TABLE 1

Description of Interventions Eligible for Inclusion in the Meta-analysis

Author (Year)Intervention NameIntervention DescriptionSummary of Intervention Effectiveness Based on the Authors' Results
Interventions included in the meta-analysis
    Angelbuer91 (1998)The Switch ApparatusThe intervention consisted of family counseling, including an educational component, television planning, an activities menu and a contract with rewards for behavior. Participants were provided a television-control device.Television viewing was reduced from ∼30 h/wk during baseline to slightly more than 10 h/wk after the intervention.
    Chin et al44 (2008)DOiT (Dutch Obesity Intervention in Teenagers)The intervention consisted of a behavioral component (11 lessons for biology and physical education classes to raise awareness and facilitate positive health behaviors) and an environmental component (encouraging additional physical education classes and changes in the school cafeteria).No significant change in screen-viewing behavior occurred.
    Dennison et al42 (2004)Brocodile the CrocodileThe intervention increased awareness by using media diaries and included activities in child care centers. Children were encouraged to turn off the television and were actively involved in identifying alternatives to watching television.Significant differences between groups; the intervention group decreased television and video viewing while the control group increased time spent viewing television and videos.
    Eisenmann et al45 (2008)Switch What You Do, Chew, and ViewA multilevel (community, school, and family) intervention to modify physical activity, screen time, and nutrition behaviors. The community-based component consisted of a campaign to increase awareness and knowledge of preventing childhood obesity. The school-based component included a school-wide kickoff event and a teacher packet with materials for classroom display and distribution to the children and ideas for integrating materials into the curricula. The family component included information on strategies for creating a family environment supportive of healthy behaviors.Significant differences in parent-reported screen time immediately after and 6 mo after the intervention were seen in the intervention group. Change in child-reported screen time was not significant but was lower after the intervention.
    Epstein et al43 (2008)Television allowanceWeekly budgets for screen time were set and budgets reduced by 10% per month until the budget was 50% of baseline. When the budget was reached, the television set could not be turned on. Rewards were earned for staying under budget. Parents also were provided with tips to reduce sedentary behavior.The intervention resulted in a statistically significant and sustained reduction in television viewing and computer use.
    Faith et al112 (2001)Television cycleDuring the intervention, television viewing was contingent on pedaling an exercise cycle at or above a prescribed intensity level.Among the treatment group, television-viewing time significantly decreased from baseline to weeks 3 to 5, and among the control group television viewing increased. During the 12-wk period, television viewing declined in both groups, with greater declines in the intervention group.
    Ford et al92 (2002)Television allowanceA clinical intervention that provided families with brief counseling about the problems associated with excessive media and 15- to 20-minute discussions about setting television budgets. Parents received a television-control device (television allowance) to help budget television time.Both groups reported decreases in screen time. Differences between groups were not significant. The families who used the television-control device generally reported greater changes.
    Foster et al47 (2008)The intervention included a school self-assessment, nutrition education and policy, social marketing, and parent outreach. School staff were provided with Planet Health and Know Your Body curricula and supporting materials; they also received nutrition and physical activity theme packets to be integrated into classroom lessons, cafeteria promotions, and parent outreach. The family outreach component consisted of the 2-1-5 challenge, during which children were challenged to be less sedentary and more physically active.Time spent watching television decreased in the intervention group and increased in the control group.
    Golan et al93 (1998)The intervention used parents as the agent of change. Parents participated in group session originally held weekly, then biweekly, than once every 6 wk (during this time families also attend five 15-min individual sessions). At all sessions parents were taught to alter the family's sedentary lifestyle.No reduction in television viewing time occurred.
    Goldfield et al46 (2006)Token televisionScreen time (television/VCR/DVD) was controlled by an electronic device (token television). When tokens were inserted into the device, the television was activated. Children wore a pedometer that provided them with feedback about their physical activity. Tokens were earned by being physically active.Screen time decreased in the intervention group and increased in the control group. The differences between groups were significant.
    Gortmaker et al94 (1999)Planet Health (Power Down)A school-based intervention that incorporated intervention material into major subject areas and physical-education classes. Materials included curriculum standards so skills and competencies are used to convey the Planet Health messages. A total of 16 core lessons were delivered each of the 2 y. An additional lesson developed a 2-wk campaign to reduce television viewing in households (Power Down).After adjusting for baseline covariates, the No. of hours of television per day was reduced in the intervention schools compared with students in control schools.
