ABSTRACT:

Objective:

To analyze the association between perceptions of neighborhood safety (PNS) and screen time among adolescents and to assess the moderating effects of sex, age and socioeconomic status.

Methods:

A cross-sectional study with school survey was conducted in Curitiba, Brazil. First, six schools (three public and three private) were intentionally selected. Next, one class within each educational level (from the sixth year of elementary school to the third year of high school) was randomly selected. PNS was assessed using a NEWS-Y scale, and daily screen time was defined as the time spent watching TV/videos/DVDs, playing video games and using the Internet. Multinomial logistic regression models were used to test the association between PNS and screen time, adjusting for the confounding variables.

Results:

The sample included 776 adolescents (boys and girls), aged between 11 and 18 years old. Perceived crime was associated with time playing video games among older teenagers (p < 0.05). Pedestrian and traffic safety was inversely associated with time playing video games among adolescents with high socioeconomic status (p < 0.05).

Conclusion:

The association between PNS and screen time is complex among adolescents and varies according to sociodemographic variables and the screen time outcome (TV/videos/DVDs, video games and the Internet).

Keywords:
Perception; Sedentary lifestyle; Adolescents; Gender; Age groups; Socioeconomic status

INTRODUCTION

Time spent in front of screens, which includes watching television, playing video games, and using the computer or Internet, is a common sedentary activity among adolescents¹1. Bauer KW, Friend S, Graham DJ, Neumark-Sztainer D. Beyond Screen Time: assessing recreational sedentary behavior among adolescent girls. J Obes 2012; 2012: 83194. DOI: 10.1155/2012/183194
https://doi.org/10.1155/2012/183194... ^,22. Council on communications and media, Strasburger VC, Hogan MJ, Mulligan DA, Ameenuddin N, Christakis DA, et al. Children, adolescents, and the media. Pediatrics 2013; 132(5): 958-61. DOI: 10.1542/peds.2013-2656
https://doi.org/10.1542/peds.2013-2656... . Currently in Brazil, 79.5% of adolescents aged between 12 and 14 years spend over two hours a day on these activities³3. Brasil. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa nacional de sau´de do escolar 2012. Rio de Janeiro: IBGE; 2012.. Evidence indicates a positive association between this behavior and obesity, diabetes and low levels of physical fitness in adolescents⁴4. Salmon J, Tremblay MS, Marshall SJ, Hume C. Health risks, correlates, and interventions to reduce sedentary behavior in young people. Am J Prev Med 2011; 41(2): 197-206. DOI: 10.1016/j.amepre.2011.05.001
https://doi.org/10.1016/j.amepre.2011.05... ^,55. Boulos R, Vikre EK, Oppenheimer S, Chang H, Kanarek RB. ObesiTV: how television is influencing the obesity epidemic. Physiol Behav 2012; 107(1): 146-53. DOI: 10.1016/j.physbeh.2012.05.022
https://doi.org/10.1016/j.physbeh.2012.0... ^,66. Mitchell JA, Rodriguez D, Schmitz KH, Audrain-McGovern J. Greater screen time is associated with adolescent obesity: a longitudinal study of the BMI distribution from ages 14 to 18. Obesity (Silver Spring) 2013; 21(3): 572-5. DOI: 10.1002/oby.20157
https://doi.org/10.1002/oby.20157... . There is also indication that this behavior increases throughout adolescence. For example, in a longitudinal study with 4,218 adolescents, an average increase of 60 minutes/day per year in the screen time in adolescents aged 11 and 15 years was observed; and this increase was associated with body adiposity⁷7. Dumith SC, Garcia LMT, Silva KS, Menezes AMB, Hallal PC. Predictors and health consequences of screen-time change during adolescence - 1993 Pelotas (Brazil) birth cohort study. J Adolesc Health 2012; 51(6 Suppl): 16-21. DOI: 10.1016/j.jadohealth.2012.06.025
https://doi.org/10.1016/j.jadohealth.201... . In addition, this behavior is more likely to continue into adulthood⁸8. Biddle SJ, Pearson N, Ross GM, Braithwaite R. Tracking of sedentary behaviours of young people: a systematic review. Prev Med 2010; 51(5): 345-51. DOI: 10.1016/j.ypmed.2010.07.018
https://doi.org/10.1016/j.ypmed.2010.07.... .

