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Our study also showed that PA and screen time were associated with each other. In addition, these associations were stronger among boys than girls, whereas the exact opposite was found in a study with secondary school students in Korea (33). The opposite associations among girls than boys might be explained by differences in social and cultural norms regarding PA (34). There was no significant association between screen time and grade; however, children who were told they were overweight or obese were more likely to report high screen time than those who were not. This suggests that regardless of grades or BMI category, students who are told they are overweight/obese are more likely to engage in sedentary behavior (35). Considering that parents need to provide adequate guidance and encouragement for children to be physically active (8), interventions designed to reduce sedentary behavior should target elementary school children and, in a tailored approach, address the role of parents in encouraging physical activity.

The student sample had a high prevalence of overweight and obese weight status, and more than half of the sample reported having been told by a doctor that they were overweight or obese. This is consistent with findings from the national YRBSS during 2003 to 2004 (28). Similar to national findings (29), we found a strong association between overweight/obese weight status and any PA (30,31). Given that elementary school students are developmentally at a stage of life in which their eating and physical activity behaviors are forming (27), interventions designed to reduce screen time sedentary behavior should target elementary school students and include strategies to increase self-efficacy and intrinsic motivation for PA (31,32).

In addition to recommendations for interventions to reduce screen time sedentary behavior that address elementary school children and their parents, this study also provides a first call to action for future research on the subject, with particular reference to youth and family studies. The characteristics that relate to screen time, namely, gender and education, have been found to predict the risk of developing obesity and other health outcomes later in life (28,29,36). However, further studies are needed to explore the potential contribution of screen time to the development of obesity and other health outcomes, especially in women. Additional studies that focus specifically on elementary school children are also warranted to better understand the role that factors outside of the family environment play in engaging in screen time sedentary behavior.

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