    Gortmaker et al95 (1999)Eat Well and Keep Moving ProgramA multicomponent school-based intervention that consisted of classroom materials that were integrated into math, science, language arts, and social studies classes. The intervention also included activities at home to involve family members.There was a nonsignificant reduction in television and video viewing.
    Harrison et al96 (2006)Switch Off Get ActiveA 10-lesson 16-week health-education intervention that emphasized 2 key messages: the need to minimize screen time and the need to increase physical activity.There was a decrease in screen time in the intervention group but postintervention viewing was not significantly different from the control group.
    Jason97 (1987)A token-activated device was attached to the television set. Children had to earn tokens by participating in prosocial activities. Unused tokens could be exchanged for nontelevision rewards (eg, money).The No. of hours of television viewing decreased during and after the intervention.
    Jason et al98 (1993)The Switch ApparatusA device was attached to the television to control electricity to the set and associated devices; parents controlled turning the switch on and off, thereby controlling television viewing.The lock was effective in reducing time spent viewing television.
    Jones et al113 (2008)IMPACT (Incorporating More Physical Activity and Calcium in Teens)The intervention used learning and environmental reinforcement to affect behavior change. It included a health curriculum that included classroom lessons and behavioral journalism, reporting role model stories, a physical education program, and a school food service component. The intervention materials were incorporated into the health and physical education curricula.Total screen time was significantly lower in the intervention group compared to the control group.
    Kipping et al109 (2008)Active for Life (Year 5)This intervention was an adaptation and abbreviated form of the Eat Well Keep Moving intervention, which consisted of 16 lessons on healthy eating, increasing physical activity, and reducing television viewing.The intervention group spent less time on screen viewing activities than the control group, but the difference was not significant.
    Mauriello et al114 (2006)Health in MotionThe intervention was tailored to participant's stage of change. Participants' stage of change was assessed and they received feedback from a computerized program tailored to their stage. The computer program begins with an introduction to the Health in Motion program and then proceeds with alternating assessments and feedback about target behaviors.The treatment group reported significantly less television viewing.
    McCanna110 (1989)The intervention consisted of attaching a television-control device (token-actuated timer to the television); in order to use the television, tokens were inserted into the timer. Participants received television tokens for participating in physical activity.The intervention was most effective for 1 excessive television viewer; for the below-average viewers' television-viewing rates were minimally affected.
    Nemet et al99 (2005)Children and parents were provided counseling and invited to lectures. The intervention included dietary counseling and a twice-weekly exercise program. In addition, participants were encouraged to reduce sedentary activity and report walking or other physical activity to their coaches weekly.Screen time did not change significantly for the intervention or control subjects.
    Niemeyer100 (1988)Books and BeyondThe program was designed to promote recreational reading and discriminate television viewing. Students were awarded prizes for reading a specified No. of pages of books. The intervention incorporated home activities, including charting time spent reading and viewing television and learning to self-monitor television viewing through a critical television-viewing skills curriculum. Parents were provided materials about discriminate television-viewing habits to read and discuss with children.There was no significant difference between the intervention and comparison groups.
    Nova et al101 (2001)The intervention occurred in a family practice office. Children and parents were interviewed about activity and eating habits and given a specific diet and detailed guidelines regarding physical activity. Active parental commitment was requested. Follow-up clinical visits were performed regularly during the intervention (at 1, 2.5, 4, 6, 9, 12, 15, 18, and 24 mo). During follow-up visits parents and children reported the child's behaviors since the last visit.No significant variations in computer or television use were noted within each group from 0 to 12 mo.
    Robinson102 (1999)The intervention included eighteen 30- to 50-min lessons that were incorporated into the standard curriculum followed by a television turnoff. Parents were provided newsletters designed to motivate them to help children stay within time budgets. The newsletters also suggested strategies for limiting screen time. Families were given a television allowance to help with budgeting.The intervention significantly decreased children's television viewing compared with control children. The intervention group children also reported significantly greater reductions in video-game use than control children.
