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BMC Public Health
Published in: BMC Public Health 1/2014

Open Access 01-12-2014 | Research article

Post-intervention effects on screen behaviours and mediating effect of parental regulation: the HEalth In Adolescents study – a multi-component school-based randomized controlled trial

Authors: Ingunn H Bergh, Maartje M van Stralen, Mona Bjelland, May Grydeland, Nanna Lien, Knut-Inge Klepp, Sigmund A Anderssen, Yngvar Ommundsen

Published in: BMC Public Health | Issue 1/2014

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Abstract

Background

To improve effectiveness of future screen behaviour interventions, one needs to know whether an intervention works via the proposed mediating mechanisms and whether the intervention is equally effective among subgroups. Parental regulation is identified as a consistent correlate of screen behaviours, but prospective evidence as well as the mediation role of parental regulation is largely lacking. This study investigated post-intervention main effects on screen behaviours in the HEIA-intervention – a Norwegian school-based multiple-behaviour study, as well as mediation effects of parental regulation by adolescents’ and parents’ report. In addition, moderating effects of gender and weight status on the intervention and mediating effects were explored.

Methods

Participating schools were randomized to control (n = 25) or intervention (n = 12) condition. Adolescents (n = 908 Control; 510 Intervention) self-reported their weekday and weekend TV-viewing and computer/game-use. Change in adolescents’ behaviours was targeted through school and parents. Adolescents, mothers (n = 591 Control; 244 Interventions) and fathers (n = 469 Control; 199 Intervention) reported parental regulation of the screen behaviours post-intervention (at 20 month). The product-of-coefficient test using linear regression analysis was conducted to examine main and mediating effects.

Results

There was no intervention effect on the screen behaviours in the total sample. Gender moderated effect on weekend computer/game-use, while weight status moderated the effect on weekday TV-viewing and computer/game-use. Stratified analyses showed a small favourable intervention effect on weekday TV-viewing among the normal weight. Parental regulation did not mediate change in the screen behaviours. However, stronger parental regulation was associated with less TV-viewing and computer/game-use with effects being conditional on adolescents’ versus parental reports. Parental regulation of the screen behaviours, primarily by the parental report, was associated with change in the respective behaviours.

Conclusion

Multiple behaviour intervention may not affect all equally well, and the effect may differ by weight status and gender. In future interventions parents should be encouraged to regulate their adolescents’ TV-viewing and computer/game-use on both weekdays and weekends as parental regulation was identified as a determinant of these screen behaviours. However, future intervention studies may need to search for more effective intervention strategies targeting parental regulation.

