|Ref||Participants||Intervention strategies||Setting||Duration||Follow up||Description|
|Children aged 2.5 – 7 years|
|Birken et al. ||
Intervention n = 64; 44 %M; 3.1 ± 0.2 yrs|
n = 68; 49 %M; 3.1 ± 0.1 yrs
General description: Parents engaged in a 10-min counselling on the health impact of screen time in children and strategies to reduce screen time (e.g. removing TV from children’s bedroom, budgeting of children’s screen time) and on safe media use.|
Theory-based: Social cognitive theory
Knowledge transfer: Parents received standard behavioural counselling on safe media use and three Canadian Pediatric Society hand-outs.
TV turnoff: One week encouraged, children received rewarding for days without TV.
Parental skills: Parents rewarded children for days without TV.
Child involvement: Children provided parents a story about TV viewing and created a list of non TV-related activities (contingency planning).
|Family/home||1-year||No||Parents received standard counselling on safe media use and a Canadian Pediatric Society hand-out.|
|Dennison et al. b ||
n = 43; 20 %M;
3.9 ± 0.1 yrs
n = 34; 18 %M;
4.0 ± 0.1 yrs
General description: Preschool/daycare staff engaged in seven 20-min sessions on reducing children’s TV viewing, including encouraging parents/staff to read stories to children daily, family mealtime with TV turned off, a party was held for children and staff for surviving a week without TV and a booster session during the National TV-Turnoff week. Children were rewarded for ‘the best reader at home’ and for days not watching TV.|
Knowledge transfer: Parents received take-home materials of all sessions and a brochure (by the American Academy of Pediatrics).
TV turnoff: One week encouraged.
Parental skills: Parents were asked to keep a diary to increase awareness of their child’s TV viewing and to reward children for each day without TV viewing.
Child involvement: Children discussed alternative activities to watching TV, made ‘no TV’ signs, planned a party for a week without TV.
|Preschool/daycare; family/home||39 weeks||No||Usual curriculum; materials and ideas for activities about health and safety were provided tot day care or preschool staff and information and materials for at-home activities were mailed to parents. Eight monthly sessions, each with a different health or safety topic, were provided for the 2nd school year.|
|Epstein et al.a ||
n = 34; 53 %M; 5.8 ± 1.2 yrs
n = 36; 53 %M; 6.1 ± 1.3 yrs
Children with a BMI > 75th percentile for age and sex
General description: Weekly time budgets for TV viewing, computer use and associated behaviours were set during home visits, using a TV control device. Families received ideas for alternatives to sedentary behaviour, a tailored monthly newsletter with parenting tips to reduce sedentary behaviour, and information about how to rearrange the home environment to reduce access to sedentary behaviour.|
Knowledge transfer: Parents received monthly newsletters including tips to reduce SB and how to arrange the home environment to reduce access to SB.
TV control device: Families received a TV allowance, attached to each TV and each computer monitor in the home.
Parental skills: Parents were instructed to praise their children for reducing TV viewing and engaging in alternate behaviours.
Goal setting: Research staff set weekly TV budgets, which were weekly reduced by 10 % to a maximum of 50 %, based on baseline amounts. When the budget was reached, the TV or computer could not be turned on for the remainder of the week. The research staff rewarded children for amount of time under budget.
|University children’s hospital; family/home||2 years (measures every 6 months from baseline)||No||Free access to TV and computers and 2-dollar budget per week for participating. Families received a newsletter providing parenting tips, sample praise statements, and child-appropriate activities and recipes.|
|Haines et al.b ||
n = 55; 56 %M; 4.1 ± 1.1 yrs
n = 56; 48 %M; 4 ± 1.1 yrs
Children from low-income and racial/ethnic minority families
General description: Parents engaged in individually tailored counselling (motivational coaching by health educator) to encourage behavioural change (four 60-min home visits and four 20-min telephone calls). Educational materials and incentives, and weekly text messages on adoption of household routines were mailed (twice weekly for 16 weeks and weekly for the last 8 weeks). Home visits targeted behavioural change: review progress and setbacks, goals and tools. Phone calls targeted parents’ progress on making change, provide support and reinforce study messages. Focus on limiting TV time, eating more meals together as a family with TV off and removing the TV from the child's bedroom.|
Theory-based: Social ecological model.
