Int J Adolesc Med Health 2016; aop

Anastasia Bounovaa,*, Maria Michalopoulou, Nikolaos Agelousis, Thomas Kourtessis

and Vassilios Gourgoulis

The parental role in adolescent screen related

sedentary behavior
DOI 10.1515/ijamh-2016-0031 Keywords: adolescents; family; screen viewing; sedentary
Received March 16, 2016; accepted August 4, 2016 behaviors.
Abstract

Background: Adolescents spend an increasing amount of

their time engaged in screen using activities. The present
Introduction
study aimed at identifying parental factors associated
Electronic entertainment products are now omnipresent
with screen time among Greek adolescents.
and increasingly affordable (1). Screen-viewing behaviors
Methods: A sample of 1141 adolescents, as well as their
(i.e. watching television, playing computer/video games,
parents, participated in this survey. Adolescents were
or using a computer for fun) are sedentary key pursuits to
asked to complete a questionnaire about time spent on
the lives of adolescents in developed countries. Children
screen-viewing behaviors. Respectively, parents com-
and teenagers aged 8–18 spend more time on electronic
pleted a questionnaire concerning family predictors.
sources of entertainment than on any other activity (sleep
Multiple regression analysis was used to determine
excluded), (2, 3) significantly exceeding the guidelines of
correlates of adolescent screen-viewing with family
the American Academy of Pediatrics (4).
predictors.
Recent study on addictive behaviors in Greek ado-
Results: The mean screen time per weekday was 193 min.
lescents (5) has highlighted that screen-viewing time
Adolescents, whose parents had received up to second-
has increased in recent years. More than half of adoles-
ary school education, spend more time in screen-viewing
cents aged 11, 13 and 15  years (54.5%) responded that
compared with the other groups. Controlling adolescents’
they spent, on average, at least 5  h a day on electronic
gender and age, all the family variables (perceived rules,
devices, with boys scoring a significantly higher percent-
parental modeling, parents’ screen related sedentary
age than girls (60.3% and 48.7%, respectively). Studies
behavior, parental concern for screen viewing, support
associated with the consequences screen-viewing has
for physical activity, parental education) were statisti-
on child and adolescent health reveal that it is associ-
cally significant in predicting adolescent screen time with
ated with overweight, reduced fitness, smoking, as well
Perceived Rules recording a higher negative beta value
as high cholesterol levels in adult life (6–8). Moreover, a
(β=−0.18, p<0.00).
relevant research indicates that time spent on a computer
Conclusion: Perceived parental screen time rules play a
was significantly associated with suffering from head-
role in the amount of screen time among adolescents.
aches, feeling low, irritability, and nervousness among
Interventions that focus on parental limit setting devel-
­adolescents (9).
opment and physical activity support may be effective
The mediating variable model suggests that in order
in decreasing screen time among youth aged 13–15
to change behaviors such as screen-viewing, we need
years.
to understand the key mediators and moderators of the
behaviors (10). Previous research has established that
a
Permanent address: Al.Ikonomou 9, 36100, Karpenissi, Greece. adolescents spend more time in screen-based activities
*Corresponding author: Anastasia Bounova, Department of than their younger counterparts. As children move into
Physical Education and Sport Sciences, Democritus University of adolescence, they have more unsupervised time and rules
Thrace, University Campus, Komotini 69100, Greece, Tel/Fax: +30 become looser, which creates opportunities to self-direct
2237022940, E-mail: anampoun@phyed.duth.gr
their screen-viewing time (11, 12). As electronic media use
Maria Michalopoulou, Nikolaos Agelousis, Thomas Kourtessis and
Vassilios Gourgoulis: Department of Physical Education and Sport
mainly occurs at home, family may be an important key
Sciences, Democritus University of Thrace, University Campus, factor that influences adolescent screen-based sedentary
Komotini 69100, Greece behavior.

