Prevalence of excessive screen time and TV viewing among Brazilian adolescents: a systematic review and meta-analysis

Schaan, Camila W.; Cureau, Felipe V.; Sbaraini, Mariana; Sparrenberger, Karen; Kohl, Harold W.; Schaan, Beatriz D.

doi:10.1016/j.jped.2018.04.011

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Review articles • J. Pediatr. (Rio J.) 95 (2) • Mar-Apr 2019 • https://doi.org/10.1016/j.jped.2018.04.011 copy

Prevalence of excessive screen time and TV viewing among Brazilian adolescents: a systematic review and meta-analysis^☆ ☆ Please cite this article as: Schaan CW, Cureau FV, Sbaraini M, Sparrenberger K, Kohl HW, Schaan BD. Prevalence of excessive screen time and TV viewing among Brazilian adolescents: a systematic review and meta-analysis. J Pediatr (Rio J). 2019;95:155-65. , ^☆☆ ☆☆ This manuscript was part of the PhD thesis of the first author in the Postgraduate Program in Endocrinology at Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Purpose:

To evaluate the prevalence of excessive screen-based behaviors among Brazilian adolescents through a systematic review with meta-analysis.

Data source:

Systematic review and meta-analysis were recorded in the International Prospective Register of Ongoing Systematic Reviews (PROSPERO-CRD 2017 CRD42017074432). This review included observational studies (cohort or cross-sectional) that evaluated the prevalence of excessive screen time (i.e. combinations involving different screen-based behaviors) or TV viewing (≥2 h/day or >2 h/day in front of screen) through indirect or direct methods in adolescents aged between 10 and 19 years. The research strategy included the following databases: MEDLINE, LILACS, SciELO and ADOLEC. The search strategy included terms for "screen time", "Brazil", and "prevalence". Random effect models were used to estimate the prevalence of excessive screen time in different categories.

Data summary:

Twenty-eight out of 775 studies identified in the search met the inclusion criteria. The prevalence of excessive screen time and TV viewing was 70.9% (95% CI: 65.5-76.1) and 58.8% (95% CI: 49.4-68.0), respectively. There was no difference between sexes in both analyses. The majority of studies included showed a low risk of bias.

Conclusions:

The prevalence of excessive screen time and TV viewing was high among Brazilian adolescents. Intervention are needed to reduce the excessive screen time among adolescents.