Knowledge transfer: Parents engaged in counselling sessions, and received educational materials and text messages.
TV control device: In subsample of 30 participants (±25 %)
Parental skills: Parents were coached on goal setting for their child’s behaviour and provided with tools to support their child’s behaviour change. Parents with TV control device were assisted with goal setting to reduce total viewing time.
Goal setting: Parents encouraged to set goals for their child’s behaviour.
|Family/home||6 months||No||Control group received four monthly mailed packages including educational materials on reaching developmental milestones during early childhood and low-cost incentives (e.g. colouring books).|
|Taveras et al. ||
n = 253; 52 %M; 4.8 ± 1.2 yrs
n = 192; 51 %M; 5.2 ± 1.1 yrs
Children with a BMI between 75th and 85th percentile
General description: Pediatric nurse practitioners conducted four 25-minute in-person chronic disease management visits and three 15-minute phone calls (motivational interviewing) in the first year of the intervention. Posters in the waiting room highlighting the targeted behaviours: less than 1 hour per day TV/video viewing, removing TV from or avoiding putting a TV in the child’s bedroom. For the chronic disease managements visits, educational modules were developed targeting TV viewing and matching the family’s stage of readiness to change. Small incentives were provided to further support behavioural change.|
Theory-based: Chronic care model.
Knowledge transfer: Families received education on TV viewing, matched with their stage of readiness to change, and were provided with tools for self-management support, an interactive website with educational materials.
TV control device: Electronic monitoring device offered to families to assist with the goal of reducing TV viewing.
|No||Usual care including well-child care visits and follow-up appointments for weight checks|
|Yilmaz et al. ||
n = 176; 65 %M; 3.5 ± 1.2 yrs
n = 187; 66 %M; 3.5 ± 1.3 yrs
General description: Families were exposed to four intervention components at two week intervals: 1) printed materials and interactive CD’s; 2) counselling call; 3) age-appropriate picture book showing a role-model families, and including knowledge on screen time; and 4) stories of role-model families.|
Theory-based: Social cognitive theory.
Knowledge transfer: Parents received several materials and counselling calls.
Parental skills: Parents received encouraging counselling call.
|Family/home||2 months||2, 6 and 9 months||-|
|Zimmerman et al. ||
n = 34; %M not reported
n = 33; %M not reported
General description: Families received written materials and four monthly newsletters targeting 1) to reduce the child’s media viewing to 1 h per day or less and 2) to replace commercial media viewing with educational viewing. A case manager contacted (phone or email) families to facilitate behaviour change, with communication in four domains: 1) positive/negative effects of TV on child’s health and development, 2) encouragement to the mother in building confidence to modify a child's TV viewing, 3) strategies for modifying the child’s TV viewing and 4) assessment and counselling in the parent’s stage of change for modifying TV viewing.|
Knowledge transfer: Parents received written materials and four monthly newsletters, and were contacted by case manager.
Parental skills: Parents were provided with encouragement in building confidence to modify the child’s TV viewing and strategies for modifying the child’s TV viewing.
Goal setting: Parents were encouraged by the research staff to reduce their child’s media viewing to 1 hour per day or less, and replace commercial TV viewing with educational viewing.
|Family/home||4 months||No||Injury-prevention and pre-schooler safety targeted. Parents were asked to promote their child’s safety in several areas, for example regular use of bike helmets, regular and appropriate use of car seats, home fire safety.|
|Children aged 7 – 12 years|
|Cardon et al. ||
n = 19; 8.3 ± 0.6 yrs; 53 %M
n = 23; 8.1 ± 0.5 yrs; 48 %M
General description: Encouragement of movement in the school, by 1) work organisation encouraging movement (e.g. information stations); 2) circumstances creating movement (e.g. stand-at places of work); and 3) behavioural influences (e.g. good examples). Ergonomic furniture in classroom allowing varying working postures and contributing to dynamic sitting. All tables have inclinable tops (minimum inclination of 16°), more floor space available in the classroom for variation in daily working routines (e.g. corner for reclining, mats on the floor).|
Knowledge transfer: Children provided with good examples, encouragement and training on awareness of healthy behaviour. Also knowledge on posture-physiology and motivation for lasting behaviour change.
