Screen time interventions encourage children to spend time away from TV and other stationary screen media (e.g., computers and video games); such interventions typically do not address use of mobile screens (e.g., smartphones and tablets). Screen time interventions teach self-management skills to initiate or maintain behavior change using tracking and monitoring, classroom-based education, counseling sessions, and/or family-based or peer social support. Screen time interventions can also include physical activity and/or healthy diet components1. Children and adolescents spend an average of 6 and 8 hours per day, respectively, in sedentary behaviors2. Although parent-reported average TV viewing time has decreased in recent years among preschoolers and children ages 6-113, overall screen time averages have increased and are substantially more than the recommended limit of 2 hours per day1, 2, 4.
Expected Beneficial Outcomes (Rated)
Reduced sedentary screen time
Increased physical activity
Improved dietary habits
Improved weight status
Evidence of Effectiveness
There is strong evidence that screen time interventions reduce sedentary screen time among children under 141, 5, 6. Interventions that include nutrition and physical activity components have also been shown to increase physical activity and improve dietary habits and weight-related outcomes for participating children1, 5, 7. Overall, screen time interventions have small but significant effects on stationary screen use with or without nutrition and physical activity components1, 5, 7; additional evidence is needed to confirm effects on mobile device use.
Screen time interventions may be especially effective for children under the age of 65, 6. Such interventions can benefit children in urban and suburban settings, children from a variety of socio-economic and racial and ethnic backgrounds, and children who are of healthy weight, overweight, and obese1.
In many cases, children who participate in screen time interventions with nutrition and physical activity components reduce their body mass index (BMI). Such interventions can also decrease the number of participating children who are obese1. High levels of TV viewing are associated with higher BMIs as early as age 28.
Family and parental support significantly increase the effectiveness of screen time interventions, reducing sedentary behavior and fostering long-term healthy screen time habits1, 6, 9. Screen time interventions that include family-based social support and electronic monitoring devices (e.g., low cost apps for mobile devices or time limits for TV or e-readers) reduce sedentary screen time1, 5. Parents can increase the effectiveness of such interventions by enforcing consistent rules about media use with a family media plan, being a role model balancing screen time and other activities, and fostering family communication about media use9, 10. Parental reductions in personal screen time can also decrease children’s screen time9.
In schools, screen time interventions can be incorporated into existing curricula. Teacher training may increase effectiveness of these interventions1. In child care settings, higher levels of education for care providers is associated with lower levels of screen time for children; screen availability and attending home-based child care are associated with higher levels of screen time11.
Impact on Disparities
States and cities can regulate screen time in various settings, especially child care centers and home-based child care settings, as in Maryland12 and New York City13. State health agencies often provide information, resources, and technical assistance to support the implementation of screen time interventions14.
There are several school-based screen time interventions that include physical activity and nutrition components. Many public middle schools in Boston, for example, implement the Planet Health curriculum15. Several elementary schools in Maplewood, New Jersey implement a week or year-long TV Turnoff Challenge16.
The 5-2-1-0 childhood obesity prevention program is an example of a multi-component intervention for reducing screen time, improving diet, and increasing physical activity; the program encourages developing daily habits that include 5 servings of fruits and vegetables, 2 hours or less of screen time, 1 hour or more of physical activity, 0 sugary drinks, and increased water consumption. The 5-2-1-0 program started in Maine17, and has expanded to cities and states across the country, for example Florida18; New Hampshire19; Baton Rouge, LA20; Chesterfield County, VA21; and Palo Alto, CA22.
USDA-Screen time - US Department of Agriculture (USDA), Team Nutrition Healthy Meals Resource System (HMRS). Electronic media use/screen time.
UW CPHN-Resources - University of Washington Center for Public Health Nutrition (UW CPHN). Early care and education: Trainings, tools, and resources.
ChangeLab-Model childcare statute - National Policy & Legal Analysis Network to Prevent Childhood Obesity (NPLAN). Model childcare licensing statute for obesity prevention. Oakland: ChangeLab Solutions; 2013.