Given this context, there is a growing interest in understanding the aspects that affect screen time, particularly aspects from the community environment⁹9. Burdette HL, Whitaker RC. A national study of neighborhood safety, outdoor play, television viewing, and obesity in preschool children. Pediatrics 2005; 116(3): 657-62.^,1010. Datar A, Nicosia N, Shier V. Parent perceptions of neighborhood safety and children's physical activity, sedentary behavior, and obesity: evidence from a national longitudinal study. Am J Epidemiol 2013; 177(10): 1065-73. DOI: 10.1093/aje/kws353.
https://doi.org/10.1093/aje/kws353... ^,1111. Brown HS, Perez A, Mirchandani GG, Hoelscher DM, Kelder SH. Crime rates and sedentary behavior among 4th grade Texas school children. Int J Behav Nutr Phys Act 2008; 5(28). DOI: 10.1186/1479-5868-5-28.
https://doi.org/10.1186/1479-5868-5-28.... ^,1212. MacLeod KE, Gee GC, Crawford P, Wang MC. Neighbourhood environment as a predictor of television watching among girls. J Epidemiol Community Health 2008; 62(4): 288-92. DOI: 10.1136/jech.2007.061424
https://doi.org/10.1136/jech.2007.061424... , and especially public safety and traffic. In fact, the perception of neighborhood safety related to crimes and traffic has an inverse association with sedentary behavior among young people¹¹11. Brown HS, Perez A, Mirchandani GG, Hoelscher DM, Kelder SH. Crime rates and sedentary behavior among 4th grade Texas school children. Int J Behav Nutr Phys Act 2008; 5(28). DOI: 10.1186/1479-5868-5-28.
https://doi.org/10.1186/1479-5868-5-28.... ^,1212. MacLeod KE, Gee GC, Crawford P, Wang MC. Neighbourhood environment as a predictor of television watching among girls. J Epidemiol Community Health 2008; 62(4): 288-92. DOI: 10.1136/jech.2007.061424
https://doi.org/10.1136/jech.2007.061424... ^,1313. Salmon J, Veitch J, Abbott G, ChinAPaw M, Brug JJ, teVelde SJ, et al. Are associations between the perceived home and neighbourhood environment and children's physical activity and sedentary behaviour moderated by urban/rural location? Health Place 2013; 24: 44-53. DOI: 10.1016/j.healthplace.2013.07.010
https://doi.org/10.1016/j.healthplace.20... . This relationship is also observed when parents perceive that their the neighborhood is unsafe⁹9. Burdette HL, Whitaker RC. A national study of neighborhood safety, outdoor play, television viewing, and obesity in preschool children. Pediatrics 2005; 116(3): 657-62.^,1010. Datar A, Nicosia N, Shier V. Parent perceptions of neighborhood safety and children's physical activity, sedentary behavior, and obesity: evidence from a national longitudinal study. Am J Epidemiol 2013; 177(10): 1065-73. DOI: 10.1093/aje/kws353.
https://doi.org/10.1093/aje/kws353... . These findings may be partly explained by the absence of safe walking places, as it reduces the adolescent’s physical activity going to and from home, and induces the adolescent to spend more time doing sedentary activities¹⁴14. Carver A, Timperio AF, Crawford DA. Neighborhood road environments and physical activity among youth: the clan study. J Urban Health 2008; 85(4): 532-44. DOI: 10.1007/s11524-008-9284-9
https://doi.org/10.1007/s11524-008-9284-... ^,1515. Santos MP, Pizarro AN, Mota J, Marques EA. Parental physical activity, safety perceptions and children's independent mobility. BMC Public Health 2013; 13: 584. DOI: 10.1186/1471-2458-13-584
https://doi.org/10.1186/1471-2458-13-584... . Such aspects may be even more important in the Brazilian context, since crime rates and traffic-related deaths¹⁶16. Waiselfisz JJ. Mapa da Violência 2013: acidentes de trânsito e motocicletas. Rio de Janeiro: Flacso; 2013.^,1717. World Health Organization (WHO). Global status report on road safety 2013: supporting a decade of action. Geneva: WHO; 2013.^,1818. Waiselfisz JJ. Mapa da violência 2013: mortes matadas por armas de fogo. Brasília: Flacso; 2013.are among the highest in the world.

