Now that we're kind of building the case of identify the physical activity is an area deserving of focus. We are looking now at trying to minimize prolonged sedentary behaviors independent of trying to promote physical activity. So in addition to trying to promote physical activity, the separate area is like okay, but let's actually just try to reduce sedentary behaviors themselves because of all of the or the things that were able to identify as being associated with physical inactivity. Include those factors such as certain demographics like age, also lower education and income such as economic status and family and work communities and then of course TV viewing and so we'll talk a bit about screen time as well. And screen time is of course something that has been a problem since the onset of TV but now with these little miniature screens and basically screens being with us and on us at all times not just you know that it used to be decades ago, you know kids having TVs in their bedrooms are bad for X number of health outcomes as well as academic outcomes. But now everyone literally has their screen on them at all times and so really kind of compounding that issue. But speaking specifically about TV, because this In time research is just getting going, you know, there's usually a 14-year lag between when research is done and when it's actually disseminated so we don't have a lot of screen time research yet, but it is of course emerging but we can still learn a lot when going back and looking at the TV viewership information and kind of extrapolating from there. And so what we know is that high viewing of television is associated with many poor health outcomes and that actually eating dinner in front of the television is something that is associated more broadly with just increase saturation of TV and screen time in general. And so that might even be one of the nutrition interventions that people have chosen to do is to try not to eat dinner in front of the TV anymore, trying to eat breakfast in front of the TV or in front of a screen anymore. And that would be something that doesn't necessarily have to be dietary level but would actually be considered a positive health intervention for one to apply at the individual level. One such trial was an intervention for producing screen time for kids, and this was a six-month family intervention, this was done at the level of the family and with the goal to reduce screen time for kids. And so it was for kids aged, what is that, third grade to sixth grade, seventh grade or so, all of whom were identified as being overweight for the CDC growth charts and who had reported getting screen time in excess of 15 hours a week. And so there were a few hundred and you know, about 250 families randomized to either the intervention group or the control group. And so here's what the actual intervention was. It was based on social cognitive theory where caregivers were parents, you know, were placed or were taught about behavioral intervention, application of reinforcement, contingencies, you know, application of things like the Premack principle and given kind of the basics of shaping positive behaviors. So saying things like, I'm so proud of you for what you did there, and I really liked how you did that. It's remarkable how kids actually respond to that kind of stuff and you know, probably all of us in general, you get the whole good job and you're like, yay, [LAUGH] and okey dokes. But you know, we're all kind of motivated by these types of social rewards, but then it also included rewards like gaining access to desired activities via reducing screen time so that, you know, kind of conditions that good you didn't play any games, so now let's go actually like get to play catcher whatever in the front yard. So giving them different systems for alternate activities as well as its kind of social reinforcement and reinforcement in the way of access to other desired activities. And it was also considered this entire behavioral economic theory in trying to modify the screen time patterns and so caregivers were taught how to modify the home environments to make screen time less easy. So putting signs over the TV during times that they shouldn't be watching TV, having alternate activities easily available, removing or shutting down the games, getting things out of the kids bedrooms, and so on. Also gave them instruction in social learning theory and modeling. Taught them how to eat together as a family, encouraged eating together as a family and not to do so in front of the TV, turn the TV off at a certain time in the evening and instead read encouraging older siblings to play instead of all the kids just sitting around watching or playing video games on their own devices and a big piece, caregivers were encouraged to put their own devices away also, okay. Also, given an alternate activity pack of fun things to do, everything from these fun-filled books too, that wasn't really just fun-filled books like they gave them like little toys and elastics and pencils and little craft things to do, playing cards, Checkers, whatever, all kinds of different kinds of games and activities that were not screen dependent. And then this was the big piece and actual budgeting and self-monitoring. It's like, yes, kids get access to the screen, but it's going to be limited to a certain amount. And also there's this need a little time machine gimmick that'll shut it down so much like Ashton's 30/30 app, perhaps, so had them actually wanting them to decide when they're going to access the screen into budget that in and then you have this wonderful lockout type of approach, right? So it was all supposed to be budgeted and like tracked on the refrigerator and this was lovely and and incorporates all these things that we know about behavior change. Okay, and the goal is to also shape it and do it gradually, awesome. Here is what we found. We've got at Baseline for BMI and for body fat, exactly no change and no difference from the intervention and the control. Okay, wildly ineffective at least with respect to, you know, wait outcomes. Okay, also with respect to sedentary minutes per day and with respect to Sleep Quality, no change, no difference for intervention, nothing happening, control looks exactly the same. Interesting, interesting. >> Can I ask a question? >> Absolutely. >> Are there stats in the adherents. >> Yes. >> Okay. >> Let me get through that physical activity, also, no difference. Still not enjoying physical activity. No difference from the control group. Okay, so you're already anticipating. Here we are, the intervention had none of the predicted effects, and even though this is well thought out obviously, you know, multi-level included the family buy-in, all of these types of components, but what they found was that when they went back to why what happened here, they didn't do it. The caregivers themselves reported not using, many of them reported not using any of the strategies. They were given about like eight to ten different strategies for how to modify and almost half of them use zero of those, no, more than half of them use zero, only 43% reported even using one of them. So adherence, no, not even from the beginning was there adherence, and you know, kind of have to wonder if isn't that last point there of like caregivers encouraged to put their own screens away, is the [INAUDIBLE] still like out, yeah, nah, you know, so, lessons here, parents might avoid limiting screen time. Now some of those were identified as that they consider the screen to be educational and don't want to undermine the child's academic achievement and there are a lot of apps these days, like a lot of the homework is coming home wit,h you know, kind of screen-based sorts of homework assignments. Also, parents might underestimate the severity of the children's media exposure, they might not realize that they're actually spending four or six hours on the screen and they also might not realize that they're also getting screen time in the classroom as it is. And the final, well also to consider that screen stuff is highly rewarding for adults also, as many of us likely know, and that budgeting and reducing screen time at the household level is extremely difficult as the final conclusion for this and maybe would need to start at the adult level before it can trickle all the way to children in the home. Now, a couple of concluding comments about Stealth interventions, I alluded to this event, but it wasn't actually a stealth intervention. But this is something where, this is an intervention that's carried out for some other reason, but can have a health positive consequence. So for example, working on things like trying to encourage people to walk to work instead of using fuel based means of transportation, would of course have the additional consequence of boosting physical activity. A congestion tax for example, or additional taxes are applied to people who are choosing to drive to work versus get through alternative means as one such stealthy type of intervention. Other types of things that we might consider as being an intervention of sorts would be like fundraising events where you're going on a walk or a run to raise money for another purpose or using computer video games like Pokemon Go or something else or Dance Dance USA or rock band or any of the others where you're actually like up and kind of active. Is it Dance Dance USA, is that the name of that game? >> Dance Dance Revolution? >> That's it. Thank you. >> It's okay. [LAUGH] >> And then also just engaging in sports and whether it's some Frisbee golf or whatever it is. What is it called? Frisbee golf? Yeah. What's the other one? >> Ultimate Frisbee? >> That's it [LAUGH] that people are actually getting a lot of activity, but it's just mostly primarily for fun. And then the various other kinds of like social support social connectedness and mental health benefits that can derive from these types of stealthy interventions or something that you know, you could also so consider or think about with respect to kind of getting involved in the interdepartmental sports leagues or whether that be bowling or any other kind of thing that has multiple benefits.