Applied Health Economics and Health Policy

, Volume 15, Issue 3, pp 323–331 | Cite as

Screen Time and Health Indicators Among Children and Youth: Current Evidence, Limitations and Future Directions

  • Travis J. Saunders
  • Jeff K. VallanceEmail author
Review Article


Despite accumulating evidence linking screen-based sedentary behaviours (i.e. screen time) with poorer health outcomes among children and youth <18 years of age, the prevalence of these behaviours continues to increase, with roughly half of children and youth exceeding the public health screen time recommendation of 2 h per day or less. The purpose of this article is to provide an overview of key research initiatives aimed at understanding the associations between screen time and health indicators including physical health, quality of life and psychosocial health. Available evidence suggests that screen time is deleteriously associated with numerous health indicators in child and youth populations, including adiposity, aerobic fitness, quality of life, self-esteem, pro-social behaviour, academic achievement, depression and anxiety. However, few longitudinal or intervention studies have been conducted, with most of these studies focusing on physical health indicators. While most studies have used self-reported assessments of screen time, the availability of more objective assessment methods presents important opportunities (e.g. more accurate and precise assessment of sedentary time and screen time) and challenges (e.g. privacy and participant burden). Novel statistical approaches such as isotemporal substitution modelling and compositional analysis, as well as studies using longitudinal and experimental methodologies, are needed to better understand the health impact of excessive screen time, and to develop strategies to minimise or reverse the negative impacts of these behaviours. The evidence to date suggests a clear need for policy aimed at minimising the hazardous health consequences associated with screen time among children and youth.


Sedentary Behaviour Sedentary Time Screen Time Television Viewing Food Advertisement 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Jeff Vallance is supported by the Canada Research Chairs Program and a Population Health Investigator Award from Alberta Innovates-Health Solutions. Travis Saunders is supported by a Jeanne and J.-Louis Lévesque Research Professorship.

Author contributions

Jeff Vallance and Travis Saunders equally contributed to conceptualising and drafting the manuscript. Both authors provided critical input and feedback during the manuscript writing process.

Compliance with Ethical Standards

Conflict of interest

Both authors declare that they have no conflicts of interest.


Travis Saunders is funded by a Jeanne and J.-Louis Levesque Research Professorship. Jeff Vallance is funded by the Canada Research Chairs Program and Alberta Innovates-Health Solutions.


