Reducing screen-time and unhealthy snacking in 9-11 year old children: the Kids FIRST pilot randomised controlled trial.

BACKGROUND: Many young people form unhealthy behavioural habits, such as low intake of fruit and vegetables, high intake of energy-dense snack foods, and excessive sedentary screen-based behaviours. However, there is a shortage of parent-and home-focused interventions to change multiple health behaviours in children. METHODS: Kids FIRST was a 12-week, home- and school-based pilot randomised controlled trial to reduce screen-time and unhealthy snacking with assessments at pre- (baseline) and post-intervention. Four UK schools were randomised to control or one of three interventions targeting reductions in (1) screen-time and unhealthy snacking (ST + Sn), (2) screen-time (ST only), (3) unhealthy snacking (Sn only), and parents with children aged 9-11 years were recruited via schools. Intervention group parents received four online 'sessions' and four packages of resources tailored to each group. Children received four 30-min lessons during school time. Children and parents reported their own screen-time behaviours, children reported their own snacking behaviours. Descriptive analyses were undertaken using principles of intention to treat. RESULTS: Initial feasibility was shown in that this study successfully recruited schools and families into all four study arms and retained them over a period of 13 weeks (retention rate ≥ 74%). Seventy-five children and 64 parents provided full baseline questionnaire data. Reductions in children's school day and weekend day TV/DVD viewing and computer game use were found in the ST + Sn and ST groups, while self-reported smartphone use increased in these groups. Similar results were found for parents' TV/DVD, computer and smartphone use in these groups. Little to no changes were found in reports of the dietary variables assessed in any intervention group for children or parents. CONCLUSIONS: These preliminary findings show some promise for the Kids FIRST intervention. Based on these findings, a future full trial should recruit a more diverse sample of families and optimise the intervention and intervention resources to more fully engage parents with the dietary-based components of the intervention programme, where fewer changes were seen. Although most parents reporting receiving the intervention resources, further development work is required to achieve higher levels of engagement. This might include greater parent and child engagement work early in the development of the project. TRIAL REGISTRATION: Retrospectively registered in June 21st 2019 with ClinicalTrials.gov (number NCT03993652).

Clustering and correlates of screen-time and eating behaviours among young adolescents.

BACKGROUND: Screen-time and eating behaviours are associated in adolescents, but few studies have examined the clustering of these health behaviours in this age group. The identification of clustered health behaviours, and influences on adolescents' clustered health behaviours, at the time when they are most likely to become habitual, is important for intervention design. The purpose of this study was to assess the prevalence and clustering of health behaviours in adolescents, and examine the sociodemographic, individual, behavioural, and home social and physical environmental correlates of clustered health behaviours. METHODS: Adolescents aged 11-12 years (n = 527, 48% boys) completed a questionnaire during class-time which assessed screen-time (ST), fruit and vegetable (FV), and energy-dense (ED) snack consumption using a Food Frequency Questionnaire. Health behaviours were categorised into high and low frequencies based on recommendations for FV and ST and median splits for ED snacks. Adolescents reported on their habits, self-efficacy, eating at the television (TV), eating and watching TV together with parents, restrictive parenting practices, and the availability and accessibility of foods within the home. Behavioural clustering was assessed using an observed over expected ratio (O/E). Correlates of clustered behaviours were examined using multivariate multinomial logistic regression. RESULTS: Approximately 70% reported having two or three health risk behaviours. Overall, O/E ratios were close to 1, which indicates clustering. The three risk behaviour combination of low FV, high ED, and high ST occurred more frequently than expected (O/E ratio = 1.06 95% CI 1.01, 1.15. Individual, behavioural, and social and physical home environmental correlates were differentially associated with behavioural clusters. Correlates consistently associated with clusters included eating ED snacks while watching TV, eating at the TV with parents, and the availability and accessibility of ED snack foods within the home. CONCLUSIONS: There is a high prevalence of screen time and unhealthy eating, and screen time is coupled with unhealthy dietary behaviours. Strategies and policies are required that simultaneously address reductions in screen time and changes to habitual dietary patterns, such as TV snacking and snack availability and accessibility. These may require a combination of individual, social and environmental changes alongside conscious and more automatic (nudging) strategies.