Change in environment: Standing work places and work organisation to encourage movement/reduce sitting.
|School||1.5 years||No||Traditional furniture|
|Carson et al.a ||
n = 74; 37 %M; 7.9 ± 1.4 yrs
n = 64; 59 %M; 8.1 ± 0.4 yrs
General description: Children received class-learning messages (9 out of 18 by mid-intervention), one standing class lesson each day (±30 minutes) and a 2-min light intensity activity break every 30 minutes within each 2-hour teaching block (teachers were provided with timers). Standing easels were placed in class so that could rotate learning activities at standing desks. Children completed homework tasks on reducing sitting time (alone and with parents).|
Theory-based: Social cognitive theory, behavioural choice theory and ecological systems theory
Knowledge transfer: Children received key-learning messages in class on raising awareness, self-monitoring, goal setting, behavioural contracts, social support and feedback and reinforcement; parents received nine newsletters including these key-learning messages, family based activities to complete with their child and information on how to reduce their child’s screen time (e.g. effective use of rules).
Change in environment: Standing easels in class to alternate sitting with standing.
|School; family/home||24 months (mid-intervention results)||No||Usual practice|
|Epstein et al. b ||
Low dose SB|
n = 20; 25 %M; 10.7 ± 1.0 yrs
High dose SB
n = 20; 40 %M; 10.6 ± 1.1 yrs
General description: Families engaged in 16 weekly meetings, followed by 2 biweekly and 2 monthly meetings on healthy diet and decreasing SB, with separate groups for children and parents. Children were reinforced for reducing SBs that compete with being active or set the occasion for eating (viewing TV/videotapes, playing computer games, talking on the phone, or playing board games). Academically relevant SBs were not targeted.|
Knowledge transfer: Families received parent and child workbooks on weight control, self-monitoring, the traffic light diet, specific activity program, behaviour change techniques and maintenance of behaviour change.
Parental skills: Parents rewarded children when meeting goals.
Goal setting: Parents and children set goals and reinforcers to be provided when meeting the goal.
|Childhood obesity research clinic; family/home||6 months||12 and 24 months||
No control group.|
Low dose or high dose groups for reducing SB.
|Epstein et al. b ||
n = 32; 34 %M;
9.8 ± 1.4 yrs
n = 30; 40 %M;
9.9 ± 1.2 yrs
Children between 20 % and 100 % overweight
General description: Families engaged in 16 weekly meetings, two biweekly meetings, 2 monthly meetings on reducing SB to no more than 15 hours per week, using shaping steps of 25, 20 and 15. Topics were self-monitoring, behavioural change and maintenance of change. Children were awarded for meeting their goals (based on baseline values) – i.e. reinforcement group. Families recorded targeted sedentary behaviour times in habit books.|
Knowledge transfer: Families engaged in meetings and received habit books.
Parental skills: Parents were instruct to monitor their child’s SB using habit books, and were taught to review habit books daily with their child, and praise and reward their child for meeting goals (contract reinforcement system).
Goal setting: Children were encouraged by the treatment staff to reduce SB to no more than 15 hours per week.
|Clinic; family/home||6 months||12 months||
Instructions to reduce SB to 15 or fewer per week, change environment to prevent engagement in targeted SB, establish rules|
regarding SB, and aid sedentary behaviour change (e.g. posting signs indicating sedentary limit and unplugging targeted SB (TVs/PCs)). Positive reinforcement for recording SB (but not for behavioural change) – i.e. stimulus control group.
|Escobar-Chaves et al. ||
n = 199; 49 %M; 8.2 ± 0.8 yrs
General description: Families engaged in one 2-hour workshop on how to incorporate the five behavioural objectives into their daily routines (including interactive discussion about TV facts and concurrent parent–child activities) and six bimonthly newsletters focusing on five behavioural objectives/steps to reduce media consumption (e.g. TV viewing): 1) reduce TV viewing; 2) turn of TV when nobody is watching; 3) no TV with meals; 4) no TV in the child’s bedroom; 5) engage in fun, non-media related activities. Parents and children worked together on a Fun Family Plan.|
Theory-based: Social cognitive theory.