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2      Bounova et al.: Parental factors in adolescent screen time
Very few research has focused on modifiable parental
variables so far, such as, for example, parental modeling,
parental rules, parent concern about time adolescents
spend on electronic forms of entertainment, as well as
parental support for children’s participation in various
forms of physical activity (13–17). Findings from these
studies highlight the important role parents can play
in reducing children’s screen related sedentary behav-
iors. In addition, children’s perceptions about parental
screen-viewing rules and family co-viewing which refers
to parents and children watching TV together are also sig-
nificant predictors of screen viewing. From the surveys
that have come to light so far, it seems that rules set by
parents concerning their children’s TV viewing play an
important role in determining viewing time (13). However,
some parents may be better equipped than others to act
on such recommendations. For example, parental educa-
tion appears to be related to certain aspects of the family
screen-viewing environment (18). Children whose parents
had received higher education had less sedentary behav-
iors (19). Furthermore, higher parental education may be
related to greater awareness of and ability to adopt screen
time recommendations (20).
The relation between the parental modeling and ado-
lescent screen-viewing may be especially strong because
sedentary co-viewing practices can be adopted by any
member of the family (e.g. the whole family can watch TV
at the same time) more easily than physical activity (21).
Relevant researches prove that adolescent TV viewing
time correlates positively with parental TV viewing
(22–24).
It is uncertain whether screen time is a substitute for
other sedentary activities or whether it takes the place of
more active pursuits such as physical activity participa-
tion (21). Related research indicates that screen time is
inversely related to adolescent physical activity (25). Sed-
entary behaviors like screen-viewing are very reinforc-
ing, and adolescents often choose to be sedentary rather
than physically active (26). As children are strongly influ-
enced by food and physical activity decisions made by
their families, we assume that parental support for ado-
lescent physical activity can be linked to reduced screen
time.
Furthermore, most research concerning screen-view-
ing examines only TV viewing among primary school-
children and do not include every electronic form of
entertainment adolescents are occupied with nowadays
(18, 27, 28), leaving in this way a gap as screen using
nowadays includes up to date electronic forms of enter-
tainment (i.e. computer surfing, console games, on line
games, social networks) (2). Totland and colleagues (29)
suggest that further investigations of different screen time
behaviors in dyads of parents and their children should
be emphasized.
This research aimed: mainly at [1] examining different
types of contemporary screen-viewing behaviors in chil-
dren-parents dyads and [2] getting a deeper insight of the
relation between parental factors and time adolescents
are occupied with electronic forms of entertainment.
To our knowledge, there has been no study conducted
in Greece that investigates the associations of parental
factors with screen-viewing by 13–15-year-old adolescents.
Understanding modifiable parental factors associated
with screen time in adolescents (a relatively understudied
age group in previous studies) (30–32) may provide oppor-
tunities to develop targeted interventions to reduce screen
time among adolescents.
Methods
Participants
Stratified random sampling was used to select the sample accord-
ing to which the student population of the Greek junior high schools
was divided into strata based on the Greek prefectures, as they were
presented in Hellenic Statistical Authority tables (2011). Seventy-six
junior high schools were approached and 41 agreed to participate. In
total, 3000 adolescents and their parents were invited to take part in
the study and 2280 parent-child dyads provided data. A further 1039
adolescents had invalid data and were subsequently removed, leav-
ing a final sample size of 1141 students from 38 junior high schools
and their respective (1141) parents. This sample represented a per-
centage of 0.34% of the total student population of the Greek junior
high schools and the 0.30% of the total population of the country
aged 13–15.
Procedure
Data were collected from February 2013 to February 2014. The stu-
dents participated in the survey voluntarily after their parents had
been informed by mail and given their informed consent. Parents
who agreed to participate in the survey completed the question-
naire at home and the completion of the questions by the stu-
dents followed at school under the researchers’ supervision. This
research data was a part of a broader survey investigating differ-
ent types of sedentary behavior in adolescents aged 13–15 years in
Greece and correlations with individual, psychosocial and environ-
mental factors. Surveying license numbers 127815/Γ2/18-10-10 and
172065/Γ2/13-11-13 were obtained from the Ministry of ­Education,
Religious Affairs, Sport and Culture for carrying out the survey
which was also approved by Institutional Ethics Committee –
Democritus University of Thrace.
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 Bounova et al.: Parental factors in adolescent screen time      3