To date, studies on the association between perceived safety and time spent by adolescents in front of the screen (watching TV/videos/DVDs, playing video games or using the internet) have not been identified in the country. Greater attention was observed in the associations between time spent watching TV, and less attention was given to other behaviors like playing videogames and using the Internet, which presented a high prevalence in this population¹⁹19. Autran RG, Rech CR, Mota J, Santos MP. Percepção de regras e de confiança em reduzir o tempo de tela em adolescentes. Rev Bras Ativ Fis Saúde 2014; 19(6): 690-9. DOI: 10.12820/RBAFS.V.19N6P690
https://doi.org/10.12820/RBAFS.V.19N6P69... .

Likewise, the moderating role of sociodemographic variables in the relationship between safety and time spent by adolescents in front of screens is also not well demonstrated. However, these variables are believed to exhibit differences in the screen-related behaviors of the population subgroups. Considering some scientific articles, there is a greater possibility for boys to play videogames in unsafe places¹¹11. Brown HS, Perez A, Mirchandani GG, Hoelscher DM, Kelder SH. Crime rates and sedentary behavior among 4th grade Texas school children. Int J Behav Nutr Phys Act 2008; 5(28). DOI: 10.1186/1479-5868-5-28.
https://doi.org/10.1186/1479-5868-5-28.... . In addition, younger female adolescents with a higher income reported a lower perceived safety²⁰20. Dallago L, Perkins DD, Santinello M, Boyce W, Molcho M, Morgan A. Adolescent place attachment, social capital, and perceived safety: a comparison of 13 countries. Am J Community Psychol 2009; 44(1-2): 148-60. DOI: 10.1007/s10464-009-9250-z
https://doi.org/10.1007/s10464-009-9250-... ^,2121. Schoen TH, Vitalle MSS. Tenho medo de quê? Rev Paul Pediatr 2012; 30(1): 72-8. DOI: 10.1590/S0103-05822012000100011
https://doi.org/10.1590/S0103-0582201200... . Moreover, it is believed that socioeconomic level is an important variant to be considered, since people with a higher income feel more unsafe in their neighborhood, possibly because those neighborhoods are more attractive to criminals²²22. Borges D. Vitimização e sentimeto de insegurança no Brasil em 2010: teoria, análise e contexto. Mediações 2013; 18(1): 141-63. DOI: 10.5433/2176-6665.2013v18n1p141
https://doi.org/10.5433/2176-6665.2013v1... . Identifying subgroups that are more exposed to the effect of insecurity can improve the understanding of this complex relationship, especially considering the role of sociodemographic aspects, which have not yet been explored.

Thus, this study aimed to:

METHODS

POPULATION AND STUDY DESIGN

This is a cross-sectional study that was conducted between September and October of 2012. The participants were adolescents aged between 11 and 18 years, of both sexes, from Curitiba, Paraná, Brazil. All procedures were approved by the Human Research Ethics Committee of the Pontifícia Universidade Católica do Paraná (Protocol No. 93.664/12).

