeBlanc AG, Kho ME, Saunders TJ, Larouche R, Colley RC, et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth. Int J Behav Nutr Phys Act. 2011;8:98. doi: 10.1186/1479-5868-8-98.
    1. Currie C: Inequalities in young people's health: HBSC international report from the 2005/2006 Survey. World Health Organization Copenhagen; 2008
    1. Guthold R, Cowan MJ, Autenrieth CS, Kann L, Riley LM. Physical activity and sedentary behavior among schoolchildren: a 34-country comparison. J Pediatr. 2010;157(1):43–9. doi: 10.1016/j.jpeds.2010.01.019.
    1. Lopes AS, Silva KS, Barbosa Filho VC, Bezerra J, de Oliveira ES, Nahas MV. Trends in screen time on week and weekend days in a representative sample of Southern Brazil students. J Public Health (Oxf) 2014;36(4):608–14. doi: 10.1093/pubmed/fdt133.
    1. Janssen I, Medina C, Pedroza A, Barquera S. Screen time in Mexican children: findings from the 2012 National Health and Nutrition Survey (ENSANUT 2012) Salud Publica Mex. 2013;55(5):484–91.
    1. Biddle SJ, O’Connell S, Braithwaite RE. Sedentary behaviour interventions in young people: a meta-analysis. Br J Sports Med. 2011;45(11):937–42. doi: 10.1136/bjsports-2011-090205.
    1. Friedrich RR, Polet JP, Schuch I, Wagner MB. Effect of intervention programs in schools to reduce screen time: a meta-analysis. J Pediatr (Rio J) 2014;90(3):232–41. doi: 10.1016/j.jped.2014.01.003.
    1. Haerens L, Deforche B, Maes L, Cardon G, Stevens V, De Bourdeaudhuij I. Evaluation of a 2-year physical activity and healthy eating intervention in middle school children. Health Educ Res. 2006;21(6):911–21. doi: 10.1093/her/cyl115.
    1. Slootmaker SM, Chinapaw MJ, Seidell JC, van Mechelen W, Schuit AJ. Accelerometers and Internet for physical activity promotion in youth? Feasibility and effectiveness of a minimal intervention [ISRCTN93896459] Prev Med. 2010;51(1):31–6. doi: 10.1016/j.ypmed.2010.03.015.
    1. Leung MM, Agaronov A, Grytsenko K, Yeh MC. Intervening to Reduce Sedentary Behaviors and Childhood Obesity among School-Age Youth: A Systematic Review of Randomized Trials. J Obes. 2012;2012:685430. doi: 10.1155/2012/685430.
    1. Jones D, Hoelscher DM, Kelder SH, Hergenroeder A, Sharma SV. Increasing physical activity and decreasing sedentary activity in adolescent girls--the Incorporating More Physical Activity and Calcium in Teens (IMPACT) study. Int J Behav Nutr Phys Act. 2008;5:42. doi: 10.1186/1479-5868-5-42.
    1. Ezendam NP, Brug J, Oenema A. Evaluation of the Web-based computer-tailored FATaintPHAT intervention to promote energy balance among adolescents: results from a school cluster randomized trial. Arch Pediatr Adolesc Med. 2012;166(3):248–55. doi: 10.1001/archpediatrics.2011.204.
    1. Singh AS, Chin APMJ, Brug J, van Mechelen W. Dutch obesity intervention in teenagers: effectiveness of a school-based program on body composition and behavior. Arch Pediatr Adolesc Med. 2009;163(4):309–17. doi: 10.1001/archpediatrics.2009.2.
    1. Spruijt-Metz D, Nguyen-Michel ST, Goran MI, Chou CP, Huang TT. Reducing sedentary behavior in minority girls via a theory-based, tailored classroom media intervention. Int J Pediatr Obes. 2008;3(4):240–8. doi: 10.1080/17477160802113415.
    1. Lubans DR, Morgan PJ, Callister R, Collins CE. Effects of integrating pedometers, parental materials, and E-mail support within an extracurricular school sport intervention. J Adolesc Health. 2009;44(2):176–83. doi: 10.1016/j.jadohealth.2008.06.020.
    1. Gortmaker SL, Peterson K, Wiecha J, Sobol AM, Dixit S, Fox MK, et al. Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. Arch Pediatr Adolesc Med. 1999;153(4):409–18. doi: 10.1001/archpedi.153.4.409.
    1. Andrade S, Lachat C, Ochoa-Aviles A, Verstraeten R, Huybregts L, Roberfroid D, et al. A school-based intervention improves physical fitness in Ecuadorian adolescents: a cluster-randomized controlled trial. Int J Behav Nutr Phys Act. 2014;11(1):153. doi: 10.1186/s12966-014-0153-5.
    1. Andrade S, Ochoa-Aviles A, Lachat C, Escobar P, Verstraeten R, Van Camp J, et al. Physical fitness among urban and rural Ecuadorian adolescents and its association with blood lipids: a cross sectional study. BMC Pediatr. 2014;14:106. doi: 10.1186/1471-2431-14-106.
    1. Van Royen K, Verstraeten R, Andrade S, Ochoa-Aviles A, Donoso S, Maes L, et al. Factors affecting physical activity in ecuadorian adolescents: a focus group study. J Phys Act Health. 2015;12(3):340–8. doi: 10.1123/jpah.2013-0288.
    1. Bartholomew LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME. Planning health promotion programs: an intervention mapping approach. United States of America: John Wiley & Sons; 2011.
    1. Lefevre P, Kolsteren P, De Wael M, Byekwaso F, Beghin I: Comprehensive participatory planning and evaluation (CPPE). International Fund for Agricultural Development. Belgium. 2001
    1. Mark AE, Janssen I. Relationship between screen time and metabolic syndrome in adolescents. J Public Health (Oxf) 2008;30(2):153–60. doi: 10.1093/pubmed/fdn022.
    1. Vandewater EA, Bickham DS, Lee JH. Time well spent? Relating television use to children’s free-time activities. Pediatrics. 2006;117(2):e181–91. doi: 10.1542/peds.2005-0812.
    1. Pediatrics AA. American Academy of Pediatrics: Children, adolescents, and television. Pediatrics. 2001;10(2):423.
    1. Sistema Integrado de Indicadores Sociales del Ecuador []
    1. Hellevik O. Linear versus logistic regression when the dependent variable is a dichotomy. Quality & Quantity. 2009;43(1):59–74. doi: 10.1007/s11135-007-9077-3.
    1. Fitzmaurice GM, Laird NM, Ware JH: Applied Longitudinal Analysis: Wiley; New Jersey, USA. 2011
    1. Must A, Tybor DJ. Physical activity and sedentary behavior: a review of longitudinal studies of weight and adiposity in youth. Int J Obes (Lond) 2005;29(Suppl 2):S84–96. doi: 10.1038/sj.ijo.0803064.
    1. Chaput JP, Klingenberg L, Astrup A, Sjodin AM. Modern sedentary activities promote overconsumption of food in our current obesogenic environment. Obes Rev. 2011;12(5):e12–20. doi: 10.1111/j.1467-789X.2010.00772.x.

Source: PubMed

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