  1. 1.
    Saunders TJ, Chaput JP, Tremblay MS. Sedentary behaviour as an emerging risk factor for cardiometabolic diseases in children and youth. Can J Diabetes. 2014;38:53–61.CrossRefPubMedGoogle Scholar
  2. 2.
    Pate RR, O’Neill JR, Lobelo F. The evolving definition of “sedentary”. Exerc Sport Sci Rev. 2008;36:173–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Suchert V, Hanewinkel R, Isensee B. Sedentary behavior and indicators of mental health in school-aged children and adolescents: a systematic review. Prev Med. 2015;76:48–57.CrossRefPubMedGoogle Scholar
  4. 4.
    Sedentary Behaviour Research Network. Letter to the editor: standardized use of the terms “sedentary” and “sedentary behaviours”. App Phys Nutr Metab. 2012;37:540–2.CrossRefGoogle Scholar
  5. 5.
    LeBlanc AG, Katzmarzyk PT, Barreira TV, et al. Correlates of total sedentary time and screen time in 9–11 year-old children around the world: the International Study of Childhood Obesity. Lifestyle and the environment. PLoS One. 2015;10:e0129622.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Gopinath B, Hardy LL, Baur LA, et al. Physical activity and sedentary behaviors and health-related quality of life in adolescents. Pediatrics. 2012;130:e167–74.CrossRefPubMedGoogle Scholar
  7. 7.
    American Academy of Pediatrics Council on Communications and Media. Children, adolescents, and the media. Pediatrics. 2013;132:958–61.CrossRefGoogle Scholar
  8. 8.
    Tremblay MS, Carson V, Chaput JP, et al. Canadian 24-hour movement guidelines for children and youth: an integration of physical activity, sedentary behaviour, and sleep. Appl Physiol Nutr Metab. 2016;41:S311–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Australian Government Department of Health. Australia’s physical activity and sedentary behaviour guidelines. Australian Government Department of Health; 2014.Google Scholar
  10. 10.
    Leatherdale ST, Ahmed R. Screen-based sedentary behaviours among a nationally representative sample of youth: are Canadian kids couch potatoes? Chronic Dis Inj Canada. 2011;31:141–6.Google Scholar
  11. 11.
    Fakhouri TI, Hughes JP, Brody DJ, et al. Physical activity and screen-time viewing among elementary school-aged children in the United States from 2009 to 2010. JAMA Pediatrics. 2013;167:223–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Tremblay MS, LeBlanc AG, Janssen I, et al. Canadian sedentary behaviour guidelines for children and youth. App Phys Nutr Metab. 2011;36:59–64.CrossRefGoogle Scholar
  13. 13.
    Bucksch J, Sigmundova D, Hamrik Z, et al. International trends in adolescent screen-time behaviors from 2002 to 2010. J Adolesc Health. 2016;58:417–25.CrossRefPubMedGoogle Scholar
  14. 14.
    Downing KL, Hnatiuk J, Hesketh KD. Prevalence of sedentary behavior in children under 2 years: a systematic review. Prev Med. 2015;78:105–14.CrossRefPubMedGoogle Scholar
  15. 15.
    Vanderloo LM, Tucker P. An objective assessment of toddlers’ physical activity and sedentary levels: a cross-sectional study. BMC Pub Health. 2015;15:969.CrossRefGoogle Scholar
  16. 16.
    Atkin AJ, Sharp SJ, Corder K, van Sluijs EMF. Prevalence and correlates of screen time in youth: an international perspective. Am J Prev Med. 2014;47:803–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Hoyos Cillero I, Jago R. Systematic review of correlates of screen-viewing among young children. Prev Med. 2010;51:3–10.CrossRefPubMedGoogle Scholar
  18. 18.
    Hale L, Guan S. Screen time and sleep among school-aged children and adolescents: a systematic literature review. Sleep Med Rev. 2015;21:50–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Saunders TJ, Tremblay MS, Mathieu ME, et al. Associations of sedentary behavior, sedentary bouts and breaks in sedentary time with cardiometabolic risk in children with a family history of obesity. PLoS One. 2013;8:e79143.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Carson V, Hunter S, Kuzik N, et al. Systematic review of the relationships between sedentary behaviour and health indicators in school-aged children and youth: an update. Appl Phys Nutr Metab. 2016;41:S240–65.CrossRefGoogle Scholar
  21. 21.
    LeBlanc AG, Spence JC, Carson V, et al. Systematic review of sedentary behaviour and health indicators in the early years (aged 0–4 years). Appl Phys Nutr Metab. 2012;37:753–72.CrossRefGoogle Scholar
  22. 22.
    Tremblay M, LeBlanc AG, Kho M, et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth. Int J Behav Nutr Phys Act. 2011;8:98.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Goldfield GS, Saunders TJ, Kenny GP, et al. Screen viewing and diabetes risk factors in overweight and obese adolescents. Am J Prev Med. 2013;44:S364–70.CrossRefPubMedGoogle Scholar
  24. 24.
    Robinson TN. Reducing children’s television viewing to prevent obesity: a randomized controlled trial. JAMA. 1999;282:1561–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Saunders TJ, Chaput JP, Goldfield GS, et al. Children and youth do not compensate for an imposed bout of prolonged sitting by reducing subsequent food intake or increasing physical activity levels: a randomised cross-over study. Br J Nutr. 2014;111:747–54.CrossRefPubMedGoogle Scholar