Knowledge transfer: Parents engaged in a 2-hour workshop and received six monthly newsletters.
Parental skills: Parents learned communication skills via role playing (from workshop) and positive peer role model stories (from newsletters).
Child involvement: Children discussed lessons learned, made a hand puppet as a cue to action and brainstormed about activities besides media consumption, and discussed these with parents.
|Ford et al. ||
n = 15; 47 %M; 9.5 ± 1.4 yrs
n = 13; 46 %M; 9.6 ± 1.7 yrs
General description: Families engaged in a brief standard counselling intervention (5–10 minutes), including discussion of potential problems associated with excessive media use and three brochures from the American Academy of Pediatrics, and engaged in a 15–20 minutes discussion about setting TV budgets.|
Theory-based: Social cognitive theory.
TV control device: Families received a TV allowance, to monitor and budget TV, videotape and video game use.
Knowledge transfer: Parents received counselling and a brochure.
Parental skills: Parents engaged in discussion on setting TV viewing budgets (counselling session) and received instructions for monitoring their child’s TV viewing, setting a weekly media budget and helping their child to stick to this budget.
Goal setting: Parents instructed to set weekly media budgets.
|Family/home||4 weeks||No||Standard counselling intervention (5–10 minutes), including discussion of potential problems associated with excessive media use and three brochures from the American Academy of Pediatrics.|
|French et al. ||n = 40; 50 %M; 9.0 ± 2.2 yrs||
General description: TV control devices (attached to every working TV in the home) implemented during initial home visit, followed by five monthly telephone calls. Number of hours programmed on the devices (lower than baseline TV viewing time; recommendation: <2 hrs/day) was discussed and agreed on (by parent) during the home visit. For phones and small screens parents were encouraged to limit their child’s use. Telephone contact, using motivational interviewing, to help parents set goals and make changes in home environment. Additionally, non-caloric beverages were delivered.|
TV control device: 6 months.
Parental skills: Parents encouraged to set goals for programming of TV viewing time, limit use of phones and small screens and make changes in home environment regarding screens.
Goal setting: Parents programmed the number of hours of TV viewing.
|Hinckson et al. ||
n = 23; 9 ± 1 yrs
n = 7; 10 ± 0 yrs
General description: Child-adjusted standing workstations were introduced in the classrooms. Exercise balls, beanbags, and mats were available for children to sit when tired. Traditional desks and chairs were removed.|
Change in environment: Standing workstations in class.
|School||4 weeks||No||Classrooms with traditional desks and chairs.|
|Maddison et al. ||
n = 127; 57 %M; 11.2 yrs
n = 124; 56 %M; 11.3 yrs
Overweight and obese children
General description: Parents were encouraged to change the home environment to facilitate behaviour change of the child and to implement behaviour change strategies (SWITCH). Three elements offered to families: 1) provision of behavioural change strategies by offering education and support; 2) assistance to budget media time, by a TV control device; and 3) an activity pack for children, including options for non-screen based activities.|
Theory-based: Social cognitive theory, behavioural economics theory.
Knowledge transfer: Parents received cultural relevant education and support to implement strategies in the home environment, and they received newsletters.
TV control device: 20 weeks
Parental skills: Parents were encouraged (during a face-to-face meeting) to include praise, positive reinforcements, environmental control budgeting and self-monitoring, positive role modelling.
|Family/home||20 weeks||24 weeks||Families continued with their usual behavior and had access to generic SWITCH public website.|
|Ni Mhurchu et al. ||
n = 15; 67 %M; 10.4 ± 0.9 yrs
n = 14; 57 %M; 10.4 ± 0.9 yrs
General description: Children were encouraged to restrict TV viewing to 1 h per day or less. Parents engaged in a discussion on how to use the TV control device within their household and discussed ideas to manage TV viewing.|
TV control device: Families received an electronic TV time monitor (up to 2 per household). Parents were given 30 tokens, each allowing 30 minutes of TV time.