Measures Parental concern

To assess parental concerns, respondents were asked four ques-
tions: “How concerned are you about your child spending too much
Adolescents’ questionnaire
time: a) … watching TV/DVD; b) … playing console games; c)… in
PC; d) … with the mobile phone?” Response options were given on a
Socio-demographic information four-point Likert scale, ranging from [1] “not concerned” to [4] “very
Adolescents completed a self-administered questionnaire reporting concerned” [16]. Internal consistency for the scale was α = 0.82.
their age, gender, date of birth, class, grade point average (GPA) score
and nationality. Body mass index (BMI) was calculated based on self-
Parent-reported support for physical activity
reported weight/height relations (kg/m2) (33) and the International
Three items formed a composite measure with an internal consist-
Obesity Task Force (IOTF) cut-off points were used to classify partici-
ency of α = 0.75: [1] encouraging your child to do physical activity; [2]
pants as underweight, normal weight, overweight and obese (34).
doing physical activity with child; and [3] providing transportation
so that your child can get to a place where he or she can do physical
Screen-based sedentary behavior activity. The five-point scale for these items ranged from “never” to
The questionnaire used for recording the adolescents’ screen-­ “every day” (12).
viewing was based on Adolescent Sedentary Activity Questionnaire
(ASAQ) (35) which calculates the time adolescents devote to a total
of sedentary behaviors per week. T ­ rigonis et  al. (36) reported high
test-retest reliability in a Greek sample (r = 0.376, p = 0.001 for week- Data analysis
days and r = 0.343, p = 0.000 for weekends) and provides evidence
for concurrent validity through examination of correlations between All statistical analyses were performed by SPSS Statistics, Version
self-reported behavior and measures obtained through triaxial accel- 19.0 (IBM Corp. 2010, Armonk, NY, USA). Descriptive statistics were
erometry (r = 0.38, p = 0.001 for weekdays and r = 0.34, p = 0.000 for used to characterize adolescent and family participation. Differences
weekends) (37). in adolescent screen time by parental education were obtained by
Adolescents were asked to answer how much time they spent two-way between-groups analysis of variance.
on screen related sedentary behaviors on a typical school day. Sed- Hierarchical multiple regression analysis was used to deter-
entary behaviors included: a) TV, video and DVDs; b) console games; mine correlates of adolescents’ screen-viewing with family variables
and c)  PC entertainment (on line games, surfing the net) or social (­perceived rules, parental modeling, parents’ screen related seden-
­networks (Facebook, Twitter). The sum of these three activities gave tary behavior, parental concern for screen viewing, support for physi-
the total time adolescents spent on screen related sedentary activities. cal activity, parental education). In order to control for other possible
influences associated with adolescent screen time, adolescent gen-
Screen-viewing household rules der and age were adjusted for, in the analysis. For each family vari-
Two items (total eight questions) assessed limits set by parents on able we calculated the total score in order to compare it with the total
screen-viewing (watching TV, video/DVD, PC games and surfing the adolescent screen time score.
Internet) with an internal consistency of α = 0.81; “Do your parents
set rules on how long you can occupy yourself with screen viewing?”,
“Do your parents set rules on when you can occupy yourself with
screen viewing?” Adolescents’ responses were collapsed into two Results
categories (no–yes).

Participant characteristics and screen-viewing behav-

Parents’ questionnaire
Parents completed a self-administered questionnaire reporting gen-
der, age and their highest level of education. For purposes of analysis,
this variable was divided into three categories: some secondary school
education or less; completed secondary school education, technical
education or apprenticeship; and university/tertiary qualification (38).
Parents reported their weight and height. BMI was calculated and they
were classified in accordance with BMI cut-off points (39).
Parental modeling
Parents reported familial co-viewing practices and the frequency of
co-viewing. Responses ranged from 1 (never– ≤  2 times per month) to
2 (once a week–daily).
Parents’ screen-based behaviors
Parents were asked to estimate the number of hours spent watching
TV/DVD, playing electronic games, and using the computer during
their leisure-time on a daily basis in a typical week (responses: none,
< 1, 1 – 2, 2 – 3, 3 – 4, 4 – 5 or > 5) (40).
iors are shown in Table 1. A significant proportion of
the parents questioned (38.2%) are university graduates
whereas the biggest percentage (47.6%) are secondary
school graduates. Adolescents reported spending a total
of 177 min per day in screen-viewing thus exceeding the
AAP guidelines (4).
A two-way analysis of variance was conducted to
explore the impact of gender and parental education on
adolescents’ daily screen viewing. The interaction effect
between gender and parental education was not statisti-
cally significant (F2,1135 = 0.19; p = 0.82, η2 = 0.00). There
was a statistically significant main effect for gender
(F1,1135 = 32.57; p < 0.01, η2 = 0.02) and parental educa-
tion (F2,1135 = 21.73; p < 0.01, η2 = 0.03) as shown in Figure
1. Post-hoc comparisons using the Tukey test indicated
that regardless of whether they are males or females,