    Robinson et al103 (2003)Stanford GEMS (GEMS Jewels and START–Sisters Taking Action to Reduce Television)GEMS Jewels dance classes were offered 5 d/wk (classes started with a snack followed by homework period and then the dance sessions followed by discussions about the importance of dance in the community and culture). START consisted of 5 lessons delivered during home visits. Television-viewing goals were set and strategies for reaching the goal discussed. Families were given a television allowance to help with budgeting and newsletters to reinforce the lessons and provide updates on dance classes.Compared with control children, the treatment group reported less media use and a significant decrease in total household television use at follow-up.
    Robinson et al104 (2006)SMART (Student Media Awareness to Reduce Television) Classroom CurriculumThe intervention included budgeting screen time and limiting physical access to screen media. A total of 18 30- to 50-min classroom lessons plus weekly 5- to 10- min boosters were delivered. The curriculum consisted of 4 sections focusing on television awareness, television turnoff, developing skills to resist television viewing, and helping others decrease television viewing. A television-control device (television allowance) was provided to help budget television. Children were provided incentives for maintaining their weekly media use budget.Compared with control children, the intervention group significantly decreased weekday television viewing and weekday and Saturday video-game playing. There were no significant differences between groups in change in self-reported weekday or Saturday time spent playing on a computer.
    Salmon et al105 (2008)Switch-PlayThe behavioral modification component of the intervention included nineteen 40- to 50-min lessons delivered in the classroom. The lessons aimed to increase awareness of current behavior and alternatives and the benefits of physical activity. Children completed a weekly contract to undertake switching off 1 television program per week over a 4-wk period.Children in the intervention group watched significantly more television on average compared with those in the control group after the intervention and at 6 and 12 mo follow-up. No significant effects were seen for electronic game playing or computer use.
    Sege et al106 (1997)Health care providers were given a 1-h training session that included a review of the parent materials to be handed out, discussions of the theoretical background of each intervention, and the opportunity to discuss implementation details. Providers were to distribute information cards to parents and discuss the material on the card with them at the time of a child's health visit.There was no significant change in weekday television-viewing habits and a trend toward reductions in weekend television viewing (the intervention group was slightly more likely to report reductions in weekend television viewing compared with the control group).
    Simon et al107 (2006)ICAPS (Intervention Centered on Adolescents' Physical Activity and Sedentary Behavior)The intervention was a multilevel program that included an educational component focusing on physical activity and sedentary behaviors. The intervention also included new opportunities for physical activity during and after the school day.Intervention students had a greater reduction over time of television and video viewing than control subjects.
    Weintraub et al111 (2008)SPORT (The Stanford Sports to Prevent Obesity Randomized Trial)The intervention included 4 (originally 3) d/wk of coed soccer. One day/week was a game and the other days practice; sessions included a 2.25-h-long homework period followed by an activity period.Inconsistent results were seen for screen time.
Interventions excluded from the analyses because of the unavailability of data
    Epstein et al89 (1995)The intervention consisted of reinforcing children for certain behaviors. All groups received written information on the positive effects of increased physical activity and the negative effects of sedentary behaviors. Participants in the sedentary behavior group were reinforced for decreasing the amount of time spent in sedentary activities and participants in the exercise group were reinforced for increasing physical activity.Information about changes in sedentary behaviors was not available.
    Epstein et al90 (2000)Participants in the decreased sedentary activity group were reinforced for reducing sedentary behaviors, including watching television and videotapes and playing computer games.Targeted sedentary behaviors showed a significant decrease from baseline at 6 and 24 mo.
    Johnson et al87 (2005)Healthy HabitsA statewide intervention in women, infants, and children clinics. The intervention consisted of 2 modules each consisting of background materials, staff training materials, posters, interactive handouts for clients, bookmarks, vouchers, coloring materials, and detailed plans for group sessions and other supportive materials.Between the baseline and the 6-mo surveys, the proportion of families who met recommendations for television viewing increased.
    Johnston et al88 (2006)Healthy StepsParents received parenting classes, developmental and behavioral advice, risk factor screening, postnatal home visits, telephone support, developmental assessments, and the Reach Out and Read literacy program.Compared with the control group, parents in the intervention group were less likely to allow their children more than 1 h of daily television viewing.