Interventions to modify television viewing behavior of children: A review, meta-analysis, and key-informant interviews

Excessive screen time and childhood obesity are two associated public health concerns. Several interventions to modify children's screen time exist. To date, no systematic review of these interventions has been conducted. This dissertation identified and summarized interventions to modify children.s screen time. Suggestions for future work are provided.;Study 1 was a systematic review and meta-analysis of documents describing interventions that modify children.s screen time. A random effects model was used to calculate effect sizes and associated 95% confidence intervals. Heterogeneity tests, moderator analyses, assessments of bias, and sensitivity analyses were also conducted.;The systematic search identified 3002 documents; 33 were eligible for inclusion and 29 were included in the analyses. The overall Standard Mean Difference (-0.148 (-0.224, -0.071)) indicated that the interventions were associated with small but significant reductions in children.s screen time. Although heterogeneity was present in the sample, no moderators were identified. The results were robust; the funnel plot and trim-and-fill methods identified few missing studies, which, if included, would not alter the overall conclusion.;Study 2 utilized a web-based survey design to collect information about programs to modify children.s screen time that were developed/implemented by state departments or agencies. Information about the programs and barriers to program development/implementation was collected and summarized.;Forty-seven individuals from 36 states completed the survey. Roughly half indicated their agency had developed/implemented a program to modify children's screen time. Several of the programs were theory-based and most were developed by the respondents' agency with federal government funding. Lack of funding and time were the most frequently cited barriers. As anticipated, few programs had been evaluated.;It was hypothesized that the systematic literature search would identify small-scale interventions with statistically significant positive results and that the survey of state personnel would identify universal interventions. Overall, the hypothesis was supported.;In summary, future interventions should (1) target both the family and child, (2) be enjoyable for children, (3) include information provision, (4) target high risk groups, and (5) focus on screen time related behaviors. Researchers should develop and evaluate evidence-based programs and program materials should be incorporated into existing structures to facilitate sustainability.