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4      Bounova et al.: Parental factors in adolescent screen time

Table 1: Descriptive information (means, SD and percent) for 275

­participant’s characteristics and screen-viewing behaviors. Male
Female
N:1141 adolescents and 1141 parents 250

  N (%)
Gender (adolescents)
225
 Male   548 (48)
 Female   593 (52)
Age

Screen time (min)

 13   488 (42.8) 200
 14   306 (26.8)
 15   347 (30.4)
Adolescents’ BMI 175
 Under weight   361 (31.6)
 Normal range   693 (60.7)
 Overweight   76 (6.7) 150
 Obese   11 (1)
  Mean±SD
Screen-viewing behaviors
125
 TV, video and DVDs   79±55
 Console games   18±32
 PC entertainment (on line games, surfing the net)   81±67
100
or social networks (Facebook, Twitter)
Some secondary Completed secondary University/tertiary
  N (%) school education or school education, qualification
Gender (parents) less technical education
or apprenticeship
 Male   347 (30.4)
 Female   794 (69.6)
Figure 1: Adolescent’s screen time and parental education.
Parents’ BMI
 Under weight   12 (1.1)
 Normal range   540 (47.5) Table 2: Regression of adolescents’ age, gender and family
 Overweight   460 (40.4) ­predictors of screen viewing.
 Obese   126 (11.1)
Parental education   B  SEB  β
 Some secondary school or less   163 (14.3)
 Secondary school, technical certificate, or   543 (47.6) Step 1
apprenticeship  Constant   134.17  5.04 
 University/tertiary certification   435 (38.2)  Gender   39.77  5.57  0.20a
 14 years old vs. 13 years old   37.99  6.85  0.17a
 15 years old vs. 13 years old   45.67  6.59  0.21a
Step 2
adolescents whose parents had received up to secondary  (Constant)   156.57  19.60 
school education spend more time screen-viewing com-  Gender   41.39  5.35  0.21a
 14 years old vs. 13 years old   27.25  6.64  0.12a
pared with the other groups.
 15 years old vs. 13 years old   30.93  6.56  0.14a
Hierarchical multiple regression analysis was used  Perceived rules   −6.78  1.09  −0.18a
to assess the ability of the family variables (perceived  Parental modeling   2.54  0.89  0.08a
rules, parental modeling, parents’ screen related sed-  Parents screen related sedentary  4.20  1.14  0.10a
entary behavior, parental concern for screen viewing, behavior
 Parental concern   2.46  0.77  0.08a
support for physical activity, parental education) to
 Support for physical activity   −4.62  1.20  −0.10a
predict adolescent screen viewing, after controlling  Some secondary vs. completed   −35.02  8.46  −0.17a
for the influence of gender and age (Table 2). Age and secondary
gender were entered at step 1 explaining 8.7% of vari-  Some secondary vs. university   −23.06  8.11  −0.11a
ance in adolescent screen viewing. After entering all the
R2 = 0.08 for step 1, ΔR2 = 0.09 for step 2 (p < 0.00). ap < 0.01.
other variables at step 2, the total variable explained by
the model as a whole was 17.8%, F(10,1130) = 24.54, p < 0.00.
The family variables explained an additional 9.2% in final model all the family variables were statistically sig-
screen-viewing after controlling for gender and age, nificant with perceived rules recording a higher negative
R2  change  =  0.092, F change(7,1130) = 18.01, p < 0.00. In the β-value (β = − 0.18, p < 0.00).

