Outcomes from the ATLAS school-based intervention incorporating smartphone technology for adolescent boys: A cluster RCT

Abstract

Background: The modest effects of physical activity (PA) interventions targeting adolescents have prompted researchers to explore the utility of eHealth (e.g., internet-based) and mHealth (i.e., mobile phones) technology for behavior change. Such strategies are unlikely to provide the 'silver bullet' for the global pandemic of inactivity, but may serve as useful adjuncts to multicomponent behavioral interventions. Therefore, the primary aim of this study was to evaluate the effects of the multi-component school-based intervention incorporating smartphone technology for adolescent boys, known as ATLAS (Active Teen Leaders Avoiding Screen-time). Methods: ATLAS was evaluated using a cluster randomized controlled trial. The study was conducted from November 2012 to August 2013 in 14 secondary schools located in low-income communities in the Hunter and Central Coast regions of New South Wales, Australia. Participants were adolescent boys aged 12-14 years (N= 361) who self-reported more than 2 h/day of recreational screen-time or less than 60 min/day of moderate-to-vigorous physical activity (MVPA). The multi-component school-based intervention was guided by Self-Determination Theory and Social Cognitive Theory and included: (i) teacher professional development, (ii) provision of fitness equipment to schools, (iii) face-to-face physical activity sessions, (iv) researcher-led seminars, (v) smartphone application and website, and (vi) parental strategies for reducing screen-time. Assessments were conducted at baseline and 9-months and included physical activity (accelerometers), screentime (Adolescent Sedentary Activity Questionnaire), and sugar sweetened beverage (SSB) intake (food frequency questionnaire). Statistical analyses were conducted using linear mixed models, adjusted for the clustered nature of the data (i.e., schools included as a random factor) and followed the intention-to-treat principle. Results: There were no intervention effects for activity counts/minute or minutes of MVPA, but significant group-by-time interaction effects were found for screen-time (mean, -30 min/d, 95% CI, -50 to -10, p = .03) and SSB consumption (mean, -0.6 glasses/d, 95% CI, -1.1 to -0.1, p = .01). Discussion: This study has demonstrated that adolescent boys 'at-risk' of inactivity and high screen-time can be successfully recruited and retained in a school-based intervention. Although the ATLAS intervention did not increase adolescent boys' objectively measured physical activity, it was successful in decreasing screen-time and SSB consumption.