  26. 26.
    Epstein LH, Roemmich JN, Robinson JL, et al. A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children. Arch Ped Adol Med. 2008;162:239.CrossRefGoogle Scholar
  27. 27.
    Boulos R, Vikre EK, Oppenheimer S, et al. ObesiTV: how television is influencing the obesity epidemic. Phys Behav. 2012;107:146–53.CrossRefGoogle Scholar
  28. 28.
    Saunders TJ, Chaput J-P. Is obesity prevention as simple as turning off the television and having a nap? Br J Nutr. 2012;108:946–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Temple JL, Giacomelli AM, Kent KM, et al. Television watching increases motivated responding for food and energy intake in children. Am J Clin Nutr. 2007;85:355–61.PubMedGoogle Scholar
  30. 30.
    Halford JCG, Boyland EJ, Hughes G, et al. Beyond-brand effect of television (TV) food advertisements/commercials on caloric intake and food choice of 5–7-year-old children. Appetite. 2007;49:263–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Harris JL, Bargh JA, Brownell KD. Priming effects of television food advertising on eating behavior. Health Psych. 2009;28:404.CrossRefGoogle Scholar
  32. 32.
    McHorney CA. Health status assessment methods for adults: past accomplishments and future challenges. Ann Rev Pub Health. 1999;20:309–35.CrossRefGoogle Scholar
  33. 33.
    Iannotti RJ, Kogan MD, Janssen I, Boyce WF. Patterns of adolescent physical activity, screen-based media use, and positive and negative health indicators in the US and Canada. J Adol Health. 2009;44:493–9.CrossRefGoogle Scholar
  34. 34.
    Lacy KE, Allender SE, Kremer PJ, et al. Screen time and physical activity behaviours are associated with health-related quality of life in Australian adolescents. Qual Life Res. 2012;21:1085–99.CrossRefPubMedGoogle Scholar
  35. 35.
    Goldfield GS, Cameron JD, Murray M, et al. Screen time is independently associated with health-related quality of life in overweight and obese adolescents. Acta Paediatr. 2015;104:e448–54.CrossRefPubMedGoogle Scholar
  36. 36.
    Buttitta M, Iliescu C, Rousseau A, Guerrien A. Quality of life in overweight and obese children and adolescents: a literature review. Qual Life Res. 2014;23:1117–39.CrossRefPubMedGoogle Scholar
  37. 37.
    Scott LF. Relationships between elementary school children and television. J Educ Res. 1958;52:134–7.CrossRefGoogle Scholar
  38. 38.
    Costigan SA, Barnett L, Plotnikoff RC, Lubans DR. The health indicators associated with screen-based sedentary behavior among adolescent girls: a systematic review. J Adol Health. 2013;52:382–92.CrossRefGoogle Scholar
  39. 39.
    Gunnell KE, Flament MF, Buchholz A, et al. Examining the bidirectional relationship between physical activity, screen time, and symptoms of anxiety and depression over time during adolescence. Prev Med. 2016;88:147–522.CrossRefPubMedGoogle Scholar
  40. 40.
    Goldfield GS, Murray M, Maras D, et al. Screen time is associated with depressive symptomatology among obese adolescents: a HEARTY study. Eur J Pediatr. 2016;175:909–19.CrossRefPubMedGoogle Scholar
  41. 41.
    Maras D, Flament MF, Murray M, et al. Screen time is associated with depression and anxiety in Canadian youth. Prev Med. 2015;73:133–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Liu M, Wu L, Yao S. Dose-response association of screen time-based sedentary behaviour in children and adolescents and depression: a meta-analysis of observational studies. Br J Sports Med. 2015;50:1252–8.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Goldfield GS, Mallory R, Parker T, et al. Effects of modifying physical activity and sedentary behavior on psychosocial adjustment in overweight/obese children. J Pediatr Psychol. 2007;32:783–93.CrossRefPubMedGoogle Scholar
  44. 44.
    Robinson TN, Killen JD, Kraemer HC, et al. Dance and reducing television viewing to prevent weight gain in African–American girls: the Stanford GEMS pilot study. Ethnic Dis. 2003;13:S65–77.Google Scholar
  45. 45.
    Simon C, Wagner A, DiVita C, et al. Intervention centred on adolescents’ physical activity and sedentary behaviour (ICAPS): concept and 6-month results. Int J Obes. 2004;28:S96–103.CrossRefGoogle Scholar
  46. 46.
    Goldfield GS, Mallory R, Parker T, et al. Effects of open-loop feedback on physical activity and television viewing in overweight and obese children: a randomized, controlled trial. Pediatrics. 2006;118:e157–66.CrossRefPubMedGoogle Scholar
  47. 47.
    Atkin AJ, Ekelund U, Møller NC, et al. Sedentary time in children: influence of accelerometer processing on health relations. Med Sci Sports Exerc. 2013;45:1097–104.CrossRefPubMedGoogle Scholar
  48. 48.