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Discussion
The aim of this study was to detect possible associa-
tion between family predictors and screen-viewing by
13–15-year-old adolescents in a nationwide sample.
Using national samples of adolescents and their
parents our results support findings from relevant studies
(2, 3) suggesting that adolescents spend a vast amount
of their free time on electronic forms of entertainment.
Watching TV, playing electronic or online games, surfing
the net and spending time in social networks are popular
activities among adolescents and they spend more than
3 h on them on a daily basis. Given the excess time ado-
lescents devote on screen viewing, further research in
modern sedentary behaviors is necessary for timely
interventions.
Some family factors are likely to be key predictors of
adolescents screen viewing. In the present research rules
set by parents and perceived by adolescents seem to asso-
ciate to reduced screen use. Although the importance of
setting rules for screen use has been mentioned in previ-
ous studies (13, 15), the results of our study provide addi-
tional evidence that parental restrictive mediation can
considerably contribute towards reducing screen-viewing
time among adolescents who are 13–15 years as well. Inter-
ventions aiming at parents with lower education back-
ground could prove more than useful as our findings, as
well as findings from similar research (18–20), indicate
that children whose parents had lower education devote
more time on screen use. This has been attributed to the
fact that their parents possibly shape a sedentary environ-
ment at home or they fail in setting rules for their chil-
dren’s screen use so as to regulate screen use successfully.
As sedentary behaviors take place in the home envi-
ronment, parental modeling, that is, parental screen use
and co-viewing screen practices with their children, is
another significant modifiable factor. There are many
potential reasons for this; for one, sedentary behavior is
perhaps more easily shared simultaneously across gener-
ations (e.g. whole family watching television) than physi-
cal activity (21). Hardy and colleagues (28) report that the
context in which families view television/video/DVDs is
complex, but it is feasible that time spent co-viewing with
parents be considered a shared social activity and may
serve as bond between young adolescents and parents. Our
research features the important positive relation between
parental modeling and screen use. These finding indicate
that parents may influence their children’s screen behav-
iors through role modeling. So, if parents adopt excess
screen viewing, this associates with their adolescent
children’s excess screen viewing. Therefore interventions
Bounova et al.: Parental factors in adolescent screen time      5
targeting both child and parent screen-viewing may be
more effective in adolescent’s screen use.
Parental concern about their children’s dealing with
electronic forms of entertainment seems to associate
positively with increased screen viewing. These findings
are consistent with previous research (16) and suggest
that parents who are concerned about their adolescent
children’s screen use have a good reason for doing so,
although they may not be aware of specific practices
concerning screen-viewing restrictions. Harnessing this
parental concern may offer considerable opportunity to
changing the family environment.
A recent study (17) shows an inverse relation between
excess screen use and the frequency of physical activity.
Present findings lead to the conclusion that parents who
are supportive to their adolescent children’s physical
activities seem to contribute considerably to their chil-
dren’s dealing with less screen viewing. Parental encour-
agement of physical activity, facilitation of the whole
process and their own participation in common activities
could be the counterweight to such sedentary behaviors.
Adolescence is surely a challenge for parents. Encourag-
ing their adolescent children to promote their talents and
pursue their interests could be a way of reducing harmful
sedentary behaviors (41).
There are some methodological issues that need to be
noted. Screen time recording was based on a self-admin-
istered questionnaire which can be either overestimated
or underestimated. However, a questionnaire enables us
to record sedentary time content which was necessary for
the present study. While the use of a self-report instrument
can be problematic among adolescents, the test-retest reli-
ability demonstrated acceptable repeatability (36). Also,
strengths of our study included having parent-­adolescent
pairs complete the survey measures for the modifiable
family factors.
The present survey contributes to the limited litera-
ture on adolescent sedentary behaviors by examining dif-
ferent types of contemporary screen-viewing behaviors in
children-parents dyads and their associations with family
factors. Results highlight the importance of the parental
role in shaping of certain forms of adolescents’ screen
based sedentary behaviors. The large sample of adoles-
cents and their respective parents taken from all the Greek
administrative districts is one of its strengths which sug-
gests that our sample may have been broadly representa-
tive; thus, our results may be generalized to apply to a
diverse population. We focused on modifiable family pre-
dictors with the aim of featuring associations useful for
introducing appropriate intervention aiming at reducing
total screen time.
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6      Bounova et al.: Parental factors in adolescent screen time
Conclusion
Our study results suggest that programs that focus on
development of parental limit setting and/or promotion of
physical activity may be effective in decreasing screen time
among adolescents aged 13–15 years. Taking into account
the fact that sedentary behaviors are deeply ingrained in
adolescence (42), it may be necessary for interventions
to be introduced at a younger age. Furthermore, family
based interventions that offer support and education to
concerned parents, as well as encouragement to introduce
changes in the family environment may be a significant
approach towards reducing adolescent excess screen use.
Acknowledgments: The authors would like to express
their heartiest thanks to all the students who devoted time
and effort to participate in the survey, as well as to their
families. Moreover, they would like to thank the school
counselors, headmasters and high school teachers for
their wholehearted support and cooperation for the suc-
cessful outcome of this nationwide survey.
Funding Source: No funding was secured for this study.
Financial disclosure: The authors have no financial rela-
tionships relevant to this article to disclose.
Conflict of interest statement: The authors have no con-
flict of interest to disclose.
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