The most recent estimates suggest that Curitiba has around 269,505 adolescents aged between 10 and 19 years, evenly distributed in terms of gender (50.5% boys). According to data from the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística, IBGE), the number of students enrolled in primary and secondary education in 2012 was 234,215 and 81,614, respectively²³23. Brasil. Instituto Brasileiro de Geografia e Estatística (IBGE). Paraná, Curitiba: ensino, matrículas, docentes e rede escolar - 2012. [Internet]. Disponível em: http://cidades.ibge.gov.br/xtras/temas.php?lang=&codmun=410690 &idtema=117&search=parana|curitiba|ensino-matriculas-docentes-e-rede-escolar-2012 (Acessado em 14 setembro de 2015).
http://cidades.ibge.gov.br/xtras/temas.p... . Most students, from both the elementary and high school, attended public educational institutions (76.4 and 73.9%, respectively). Thus, to try to obtain a sample that contemplated students of public and private schools, the selection was performed in two stages. Initially, six schools (three public and three private) were chosen from the elementary and middle schools in Curitiba, Paraná. This criterion was adopted in order to include students from the region that belongs to both the highest and lowest socioeconomic classes. In the second stage, all schools that met the following criteria were eligible:

Thereby, it was decided to randomly select one teaching period at each school among the eligible classes. Finally, 42 classes and an estimated total of 1,344 adolescents were selected. However, a sample of 1,081 adolescents (54% girls) was obtained during the collection.

STUDY VARIABLES

For data collection, an instrument composed of three sessions was applied:

The instrument was applied at school and during the classes with the permission of the school board and conducted by a team of three trained evaluators.

Screen time was analyzed based on the time spent watching television/videos/DVDs daily, in addition to playing videogames and using the Internet. This did not include school hours or weekend days. Participants were asked how many minutes per day they spent on these activities. The response was obtained on an ordinal scale of seven points (none, 15 minutes, 30 minutes, 1 hour, 2 hours, 3 hours, ≥ 4 hours). This procedure has been used in similar studies to analyze screen time²⁴24. Rosenberg DE, Sallis JF, Kerr J, Maher J, Norman GJ, Durant N, et al. Brief scales to assess physical activity and sedentary equipment in the home. Int J Behav Nutr Phys Act 2010; 7:10. DOI: 10.1186/1479-5868-7-10
https://doi.org/10.1186/1479-5868-7-10... . For analysis purposes, responses were grouped into three levels: up to 15 minutes; from 30 minutes to 1 hour; 2 hours or more.

Perceptions of traffic and crime-related safety were assessed using the Neighborhood Environment Walkability Scale for Youth (NEWS-Y)²⁵25. Rosenberg D, Ding D, Sallis JF, Kerr J, Norman GJ, Durant N, et al. Neighborhood environment walkability scale for youth (NEWS-Y): reliability and relationship with physical activity. Prev Med 2009; 49(2-3): 213-8. DOI: 10.1016/j.ypmed.2009.07.011
https://doi.org/10.1016/j.ypmed.2009.07.... . The scales that were related to traffic safety and crime were translated and adapted to the Brazilian context and its final version presented adequate conceptual and semantic equivalence²⁶26. Lima AV, Rech CR, Reis RS. Semantic, item, and conceptual equivalence of the brazilian version of the neighborhood environment walkability scale for youth (NEWS-Y). Cad Saúde Pública 2013; 29(12): 2547-53. DOI: 10.1590/0102-311X00182512
https://doi.org/10.1590/0102-311X0018251... . Perceptions on traffic safety were evaluated using eight items related to vehicle traffic and pedestrians in the neighborhood. Safety from crimes in the neighborhood was evaluated through seven items and using a four-point ordinal scale ranging from “totally disagree” to “totally agree”.

