Effectiveness and moderators of a multicomponent school-based intervention on screen time devices: the Movimente cluster-randomized controlled trial

Abstract

Interventions targeting reduce screen time in adolescents are urgently needed, mainly in low and middle-income countries because of the lack of evidence. Thus, the aims of the study were to examine the effect of a cluster-randomized controlled trial on screen time (ST) devices among Brazilian adolescents and to identify possible moderators. Movimente was a multicomponent school-based intervention that was performed in 2017 and consisted of teacher training, education curriculum, and environmental improvements. Baseline and post-intervention assessments (over one academic year) were conducted with students aged 10–16\u2009years at baseline (baseline n\u2009=\u2009921, [n\u2009=\u2009538 intervention group; n\u2009=\u2009383 control group]). A self-report questionnaire was used to measure daily minutes of device specific screen time (TV, computer, video games and smartphone) and demographic variables. Linear mixed models were used to examine intervention effects and an exploratory moderation analysis (sex, grade and socioeconomic status) was performed. The intervention had no significant effects on TV time (β\u2009=\u2009−\u20096.4, 95% CI: −\u20096.1;13.4), game time (β\u2009=\u2009−\u20098.2, 95% CI: −\u20097.2;10.8), computer time (β\u2009=\u20091.1, 95% CI: −\u20096.3;18.5), smartphone time (β\u2009=\u2009−\u200910.2, 95% CI: −\u200932.5;12.1), screen time (β\u2009=\u2009−\u200912.8, 95% CI: −\u200950.5;24.8), meeting screen time guidelines (OR: 1.29, 95% CI: 0.65,2.57) and meeting screen time guidelines with smartphone (OR:\u20091.66, 95% CI: 0.37,7.40). There was a significant intervention effect on reducing TV time (β\u2009=\u2009−\u200937.1, 95% CI: −\u200973.0, −\u20091.3) among 8th grade students only. The Movimente intervention was effective only for TV time among 8th grade students. Understanding how school-based interventions can improve adolescents’ device specific screen time across age groups is needed. Future strategies should cover all screen-based devices. Further, there is a need for more studies in low- and-middle income countries to assist in the development of effective strategies. Clinicaltrials.gov identifier NCT02944318 (25/10/2016).