HOST-PA - Healthy Out-of-School Time (HOST) Coalition. Resources: Physical activity (PA).
AAP-Media - American Academy of Pediatrics (AAP). Media and children communication toolkit: AAP recommendations and resources for parents.
* Journal subscription may be required for access.
1 CG-Obesity - The Guide to Community Preventive Services (The Community Guide). Obesity.
2 ALR-Lou 2014 - Lou DW. Research review: Sedentary behaviors and youth: Current trends and the impact on health. Active Living Research (ALR); 2014.
3 Loprinzi 2016* - Loprinzi PD, Davis RE. Secular trends in parent-reported television viewing among children in the United States, 2001-2012. Child: Care, Health and Development. 2016;42(2):288-291.
4 AAP-Media - American Academy of Pediatrics (AAP). Media and children communication toolkit: AAP recommendations and resources for parents.
5 Biddle 2014* - Biddle SJH, Petrolini I, Pearson N. Interventions designed to reduce sedentary behaviours in young people: A review of reviews. British Journal of Sports Medicine. 2014;48:182-186.
6 Marsh 2014* - Marsh S, Foley LS, Wilks DC, Maddison R. Family-based interventions for reducing sedentary time in youth: A systematic review of randomized controlled trials. Obesity Reviews. 2014;15:117-133.
7 Friedrich 2014* - Friedrich RR, Polet JP, Schuch I, Wagner MB. Effect of intervention programs in schools to reduce screen time: A meta-analysis. Jornal de Pediatria. 2014;90(3):232-241.
8 Wen 2014 - Wen LM, Baur LA, Rissel C, Xu H, Simpson JM. Correlates of body mass index and overweight and obesity of children aged 2 years: Findings from the healthy beginnings trial. Obesity. 2014;22(7):1723-1730.
9 Xu 2015 - Xu H, Wen LM, Rissel C. Associations of parental influences with physical activity and screen time among young children: A systematic review. Journal of Obesity. 2015;2015:546925.
10 Chassiakos 2016 - Chassiakos YR, Radesky J, Christakis D, Moreno MA, Cross C. Children and adolescents and digital media. Pediatrics. 2016;138(5):e20162593.
11 Vanderloo 2014 - Vanderloo L. Screen-viewing among preschoolers in childcare: A systematic review. BMC Pediatrics. 2014;14:205.
12 NCSL-ECE - National Conference of State Legislatures (NCSL). Early care and education (ECE) 2014 legislative action.
13 Nonas 2014 - Nonas C, Silver LD, Khan LK, Leviton L. Rationale for New York City’s regulations on nutrition, physical activity, and screen time in early child care centers. Preventing Chronic Disease. 2014;11:E182.
14 ASTHO-Screen time - Association of State and Territorial Health Officials (ASTHO). Action sheet: Preventing obesity through reduced screen time interventions.
15 CDC-Planet health - Centers for Disease Control and Prevention (CDC), Boston Steps, Boston Public Health Commission. Boston’s Steps Program: Increasing healthy behaviors among students and implementing the Planet Health curriculum.
16 TV Turnoff - TVturnoff.net. Ultimate TV turnoff challenge: Program outline.
17 MH-Let’s go - MaineHealth (MH). Let's go!
18 FL DOH-5210 - Florida Department of Health (FL DOH), FloridaHealth Lee County. The 5-2-1-0 plan for a healthier active lifestyle.
19 FHC-5210 - Foundation for Healthy Communities (FHC). 5-2-1-0 Healthy NH.
20 MHCI-5210 plus 10 - Mayor's Healthy City Initiative (MHCI). Healthy Baton Rouge: 5-2-1-0+10: Numbers for your children's health!
21 COACH-5210 everyday - Chesterfield County's Coalition for Active Children (COACH). 5-2-1-0 Everyday!
22 PAMF-5210 resources - Sutter Health Palo Alto Medical Foundation (PAMF). 5-2-1-0 Resources.
23 CSE-Families - Common Sense Education (CSE), Common Sense Media. Connecting families: Our family toolbox.
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