Finally, participants were asked about sociodemographic characteristics such as gender (male/female), age (years) and socioeconomic status (SES). Finally, SES was determined through a protocol suggested by the Brazilian Association of Research Companies (Associação Brasileira das Empresas de Pesquisa-ABEP), which considers the possession of items at home and categorize families into the seven economic (A1, A2, B1, B2, C1, C2, D and E)²⁷27. Associação Brasileira de Empresas e Pesquisa. Brazilian criteria foreconomic classification. [Internet]. Disponível em: http://www.abep.org/criterio-brasil (Acessado em 02 de dezembro de 2014).
http://www.abep.org/criterio-brasil... . For this study participants were grouped into three categories: high (class A1 + A2), middle (class B1 + B2) and low (class C1 + C2 + D + E).

DATA ANALYSIS

The description of the study variables was performed by means of descriptive statistics according to the measurement scale of each variant. Quantitative variables were described by mean and standard deviation, while qualitative variables were determined by means of the absolute and relative frequency distribution. In order to confirm the main components of each NEWS-Y scale, an exploratory factorial analysis was performed with traffic and crime-related safety perception scales.

The bivariate association between the variables gender, age and SES was measured using the χ² test for proportions. The multivariate association of the variables gender, age, SES, safety perception and the three categories of time of sedentary behaviors (up to 15 minutes, from 30 minutes to 1 hour, and 2 hours or more) was examined using multinomial logistic regression analysis, as the data did not confirm previous assumptions to allow ordinal logistic regression to be performed. In the multivariate analysis, all variables were inserted into the model. The odds ratio (OR) was estimated from the association between independent variables (perception of crime-related safety, vehicle traffic and pedestrian traffic), inserted in the model as continuous variables (standardized factor load) and interpreted as the cause of increase of the OR and for the increase of a standard deviation in the standard factorial load.

Furthermore, the interaction between the independent variables (perception of crime-related safety, vehicular traffic and pedestrian traffic) was tested with the variables gender (male = 0 versus female = 1), age (11-14 years = 0 versus 15 to 18 years = 1) and socioeconomic level (“C”, “B” and “A”). To this end, a term was created to describe the interaction between the independent variables and the potential moderating variables (gender, age and SES) by means of the product between them. SES was converted into two dummy variants to identify participants with socioeconomic status “B” and “A”. The interaction terms were inserted into the adjusted model for the other potential confounding variables. All analyzes were performed using the statistical package STATA, version 11.0, and adopting a significance level of p < 0.05.

RESULTS

The results of the exploratory factor analysis (Table 1) were composed of three factors:

A total of 1,081 adolescents (55.0% girls), aged between 11 and 18 years, participated in this study. Of these, 776 (72% of the initial sample) had a complete set of data to perform the analysis. First, a non-response evaluation was carried out to identify possible differences between adolescents who were included and those who were not included in the sample. There was no significant difference in this analysis (data not shown). A large part of the participants of the sample was aged between 14 and 16 years old (57.0%) and had high SES (51.0%; n = 393). The proportion of adolescents that watch television more than 2 hours per day was 45.0%, with a 95% confidence interval (95%CI) 42.4 - 48.7. This proportion was higher among girls (48.0 versus 41.0%), aged 13 years old (54.0%), and in the middle class (57.0%). Videogame use for more than 2 hours per day was reported by 48.0% (95%CI 45.9 - 52.2) of the sample, with a higher prevalence for boys (62.0 versus 36.0%), aged 13 years old (54.0%) and high SES (50.0%). More time spent in front of the screen surfing the Internet was observed in 61.0% (95%CI 57.8 - 63.9) of the sample. Girls (63.0 versus 57.0%) aged 15 years old (67.0%) and “middle” SES (62.0%) showed a higher prevalence for this behavior. Table 2 presents other descriptive characteristics of the participants.

The bivariate analysis observed a lower chance of adolescents watching TV in excess as they grow older (OR = 0.84, 95%CI 0.74 - 0.94). There was a 13.0% increase in the possibility of excessive Internet use for each year of life. Girls were less likely to spend their time playing videogames (OR = 0.18; 95%CI 0.12 - 0.27) compared to boys.

