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

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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.
Keywords
Adolescents, Randomised controlled trial, Questionnaires, Sedentary behaviours, Screen-time, Computer, Video games, PHYSICAL-ACTIVITY, SEDENTARY BEHAVIOR, YOUTH, CHILDREN, METAANALYSIS, FITNESS, OBESITY, GIRLS

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Chicago
Andrade Tenesaca, Dolores Susana, Maïté Verloigne, Greet Cardon, Patrick Kolsteren, Angélica María Ochoa Avilés, Roosmarijn Verstraeten, Silvana Donoso, and Carl Lachat. 2015. “School-based Intervention on Healthy Behaviour Among Ecuadorian Adolescents : Effect of a Cluster-randomized Controlled Trial on Screen-time.” Bmc Public Health 15.
APA
Andrade Tenesaca, D. S., Verloigne, M., Cardon, G., Kolsteren, P., Ochoa Avilés, A. M., Verstraeten, R., Donoso, S., et al. (2015). School-based intervention on healthy behaviour among Ecuadorian adolescents : effect of a cluster-randomized controlled trial on screen-time. BMC PUBLIC HEALTH, 15.
Vancouver
1.
Andrade Tenesaca DS, Verloigne M, Cardon G, Kolsteren P, Ochoa Avilés AM, Verstraeten R, et al. School-based intervention on healthy behaviour among Ecuadorian adolescents : effect of a cluster-randomized controlled trial on screen-time. BMC PUBLIC HEALTH. 2015;15.
MLA
Andrade Tenesaca, Dolores Susana, Maïté Verloigne, Greet Cardon, et al. “School-based Intervention on Healthy Behaviour Among Ecuadorian Adolescents : Effect of a Cluster-randomized Controlled Trial on Screen-time.” BMC PUBLIC HEALTH 15 (2015): n. pag. Print.
@article{6935855,
  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 {\textpm} 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 (\ensuremath{\beta} = \ensuremath{-}15.7 min; P = 0.003) and weekend day (\ensuremath{\beta} = \ensuremath{-}18.9 min; P = 0.005), in total screen-time on a weekday (\ensuremath{\beta} = \ensuremath{-}25.9 min; P = 0.03) and in the proportion of adolescents that did not meet the screen-time recommendation (\ensuremath{\beta} = \ensuremath{-}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 (\ensuremath{\beta} = 13.1 min; P = 0.02), and total screen-time on a weekday (\ensuremath{\beta} = 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{\textquoteright} 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.},
  articleno    = {942},
  author       = {Andrade Tenesaca, Dolores Susana and Verloigne, Ma{\"i}t{\'e} and Cardon, Greet and Kolsteren, Patrick and Ochoa Avil{\'e}s, Ang{\'e}lica Mar{\'i}a and Verstraeten, Roosmarijn and Donoso, Silvana and Lachat, Carl},
  issn         = {1471-2458},
  journal      = {BMC PUBLIC HEALTH},
  keyword      = {Adolescents,Randomised controlled trial,Questionnaires,Sedentary behaviours,Screen-time,Computer,Video games,PHYSICAL-ACTIVITY,SEDENTARY BEHAVIOR,YOUTH,CHILDREN,METAANALYSIS,FITNESS,OBESITY,GIRLS},
  language     = {eng},
  pages        = {11},
  title        = {School-based intervention on healthy behaviour among Ecuadorian adolescents : effect of a cluster-randomized controlled trial on screen-time},
  url          = {http://dx.doi.org/10.1186/s12889-015-2274-4},
  volume       = {15},
  year         = {2015},
}

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