Trial registration

Current Controlled Trials ISRCTN98552879
Appendix
Available only for authorised users
Literature
1.
Lobstein T, Baur L, Uauy R: Obesity in children and young people: a crisis in public health. Obes Rev. 2004, 5 (Suppl 1): 4-104.CrossRefPubMed
2.
3.
Brug J, Van Stralen MM, Te Velde SJ, Chinapaw MJ, De BI, Lien N, Bere E, Maskini V, Singh AS, Maes L, Moreno L, Jan N, Kovacs E, Lobstein T, Manios Y: Differences in Weight Status and Energy-Balance Related Behaviors among Schoolchildren across Europe: The ENERGY-Project. PLoS One. 2012, 7: e34742-10.1371/journal.pone.0034742.CrossRefPubMedPubMedCentral
4.
Brown T, Summerbell C: Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: an update to the obesity guidance produced by the National Institute for Health and Clinical Excellence. Obes Rev. 2009, 10: 110-141. 10.1111/j.1467-789X.2008.00515.x.CrossRefPubMed
5.
van Grieken A, Ezendam NP, Paulis WD, van der Wouden JC, Raat H: Primary prevention of overweight in children and adolescents: a meta-analysis of the effectiveness of interventions aiming to decrease sedentary behaviour. Int J Behav Nutr Phys Act. 2012, 9: 61-10.1186/1479-5868-9-61.CrossRefPubMedPubMedCentral
6.
Altenburg TM, Singh AS, Van MW, Brug J, Chinapaw MJ: Direction of the association between body fatness and self-reported screen time in Dutch adolescents. Int J Behav Nutr Phys Act. 2012, 9: 4-10.1186/1479-5868-9-4.CrossRefPubMedPubMedCentral
7.
Ekelund U, Brage S, Froberg K, Harro M, Anderssen SA, Sardinha LB, Riddoch C, Andersen LB: TV viewing and physical activity are independently associated with metabolic risk in children: the European Youth Heart Study. PLoS Med. 2006, 3: e488-10.1371/journal.pmed.0030488.CrossRefPubMedPubMedCentral
8.
Chinapaw MJ, Proper KI, Brug J, Van MW, Singh AS: Relationship between young peoples' sedentary behaviour and biomedical health indicators: a systematic review of prospective studies. Obes Rev. 2011, 12: e621-e632. 10.1111/j.1467-789X.2011.00865.x.CrossRefPubMed
9.
Salmon J, Tremblay MS, Marshall SJ, Hume C: Health Risks, Correlates, and Interventions to Reduce Sedentary Behavior in Young People. Am J Prev Med. 2011, 41: 197-206. 10.1016/j.amepre.2011.05.001.CrossRefPubMed
10.
Yang F, Helgason AR, Sigfusdottir ID, Kristjansson AL: Electronic screen use and mental well-being of 10-12-year-old children. Eur J Public Health. 2013, 23: 492-498. 10.1093/eurpub/cks102.CrossRefPubMed
11.
Gorely T, Marshall SJ, Biddle SJH, Cameron N: The prevalence of leisure time sedentary behaviour and physical activity in adolescent girls: An ecological momentary assessment approach. Int J Pediatr Obes. 2007, 2: 227-234. 10.1080/17477160701408833.CrossRefPubMed
12.
Gorely T, Biddle SJH, Marshall SJ, Cameron N: The prevalence of leisure time sedentary behaviour and physical activity in adolescent boys: An ecological momentary assessment approach. Int J Pediatr Obes. 2009, 4: 289-298. 10.3109/17477160902811181.CrossRefPubMed
13.
Raudsepp L, Neissaar I, Kull M: Longitudinal stability of sedentary behaviors and physical activity during early adolescence. Pediatr Exerc Sci. 2008, 20: 251-262.PubMed
14.
Biddle SJ, Pearson N, Ross GM, Braithwaite R: Tracking of sedentary behaviours of young people: a systematic review. Prev Med. 2010, 51: 345-351. 10.1016/j.ypmed.2010.07.018.CrossRefPubMed
15.
Kamath CC, Vickers KS, Ehrlich A, McGovern L, Johnson J, Singhal V, Paulo R, Hettinger A, Erwin PJ, Montori VM: Clinical review: behavioral interventions to prevent childhood obesity: a systematic review and metaanalyses of randomized trials. J Clin Endocrinol Metab. 2008, 93: 4606-4615. 10.1210/jc.2006-2411.CrossRefPubMed
16.
Biddle SJ, O'Connell S, Braithwaite RE: Sedentary behaviour interventions in young people: a meta-analysis. Br J Sports Med. 2011, 45: 937-942. 10.1136/bjsports-2011-090205.CrossRefPubMed
17.
Maniccia DM, Davison KK, Marshall SJ, Manganello JA, Dennison BA: A meta-analysis of interventions that target children's screen time for reduction. Pediatrics. 2011, 128: e193-e210. 10.1542/peds.2010-2353.CrossRefPubMed
18.
Gentile DA, Welk G, Eisenmann JC, Reimer RA, Walsh DA, Russell DW, Callahan R, Walsh M, Strickland S, Fritz K: Evaluation of a multiple ecological level child obesity prevention program: Switch (R) what you Do, View, and Chew. BMC Med. 2009, 7: 49-10.1186/1741-7015-7-49.CrossRefPubMedPubMedCentral