Knowledge transfer: Parents were engaged in discussion.
Parental skills: Parents discussed the usage of the TV control device (e.g. creating rules around household TV viewing) and had the option of blocking out certain time periods to help control the content of TV programmes viewed by children.
Goal setting: Parents were encouraged by the research staff to restrict their child’s TV viewing to 1 h per day or less.
|Family/home||6 weeks||No||Families received verbal advise on general strategies to decrease TV watching (single session).|
|Robinson et al. ||
n = 92; 55 %M; 8.9 ± 0.64 yrs
n = 100; 51 %M; 8.9 ± 0.7 yrs
General description: Children received 18 lessons of 30–50 minutes, including self-monitoring and self-reporting of TV/video and video game use. A TV turnoff period was encouraged as well as a 7-hour per week budget of TV/video and video game use. Parents received newsletters motivating them to help their children to stay within their budget and suggesting strategies for limiting TV/video and video game use were provided by newsletters.|
Theory-based: Social cognitive theory.
TV turnoff: Ten days encouraged.
TV control device: Families received a TV allowance for each TV in the home to help with budgeting.
Knowledge transfer: Children engaged in lessons on self-monitoring and self-reporting of TV/video and video game use, on becoming ‘intelligent viewers’ and being advocates for reducing media use. Parents received newsletters on strategies to reduce TV/video and video game use.
Parental skills: Parents were encouraged to motivate their children to stay within their budget.
Goal setting: Children were encouraged by the research staff to limit their TV viewing to 7 hours per week.
|School; family/home||6 months||No||Assessment only|
|Todd et al. ||
n = 11; 100 %M;
10.0 ± 0.8 yrs
n = 10; 100 %M; 9.7 ± 1.2 yrs
General description: Children engaged in a seminar to enhance awareness of electronic media use and to set goals to minimize use. Awareness and strategies to help minimize media use included: a 90-minute family-centred interactive session, three follow-up newsletters, TV allowance, ENUFF software to limit computer and internet use, follow-up phone call to ensure installation of TV Allowance and ENUFF software, recommendation for progressive reduction in electronic media use to 90 min per day or less in the first 10 weeks. Parents were contacted weekly by phone calls to encourage and reinforce compliance with the intervention strategy.|
TV control device: Families received a TV allowance (up to 2 per family)
Knowledge transfer: Families engaged in interactive session and parents received three newsletters.
Goal setting: Children set goals to minimize use (seminar) and were recommended by the research staff to limit media use to 90 minutes per day or less in the first 10 weeks.
|Family/home||20 weeks||No||Only data collection|
|Verloigne et al. ||
10.9 ± 0.7 yrs
n = 141; 40 %M
n = 231; 39 %M
Children from Belgium
General description: Children engaged in one or two lessons per week (at school) on reducing screen time and breaking up sitting time (UP4FUN) covering one specific theme each week: 1) Introduction of the project, 2) awareness of sitting time, 3) evaluation of sitting time, 4) influencing factors at home, 5) possibilities for activity breaks and active transportation, 6) Family Fun Event. To increase parental involvement, the teacher handed out a weekly newsletter to the children containing personalized messages of the children and homework tasks. Motivational factors included the ‘fun’ aspect of the intervention (e.g. step counters and stickers) and public commitment to the project message (by UP4FUN bracelets).|
Theory-based: Social ecological perspective.
Knowledge transfer: Children engaged in lessons on SB. Parents received six weekly newsletters.
Child involvement: Activities such as making list of non-sedentary activities, writing personal goals, discussing family screen time rules.
Goal setting: Based on sitting time in week 2, children set personal goals.
|School||6 weeks||No||Usual curriculum|
|Vik et al. ||
Intervention: n = 1569|
Control: n = 1578
49 %M; 11.2 yrs
From 5 European countries
|UP4FUN intervention, for intervention characteristics see description given above (Verloigne et al.).|