A Review of Different Behavior Modification Strategies Designed to Reduce Sedentary Screen Behaviors in Children

Table 2

Characteristics of randomized controlled trials focused on multiple behaviors with a sedentary screen behaviors reduction component organized by method of reduction and age of children (𝑁=10).

Source	𝑁, age (y), % girls	Delivery location, delivery target, duration	Treatment groups	Target behaviors and SSB goal(s)	Theoretical perspective, strategy to change SSB	Measure of SSB outcomes
Interventions using behavior modification techniques only
Whaley et al. 2010 [58]	(i) 589; (ii) 1–5; (iii) NR	(i) WIC program; (ii) Parent focused; (iii) 2 sessions, 12 mos	(1) Enhanced WIC individual nutritional education; (2) Routine WIC individual nutrition education	(i) Food and beverage intake, PA and TV; (ii) NR	(i) Stages of change theory, transtheoretical model; (ii) 3 B Mods NR for specific B: (goal set, preplan, prob solve); motivational interviewing (1)	Self-report: parent report (recall)
Epstein et al. 2000 [59]	(i) 90; (ii) 8–12; (iii) 68.4%	(i) Childhood obesity research clinic; (ii) Child and parent focused; (iii) 20 sessions, 6 mos	(1) ↓ SB high (20 h/wk); (2) ↓ SB low (10 h/wk); (3) ↑ PA high (20 mi/wk); (4) ↑ PA low (10 mi/wk)	(i) SB (TV, video, computer games, board games, or talking on the phone) and diet; (ii) ↓ SB 20 h/wk (1), ↓ SB 10 h/wk (2)	(i) NR; (ii) 6 B Mods for both SB and diet: (B contract goal set, preplan, + reinforcement, prob solve, self-monitor) (1, 2, 3, 4)	Self-report: parent aided child report (recall)
Epstein et al. 2004 [60]	(i) 63; (ii) 8–12; (iii) 61.9%	(i) Childhood obesity research clinic; (ii) Child and parent focused; (iii) 20 sessions, 6 mos	(1) Reinforced ↓ SSB (15 h/wk); (2) Stim control ↓ SSB (15 h/wk)	(i) TV, VCR/DVDs, video games, or computer use not for school, and diet; (ii) ↓ SSB (15 h/wk) (1, 2)	(i) NR; (ii) 4 B Mods for reinforced ↓ SSB: (B contract, goal set, + reinforcement for ↓ SSB, self-monitor); (iii) 3 B Mods for stim control of SSB: (goal set, self-monitor, stim control); (iv) 4 B Mods for diet: (goal set, preplan, + reinforcement, self-monitor)	Self-report: parent aided child report (log books)
Harrison et al. 2006 [61]	(i) 312; (ii) 9–11; (iii) 43%	(i) Elementary school; (ii) Child focused; (iii) 10 lessons, 4 mos	(1) Modified curriculum; (2) Usual health curriculum	(i) ST (TV, videotape/DVD, or computer games) and PA; (ii) ↓ ST	(i) Social cognitive theory; (ii) 7 B Mods used for both ST and PA: (goal set, preplan, + reinforcement, prob solve, relapse prev, self-monitor, social support)	Self-report: child report (recall)
Gentile et al. 2009 [62]	(i) 1323; (ii) 9–11; (iii) 53%	(i) Mailings to home, community, elementary school (optional); (ii) Child and parent focused; (iii) 9 mos community ad campaign, and 9 mailings, 9 mos	(1) Enhanced school curriculum (optional), behavioral tools packets mailed home, community ad campaign; (2) Regular school curriculum, no materials mailed home, community ad campaign	(i) PA, ST (TV and video games), and F and V ↓; (ii) ST 2 h/day	(i) Not reported; (ii) 5 B Mods used for PA, ST and F and V: (goal set, preplan, + reinforcement, prob solve, self-monitor) (1)	Self-report: parent and child report (recall)
Salmon et al. 2008 [63]	(i) 311; (ii) 10–11; (iii) 51.3%	(i) Elementary school; (ii) Child and parent focused; (iii) 19 sessions, 9 mos	(1) ↓ TV through B-Mod-based curriculum; (2) ↑ skills through modified PE curriculum; (3)↓ TV and ↑ skills curriculums; (4) Usual class and PE curriculum	(i) Rec screen B (TV, computer, and electronic games), and PA; (ii) ↓ ST (switch-off one program per wk over 4 wk period)	(i) Social cognitive theory and behavioral choice theory; (ii) 7 B Mods used for ST: (B contract, goal set, preplan, prob solve, self-monitor, stim control, + reinforcement) (1, 3); (iii) 3 B Mods used for PA: (self-monitor, preplan, prob solve)	Self-report: child report (recall)
Gortmaker et al. 1999 [48]	(i) 1295; (ii) 10–12; (iii) 48%	(i) Middle school; (ii) Child focused; (iii) 32 lessons, 24 mos	(1) Modified curriculum; (2) Regular school curriculum	(i) F and V intake, PA, total calories, and % calories from fat, TV; (ii) ↓ TV 2 h/day(1)	(i) Social cognitive theory, and behavioral choice theory; (ii) B Mods NR	Self-report: child report (recall)
Interventions using behavioral modification techniques plus contingent TV
Faith et al. 2001 [50]	(i) 10; (ii) 8–12; (iii) 30%	(i) Obesity research center; (ii) Child focused; (iii) 3 mos	(1) TV contingent upon cycling ergometer; (2) TV not contingent upon cycling ergometer	(i) PA and TV; (ii) 1 min cycling = 2 min TV (1)	(i) Behavioral choice theory; (ii) 1 B Mod used for TV viewing and TV-related PA: (+ reinforcement); and TV cycle (1)	Electronic: microcomputer of the TV cycle
Roemmich et al. 2004 [64]	(i) 18; (ii) 8–12; (iii) 38.9%	(i) Behavioral medicine laboratory; (ii) Child and parent focused; (iii) 6 wkly meetings, 6 wks	(1) Open-loop feedback of PA plus + reinforcement; (2) No feedback, no + reinforcement	(i) PA and TV, video, DVD, and video games; (ii) 400 activity counts = 60 min of TV (1)	(i) Reinforcement theory; (ii) 4 B Mods used for PA and TV: (+ reinforcement); and TV device (1); (goal set, prob solve, self-monitor) (1, 2)	Self-report: child report (log book)
Goldfield et al. 2006 [65]	(i) 30; (ii) 8–12; (iii) 56.5%	(i) Children’s hospital research institute; (ii) Child and parent focused; (iii) Bi-wkly meetings, 2 mos	(1) Open-loop feedback of PA plus + reinforcement; (2) Open-loop feedback of PA	(i) PA and TV, VCR/DVD, and video games; (ii) 400 counts on pedometer = 160 min of TV (1)	(i) Reinforcement theory; (ii) 3 B Mods used for PA and TV: (goal set, + reinforcement, self-monitor); TV device (1)	Self-report: child report (recall)

𝑁: number of participants randomized to conditions; y: years; SSB: sedentary screen behaviors; B: behavior; NR: not reported; mos: months; PA: physical activity; B Mods: behavior modification techniques; set: setting; plan: planning; prob solve: problem solving; numbers in the ( ) in column 5 and 6: treatment groups, SB: sedentary behaviors; h: hours; wk: week; mi: miles; B contract: behavioral contracting; +: positive; monitor: monitoring; stim: stimulus; ST: screen time; prev: prevention; ad: advertisement; F and V: fruits and vegetables; PE: physical education, Rec screen B: recreational screen behaviors; min: minutes.