    Saunders TJ, Prince SA, Tremblay MS. Clustering of children’s activity behaviour: the use of self-report versus direct measures. Int J Behav Nutr Phys Act. 2011;8:48 (author reply 49).CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Ainsworth BE, Caspersen CJ, Matthews CE, et al. Recommendations to improve the accuracy of estimates of physical activity derived from self report. J Phys Act Health. 2012;9(Suppl 1):S76–84.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Kelly P, Doherty A, Berry E, et al. Can we use digital life-log images to investigate active and sedentary travel behaviour? Results from a pilot study. Int J Behav Nutr Phys Act. 2011;8:44.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Kerr J, Marshall SJ, Godbole S, et al. Using the SenseCam to improve classifications of sedentary behavior in free-living settings. Am J Prev Med. 2013;44:290–6.CrossRefPubMedGoogle Scholar
  52. 52.
    Kelly P, Marshall SJ, Badland HM, et al. An ethical framework for automated, wearable cameras in health behavior research. Am J Prev Med. 2013;44:314–9.CrossRefPubMedGoogle Scholar
  53. 53.
    Saunders T, Gray C, Poitras V, et al. Combinations of physical activity, sedentary behaviour and sleep: relationships with health indicators in school-aged children and youth. Appl Phys Nutr Metab. 2016;41(6 Suppl 3):S283–93.CrossRefGoogle Scholar
  54. 54.
    Chastin SFM, Palarea-Albaladejo J, Dontje ML, Skelton DA. Combined effects of time spent in physical activity, sedentary behaviors and sleep on obesity and cardio-metabolic health markers: a novel compositional data analysis approach. PLoS One. 2015;10:e0139984.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Mekary RA, Willett WC, Hu FB, Ding EL. Isotemporal substitution paradigm for physical activity epidemiology and weight change. Am J Epidemiol. 2009;170:519–27.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Buman MP, Winkler EA, Kurka JM, et al. Reallocating time to sleep, sedentary behaviors, or active behaviors: associations with cardiovascular disease risk biomarkers, NHANES 2005-2006. Am J Epidemiol. 2014;179:323–34.CrossRefPubMedGoogle Scholar
  57. 57.
    Benatti FB, Ried-Larsen M. The effects of breaking up prolonged sitting time: a review of experimental studies. Med Sci Sports Exerc. 2015;47:2053–61.CrossRefPubMedGoogle Scholar
  58. 58.
    Healy GN, Matthews CE, Dunstan DW, et al. Sedentary time and cardio-metabolic biomarkers in US adults: NHANES 2003–06. Eur Heart J. 2011;32:590–7.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Saunders TJ, Chaput JP, Goldfield GS, et al. Prolonged sitting and markers of cardiometabolic disease risk in children and youth: a randomized crossover study. Metabolism. 2013;62:1423–8.CrossRefPubMedGoogle Scholar
  60. 60.
    Belcher BR, Berrigan D, Papachristopoulou A, et al. Effects of interrupting children’s sedentary behaviors with activity on metabolic function: a randomized trial. J Clin Endocrin Metab. 2015;100:3735–43.CrossRefGoogle Scholar
  61. 61.
    Sisson SB, Anderson AE, Short KR, et al. Light activity following a meal and postprandial cardiometabolic risk in adolescents. Ped Exerc Sci. 2013;25:347–59.CrossRefGoogle Scholar
  62. 62.
    Handsley E, Mehta K, Coveney J, Nehmy C. Regulatory axes on food advertising to children on television. Aus NZ Health Pol. 2009;6:1.CrossRefGoogle Scholar
  63. 63.
    Dhar T, Baylis K. Fast-food consumption and the ban on advertising targeting children: the Quebec experience. J Market Res. 2011;48:799–813.CrossRefGoogle Scholar
  64. 64.
    Kristensen AH, Flottemesch TJ, Maciosek MV, et al. Reducing childhood obesity through US federal policy: a microsimulation analysis. Am J Prev Med. 2014;47:604–12.CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Fried CB. In-class laptop use and its effects on student learning. Comp Educ. 2008;50:906–14.CrossRefGoogle Scholar
  66. 66.
    Clemes SA, Barber SE, Bingham DD, et al. Reducing children’s classroom sitting time using sit-to-stand desks: findings from pilot studies in UK and Australian primary schools. J Pub Health (Oxf). 2015. [Epub ahead of print].Google Scholar
  67. 67.
    Koepp GA, Snedden BJ, Flynn L, et al. Feasibility analysis of standing desks for sixth graders. Child Obes Nutr. 2012;12:89–92.Google Scholar
  68. 68.
    Jussila AM, Vasankari T, Paronen O, et al. KIDS OUT! Protocol of a brief school-based intervention to promote physical activity and to reduce screen time in a sub-cohort of Finnish eighth graders. BMC Public Health. 2015;15:634.CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Babic MJ, Morgan PJ, Plotnikoff RC, et al. Rationale and study protocol for ‘Switch-off 4 Healthy Minds’ (S4HM): a cluster randomized controlled trial to reduce recreational screen time in adolescents. Contemp Clin Trials. 2015;40:150–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Applied Human Sciences, Faculty of ScienceUniversity of Prince Edward IslandCharlottetownCanada
  2. 2.Faculty of Health Disciplines, Centre for Nursing and Health StudiesAthabasca UniversityAthabascaCanada

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