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.
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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.
Pate RR, O’Neill JR, Lobelo F. The evolving definition of “sedentary”. Exerc Sport Sci Rev. 2008;36:173–8.
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.
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.
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.
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.
American Academy of Pediatrics Council on Communications and Media. Children, adolescents, and the media. Pediatrics. 2013;132:958–61.
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.
Australian Government Department of Health. Australia’s physical activity and sedentary behaviour guidelines. Australian Government Department of Health; 2014.
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.
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.
Tremblay MS, LeBlanc AG, Janssen I, et al. Canadian sedentary behaviour guidelines for children and youth. App Phys Nutr Metab. 2011;36:59–64.
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.
Downing KL, Hnatiuk J, Hesketh KD. Prevalence of sedentary behavior in children under 2 years: a systematic review. Prev Med. 2015;78:105–14.
Vanderloo LM, Tucker P. An objective assessment of toddlers’ physical activity and sedentary levels: a cross-sectional study. BMC Pub Health. 2015;15:969.
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.
Hoyos Cillero I, Jago R. Systematic review of correlates of screen-viewing among young children. Prev Med. 2010;51:3–10.
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.
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.
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.
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.
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.
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.
Robinson TN. Reducing children’s television viewing to prevent obesity: a randomized controlled trial. JAMA. 1999;282:1561–7.
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.
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.
Boulos R, Vikre EK, Oppenheimer S, et al. ObesiTV: how television is influencing the obesity epidemic. Phys Behav. 2012;107:146–53.
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.
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.
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.
Harris JL, Bargh JA, Brownell KD. Priming effects of television food advertising on eating behavior. Health Psych. 2009;28:404.
McHorney CA. Health status assessment methods for adults: past accomplishments and future challenges. Ann Rev Pub Health. 1999;20:309–35.
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.
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.
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.
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.
Scott LF. Relationships between elementary school children and television. J Educ Res. 1958;52:134–7.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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).
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Handsley E, Mehta K, Coveney J, Nehmy C. Regulatory axes on food advertising to children on television. Aus NZ Health Pol. 2009;6:1.
Dhar T, Baylis K. Fast-food consumption and the ban on advertising targeting children: the Quebec experience. J Market Res. 2011;48:799–813.
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.
Fried CB. In-class laptop use and its effects on student learning. Comp Educ. 2008;50:906–14.
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].
Koepp GA, Snedden BJ, Flynn L, et al. Feasibility analysis of standing desks for sixth graders. Child Obes Nutr. 2012;12:89–92.
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.
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.
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.
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.
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.
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Saunders, T.J., Vallance, J.K. Screen Time and Health Indicators Among Children and Youth: Current Evidence, Limitations and Future Directions. Appl Health Econ Health Policy 15, 323–331 (2017). https://doi.org/10.1007/s40258-016-0289-3
- Sedentary Behaviour
- Sedentary Time
- Screen Time
- Television Viewing
- Food Advertisement