19.
Salmon J, Ball K, Hume C, Booth M, Crawford D: 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. Int J Obes. 2008, 32: 601-612. 10.1038/sj.ijo.0803805.CrossRef
20.
Singh AS, Chin APM, Brug J, Van MW: Dutch obesity intervention in teenagers: effectiveness of a school-based program on body composition and behavior. Arch Pediatr Adolesc Med. 2009, 163: 309-317. 10.1001/archpediatrics.2009.2.CrossRefPubMed
21.
Salmon J, Jorna M, Hume C, Arundell L, Chahine N, Tienstra M, Crawford D: A translational research intervention to reduce screen behaviours and promote physical activity among children: Switch-2-Activity. Health Promot Int. 2011, 26: 311-321. 10.1093/heapro/daq078.CrossRefPubMed
22.
Bauman AE, Sallis JF, Dzewaltowski DA, Owen N: Toward a better understanding of the influences on physical activity - The role of determinants, correlates, causal variables, mediators, moderators, and confounders. Am J Prev Med. 2002, 23: 5-14. 10.1016/S0749-3797(02)00469-5.CrossRefPubMed
23.
Baranowski T, Jago R: Understanding the mechanisms of change in children's physical activity programs. Exerc Sport Sci Rev. 2005, 33: 163-168. 10.1097/00003677-200510000-00003.CrossRefPubMed
24.
Van Stralen MM, Yildirim M, te Velde SJ, Brug J, Van Mechelen W, Chinapaw MJ: What works in school-based energy balance behaviour interventions and what does not? A systematic review of mediating mechanisms. Int J Obes. 2011, 35: 1251-1265. 10.1038/ijo.2011.68.CrossRef
25.
Pate RR, Mitchell JA, Byun W, Dowda M: Sedentary behaviour in youth. Br J Sports Med. 2011, 45: 906-913. 10.1136/bjsports-2011-090192.CrossRefPubMed
26.
Ramirez ER, Norman GJ, Rosenberg DE, Kerr J, Saelens BE, Durant N, Sallis JF: Adolescent screen time and rules to limit screen time in the home. J Adolesc Health. 2011, 48: 379-385. 10.1016/j.jadohealth.2010.07.013.CrossRefPubMed
27.
Hoyos CI, Jago R: Systematic review of correlates of screen-viewing among young children. Prev Med. 2010, 51: 3-10. 10.1016/j.ypmed.2010.04.012.CrossRef
28.
Granich J, Rosenberg M, Knuiman M, Timperio A: Understanding children's sedentary behaviour: a qualitative study of the family home environment. Health Educ Res. 2010, 25: 199-210. 10.1093/her/cyn025.CrossRefPubMed
29.
Carlson SA, Fulton JE, Lee SM, Foley JT, Heitzler C, Huhman M: Influence of limit-setting and participation in physical activity on youth screen time. Pediatrics. 2010, 126: e89-e96. 10.1542/peds.2009-3374.CrossRefPubMed
30.
Verloigne M, Lippevelde WV, Maes L, Yildirim M, ChinAPaw M, Manios Y, Androutsos O, Kovacs E, Bringolf-Isler B, Brug J, De Bourdeaudhuij I: Self-reported TV and computer time do not represent accelerometer-derived total sedentary time in 10 to 12-year-olds. Eur J Public Health. 2012, 23: 30-32.CrossRefPubMed
31.
Uijtdewilligen L, Nauta J, Singh AS, Van MW, Twisk JW, van der Horst K, Chinapaw MJ: Determinants of physical activity and sedentary behaviour in young people: a review and quality synthesis of prospective studies. Br J Sports Med. 2011, 45: 896-905. 10.1136/bjsports-2011-090197.CrossRefPubMed
32.
O'Connor TM, Jago R, Baranowski T: Engaging parents to increase youth physical activity a systematic review. Am J Prev Med. 2009, 37: 141-149. 10.1016/j.amepre.2009.04.020.CrossRefPubMed
33.
Yildirim M, Van Stralen MM, Chinapaw MJBJ, Van Mechelen W, Twisk J, te Velde S: For Whom and Under What Circumstances Do School-based Interventions Aimed at Energy Balance Behaviour Work? Systematic Review on Moderators. Int J Pediatr Obes. 2011, 6: e446-e457.CrossRef
34.
Bjelland M, Bergh IH, Grydeland M, Klepp KI, Andersen LF, Anderssen SA, Ommundsen Y, Lien N: Changes in adolescents' intake of sugar-sweetened beverages and sedentary behaviour: Results at 8 month mid-way assessment of the HEIA study - a comprehensive, multi-component school-based randomized trial. Int J Behav Nutr Phys Act. 2011, 8: 63-10.1186/1479-5868-8-63.CrossRefPubMedPubMedCentral
35.
Lien N, Bjelland M, Bergh IH, Grydeland M, Anderssen SA, Ommundsen Y, Andersen LF, Henriksen HB, Randby JS, Klepp KI: Design of a 20-month comprehensive, multicomponent school-based randomised trial to promote healthy weight development among 11-13 year olds: The HEalth In Adolescents study. Scand J Public Health. 2010, 38: 38-51. 10.1177/1403494810379894.CrossRefPubMed
36.