KEYWORDS
Sedentary lifestyle; Adolescent; Meta-analysis

Study by region	Year of study	City/state	Study design	Sample	Age	Components of sedentary behavior	Cutoff point (hours per day)
Northeast
Rivera et al., 2010 ⁴⁷47 Rivera IR, Silva MA, Silva RD, Oliveira BA, Carvalho AC. Physical inactivity, TV-watching hours and body composition in children and adolescents. Arq Bras Cardiol. 2010;95:159-65.	2001	Maceió, AL	Cross-sectional	1004	10-17 y.o.	TV	>2 h/day
Tenório et al., 2010 ⁴⁹49 Tenorio MC, Barros MV, Tassitano RM, Bezerra J, Tenorio JM, Hallal PC. Physical activity and sedentary behavior among adolescent high school students. Rev Bras Epidemiol. 2010;13:105-17.	2006	Pernambuco (PE)	Cross-sectional	4210	14-19 y.o.	TV	>2 h/day
Silva et al., 2014 ⁴⁸48 Silva DA, Tremblay MS, Goncalves EC, Silva RJ. Television time among Brazilian adolescents: correlated factors are different between boys and girls. Sci World J. 2014;2014:794539.	2011	Aracaju, SE	Cross-sectional	2174	13-18 y.o.	TV	≥2 h/day
de Lucena et al., 2015 ²⁶26 de Lucena JM, Cheng LA, Cavalcante TL, da Silva VA, de Farias Junior JC. Prevalence of excessive screen time and associated factors in adolescents. Rev Paul Pediatr. 2015;33:407-14.	2009	João Pessoa, PB	Cross-sectional	2879	14-19 y.o.	TV/video game/computer	>2 h/day
Silva et al., 2016 ³⁵35 Silva FM, Smith-Menezes A, Duarte Mde F. Consumption of fruits and vegetables associated with other risk behaviors among adolescents in Northeast Brazil. Rev Paul Pediatr. 2016;34:309-15.	2011	Sergipe (SE)	Cross-sectional	3992	14-19 y.o.	TV/video game/computer	>2 h/day
Midwest
Wendpap et al., 2014 ³⁸38 Wendpap LL, Ferreira MG, Rodrigues PR, Pereira RA, Loureiro Ada S, Goncalves-Silva RM. Adolescents' diet quality and associated factors. Cad Saude Publica. 2014;30:97-106.	2009/2011	Cuiabá, MT	Cross-sectional	1326	10-14 y.o.	TV/video game/computer	>2 h/day
Southeast
Ceschini et al., 2009 ⁴⁵45 Ceschini FL, Andrade DR, Oliveira LC, Araujo Junior JF, Matsudo VK. Prevalence of physical inactivity and associated factors among high school students from state's public schools. J Pediatr (Rio J). 2009;85:301-6.	2006	São Paulo, SP	Cross-sectional	2021	14-16 y.o.	TV	>2 h/day
de Vitta et al., 2011 ²⁷27 De Vitta A, Martinez MG, Piza NT, Simeao SF, Ferreira NP. Prevalence of lower back pain and associated factors in students. Cad Saude Publica. 2011;27:1520-8.	2007	Bauru, SP	Cross-sectional	1236	11-14 y.o.	TV/video game/computer	>2 h/day
de Vitta et al., 2014 ²⁸28 De Vitta A, Trize DdM, Fiorelli A, Carnaz L, De Conti MH, Simeão SF. Neck/shoulders pain and its relation to the use of TV/computer/videogame and physical activity in school students from Bauru. Fisioter mov. 2014;27:111-8.	2009	Bauru, SP	Cross-sectional	524	10-14 y.o.	TV/video game/computer	>2 h/day
de Prado Junior et al., 2015 ²⁹29 do Prado Junior PP, de Faria FR, de Faria ER, Franceschini Sdo C, Priore SE. Cardiovascular risk and associated risk factors in adolescents. Nutr Hosp. 2015;32:897-904.	2010/2011	Viçosa, MG	Cross-sectional	676	10-19 y.o.	TV/video game/computer	>2 h/day
Fernandes et al., 2015 ³¹31 Fernandes JA, Genebra CV, Maciel NM, Fiorelli A, de Conti MH, de Vitta A. Low back pain in schoolchildren: a cross-sectional study in a western city of Sao Paulo State, Brazil. Acta Ortop Bras. 2015;23:235-8.	2009	Ourinhos, SP	Cross-sectional	1461	10-14 y.o.	TV/video game/computer	>2 h/day
South
Dutra et al., 2006 ⁴⁶46 Dutra CL, Araújo CL, Bertoldi AD. Prevalência de sobrepeso em adolescentes: um estudo de base populacional em uma cidade no Sul do Brasil. Cad Saude Publica. 2006;22:151-62.	2003	Pelotas, RS	Cross-sectional	810	10-19 y.o.	TV	≥2 h/day
Silva et al., 2008 ³⁷37 Silva KSd, Nahas MV, Hoefelmann LP, Lopes AdS, Oliveira ESd. Associations between physical activity, body mass index, and sedentary behaviors in adolescents. Rev Bras Epidemiol. 2008;11:159-68.	2002	Santa Catarina (SC)	Cross-sectional	5028	15-19 y.o.	TV/video game/computer	≥2 h/day
Campagnolo et al., 2007 ⁴⁴44 Campagnolo PD, Vitolo MR, Gama CM, Stein AT. Prevalence of overweight and associated factors in southern Brazilian adolescents. Public Health. 2008;122:509-15.	2002/2003	São Leopoldo, RS	Cross-sectional	722	10-19 y.o.	TV	>2 h/day
Dumith et al., 2010 ³⁰30 Dumith SC, Hallal PC, Menezes AM, Araujo CL. Sedentary behavior in adolescents: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study. Cad Saude Publica. 2010;26:1928-36.	2004/2005	Pelotas, RS	Cohort	4431	11-15 y.o.	TV/video game/computer	>2 h/day
Silva et al., 2011 ³⁶36 Silva KS, Vasques DG, Martins Cde O, Williams LA, Lopes AS. Active commuting: prevalence, barriers, and associated variables. J Phys Act Health. 2011;8:750-7.	2007	Caxias do Sul, RS	Cross-sectional	1622	11-17 y.o.	TV/computer	>2 h/day
Barbosa Filho et al., 2012 ⁴²42 Barbosa Filho VC, de Campos W, Bozza R, Lopes Ada S. The prevalence and correlates of behavioral risk factors for cardiovascular health among Southern Brazil adolescents: a cross-sectional study. BMC Pediatr. 2012;12:130.	2011	Curitiba, PR	Cross-sectional	1628	11-18 y.o.	TV	>2/day
Rech et al., 2013 ³⁴34 Rech RR, Halpern R, Tedesco A, Santos DF. Prevalence and characteristics of victims and perpetrators of bullying. J Pediatr (Rio J). 2013;89:164-70.	2011	Caxias do Sul, RS	Cross-sectional	1230	11-14 y.o.	TV/video game/computer	>2/day
Silva et al., 2014^a a Included four times in the analysis (data from TV viewing and total screen time in 2001 and 2011). All studies evaluated screen time by questionnaire. ²⁴24 Silva KS, da Silva Lopes A, Dumith SC, Garcia LM, Bezerra J, Nahas MV. Changes in television viewing and computers/videogames use among high school students in Southern Brazil between 2001 and 2011. Int J Public Health. 2014;59:77-86.	2001/2011	Santa Catarina (SC)	Cross-sectional	5028	15-19 y.o.	TV/video game/computer	≥2 h/day
Coledam et al., 2014 ⁴¹41 Coledam DH, Ferraiol PF, Pires R, Ribeiro EA, Ferreira MA, de Oliveira AR. Concordância entre dois pontos de corte para atividade física e fatores associados em jovens. Rev Paul Pediatr. 2014;32:215-22.	2014	Londrina, PR	Cross-sectional	738	10-17 y.o.	TV/video game/computer	>2 h/day
Christofaro et al., 2015 ⁴4 Christofaro DG, de Andrade SM, Cardoso JR, Mesas AE, Codogno JS, Fernandes RA. High blood pressure and sedentary behavior in adolescents are associated even after controlling for confounding factors. Blood Press. 2015;24:317-23.	2011	Londrina, PR	Cross-sectional	1231	10-17 y.o.	TV/video game/computer	≥2 h/day
Castro et al., 2016 ²⁵25 Castro JA, Nunes HE, Silva DA. Prevalence of abdominal obesity in adolescents: association between sociodemographic factors and lifestyle. Rev Paul Pediatr. 2016;34:343-51.	2014	São José, SC	Cross-sectional	930	14-19 y.o.	TV/video game/computer	≥2 h/day
Gonçalves et al., 2016 ³³33 Goncalves EC, Silva DA. Factors associated with low levels of aerobic fitness among adolescents. Rev Paul Pediatr. 2016;34:141-7.	2014	São José, SC	Cross-sectional	879	14-19 y.o.	TV/video game/computer	≥2 h/day
Bacil et al., 2016 ³⁹39 Bacil ED, Rech CR, Hino AA, de Campos W. Excesso de peso em adolescentes: papel moderador do sexo e da escolaridade materna. Rev Bras Promoç Saude. 2016;29:515-24.	2014	Ponta Grossa, PR	Cross-sectional	945	14-18 y.o.	TV/computer	>2/day
Ferreira et al., 2016 ³²32 Ferreira RW, Rombaldi AJ, Ricardo LI, Hallal PC, Azevedo MR. Prevalence of sedentary behavior and its correlates among primary and secondary school students. Rev Paul Pediatr. 2016;34:56-63.	2013	Pelotas, RS	Cross-sectional	8661	12-16 y.o.	TV/video game/computer/sitting activities	≥2 h/day
National estimates
Camelo et al., 2012 ⁴³43 Camelo Ldo V, Rodrigues JF, Giatti L, Barreto SM. Sedentary leisure time and food consumption among Brazilian adolescents: the Brazilian National School-Based Adolescent Health Survey (PeNSE), 2009. Cad Saude Publica. 2012;28:2155-62.	2009	Capitals (PeNSE, 2009)	Cross-sectional	59,809	13-16 y.o.	TV	>2 h/day
de Rezende et al., 2014 ⁴⁰40 de Rezende LF, Azeredo CM, Canella DS, Claro RM, de Castro IR, Levy RB, et al. Sociodemographic and behavioral factors associated with physical activity in Brazilian adolescents. BMC Public Health. 2014;14:485.	2012	Capitals (PeNSE, 2012)	Cross-sectional	109,104	13-16 y.o.	TV/video game/computer	>2 h/day
Oliveira et al., 2016 ¹⁴14 Oliveira JS, Barufaldi LA, Abreu Gde A, Leal VS, Brunken GS, Vasconcelos SM, et al. ERICA: use of screens and consumption of meals and snacks by Brazilian adolescents. Rev Saude Publica. 2016;50:S7.	2013/2014	Capitals and other cities (ERICA)	Cross-sectional	74,589	12-17 y.o.	TV/video game/computer	>2 h/day

Variables	n	Prevalence (95% CI)	I ² %
Screen time
Age group
"Younger"	13	67.9 (62.6-72.9)	100
"Older"	8	75.6 (64.0-86.2)	100
Region
South	13	74.1 (67.0-80.8)	100
Southeast	4	70.5 (65.9-74.9)	89
Northeast	2	64.0 (28.3-95.3)	100
National estimates	2	56.9 (46.9-66.6)	100
Year of the study
Until 2007	7	73.7 (66.9-80.1)	99
2008-2012	9	70.0 (58.3-81.0)	100
After 2012	5	70.9 (65.5-76.1)	100
Cutoff point
>2 h/day	15	66.5 (61.6-71.3)	100
≥2 h/day	6	80.9 (72.6-88.5)	99
TV time
Region
South	7	59.0 (46.9-70.7)	100
Northeast	3	58.4 (41.2-75.0)	100
Year of the study
Until 2007	6	61.0 (41.7-79.3)	100
2008-2012	4	55.7 (44.7-66.4)	100
Cutoff point
>2 h/day	6	50.7 (34.5-66.9)	100
≥2 h/day	4	70.5 (61.7-78.6)	99

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[1] * Corresponding author. E-mails:cschaan@hcpa.edu.br, camilawschaan@gmail.com (C.W. Schaan).