Bergh IH, Bjelland M, Grydeland M, Lien N, Andersen LF, Klepp K-I, Anderssen SA, Ommundsen Y: Mid-way and post-intervention effects on potential determinants of physical activity and sedentary, results of the HEIA study - a multicomponent school-based randomized trial. Int J Behav Nutr Phys Act. 2012, 9: 63-10.1186/1479-5868-9-63.CrossRefPubMedPubMedCentral
37.
Hardy LL, Baur LA, Garnett SP, Crawford D, Campbell KJ, Shrewsbury VA, Cowell CT, Salmon J: Family and home correlates of television viewing in 12-13 year old adolescents: the Nepean Study. Int J Behav Nutr Phys Act. 2006, 3: 24-10.1186/1479-5868-3-24.CrossRefPubMedPubMedCentral
38.
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH: Establishing a standard definition for child overweight and obesity worldwide: international survey. Br Med J. 2000, 320: 1240-1243. 10.1136/bmj.320.7244.1240.CrossRef
39.
Heck HR, Thomas SL, Tabata LN: Introduction to Multilevel and Longitudianl Modeling with IBM SPSS. Multilevel and Longitudinal Modeling with IBM SPSS. 2010, New York: Routledge, Taylor and Francis group, LLC, 1-20. 1
40.
41.
Preacher KJ, Hayes AF: Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008, 40: 879-891. 10.3758/BRM.40.3.879.CrossRefPubMed
42.
Cerin E, Mackinnon DP: A commentary on current practice in mediating variable analyses in behavioural nutrition and physical activity. Public Health Nutr. 2009, 12: 1182-1188. 10.1017/S1368980008003649.CrossRefPubMed
43.
44.
Stone-Romero EF, Liakhovitski D: Strategies for detecting moderator variables: A review of conceptual and empirical issues. Res Pers Hum Resour Manage. 2002, 21: 333-372.
45.
Rey-Lopez JP, Vicente-Rodriguez G, Biosca M, Moreno LA: Sedentary behaviour and obesity development in children and adolescents. Nutr Metab Cardiovasc Dis. 2008, 18: 242-251. 10.1016/j.numecd.2007.07.008.CrossRefPubMed
46.
Grydeland M, Bergh IH, Bjelland M, Lien N, Andersen LF, Ommundsen Y, Klepp KI, Anderssen SA: Intervention effects on physical activity: the HEIA study - a cluster randomized controlled trial. Int J Behav Nutr Phys Act. 2013, 10: 17-10.1186/1479-5868-10-17.CrossRefPubMedPubMedCentral
47.
Grydeland M, Bjelland M, Anderssen SA, Klepp K-I, Bergh IH, Andersen LF, Ommundsen Y, Lien N: Effects on anthropometric outcomes from a 20-month cluster randomized controlled school-based intervention: the HEIA study. Br J Sports Med. in press
48.
Simon C, Schweitzer B, Oujaa M, Wagner A, Arveiler D, Triby E, Copin N, Blanc S, Platat C: Successful overweight prevention in adolescents by increasing physical activity: a 4-year randomized controlled intervention. Int J Obes (Lond). 2008, 32: 1489-1498. 10.1038/ijo.2008.99.CrossRef
49.
Brehm JW: A Theory of Psychological Reactance. 1966, New York: Academic Press
50.
Bjelland M: Obesity prevention targeting Norwegian adolescents: prevalence rates, determinants and intervention effects by gender, parental education and parent-child associations. 2011, University of Oslo, Unipub: PhD thesis
51.
Robinson TN, Borzekowski DLG: Effects of the SMART classroom curriculum to reduce child and family screen time. J Commun. 2006, 56: 1-26. 10.1111/j.1460-2466.2006.00001.x.CrossRef
52.
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: 240-248. 10.1080/17477160802113415.CrossRefPubMedPubMedCentral
53.
Chin APM, Singh AS, Brug J, Van MW: Why did soft drink consumption decrease but screen time not? Mediating mechanisms in a school-based obesity prevention program. Int J Behav Nutr Phys Act. 2008, 5: 41-10.1186/1479-5868-5-41.CrossRef
54.
Mcminn AM, Griffin SJ, Jones AP, van Sluijs EM: Family and home influences on children's after-school and weekend physical activity. Eur J Public Health. 2012
55.
Bryant MJ, Lucove JC, Evenson KR, Marshall S: Measurement of television viewing in children and adolescents: a systematic review. Obes Rev. 2007, 8: 197-209. 10.1111/j.1467-789X.2006.00295.x.CrossRefPubMed
Metadata
Title
Post-intervention effects on screen behaviours and mediating effect of parental regulation: the HEalth In Adolescents study – a multi-component school-based randomized controlled trial
Authors
Ingunn H Bergh
Maartje M van Stralen
Mona Bjelland
May Grydeland
Nanna Lien
Knut-Inge Klepp
Sigmund A Anderssen
Yngvar Ommundsen
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2014
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-14-200

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