Perception of safety was not associated with time devoted to watching television; however, statistically significant association were observed between pedestrian traffic safety and time devoted to playing videogames (OR = 1.27, 95%CI 1.04 - 1.55) and vehicle traffic safety and time on the Internet (OR = 1.32, 95%CI 1.04 - 1.69), both in the reverse order than expected. The perception of safety related to crime (Table 3) remained associated with the use of videogames and the Internet, contrary to our hypothesis (p < 0.05).

After adjusting for the confounding variables (Table 4), the perception of safety related to crime was associated with 30 minutes to 1 hour playing videogames by older adolescents (OR = 1.15, 95%CI 1.03 - 1.29). The perception of safety related to pedestrian traffic was associated with the presence of 30 minutes to 1 hour playing videogames by adolescents with higher SES (OR = 2.40, 95%CI 1.05 - 5.47). The association between safety perception related to pedestrian traffic and playing videogames for 2 hours or more, decreases with increasing age (OR = 0.87; 95%CI 0.79 - 0.97).

DISCUSSION

The results in this study indicate different directions and magnitudes in the association between the perception of safety and the screen time of adolescents. There was a high prevalence of adolescents who did screen-related activities for more than two hours daily, corroborating other findings³3. Brasil. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa nacional de sau´de do escolar 2012. Rio de Janeiro: IBGE; 2012.^,77. Dumith SC, Garcia LMT, Silva KS, Menezes AMB, Hallal PC. Predictors and health consequences of screen-time change during adolescence - 1993 Pelotas (Brazil) birth cohort study. J Adolesc Health 2012; 51(6 Suppl): 16-21. DOI: 10.1016/j.jadohealth.2012.06.025
https://doi.org/10.1016/j.jadohealth.201... ^,1313. Salmon J, Veitch J, Abbott G, ChinAPaw M, Brug JJ, teVelde SJ, et al. Are associations between the perceived home and neighbourhood environment and children's physical activity and sedentary behaviour moderated by urban/rural location? Health Place 2013; 24: 44-53. DOI: 10.1016/j.healthplace.2013.07.010
https://doi.org/10.1016/j.healthplace.20... . When considering the sedentary activities separately, it was observed that the prevalence of each one differs according to gender, age and SES.

The predominance in TV use was higher among girls and low-income youth. The lack of safety present in the community, combined with social norms that inhibit girls’ autonomy, could, at least partially, explain this result. For example, parents may prohibit activities away from home, leading girls to opt for more sedentary activities. Greater TV use in low-income economic classes has been demonstrated in other studies⁹9. Burdette HL, Whitaker RC. A national study of neighborhood safety, outdoor play, television viewing, and obesity in preschool children. Pediatrics 2005; 116(3): 657-62.^,1212. MacLeod KE, Gee GC, Crawford P, Wang MC. Neighbourhood environment as a predictor of television watching among girls. J Epidemiol Community Health 2008; 62(4): 288-92. DOI: 10.1136/jech.2007.061424
https://doi.org/10.1136/jech.2007.061424... ^,2828. Chowhan J, Stewart JM. Television and the behaviour of adolescents: does socio-economic status moderate the link? Soc Sci Med 2007; 65(7): 1324-36. DOI: 10.1016/j.socscimed.2007.05.019
https://doi.org/10.1016/j.socscimed.2007... ^,2929. Molnar BE, Gortmaker SL, Bull FC, Buka SL. Unsafe to play? neighborhood disorder and lack of safety predict reduced physical activity among urban children and adolescents. Am J Health Promot 2004;18(5): 378-86.. Among girls, during adolescence, there is a predominance of Internet use. It can be speculated that this age group prefers to participate in social networks, chats, blogs and other activities related to the Internet³⁰30. Brasil. Fundo das Nações Unidas para a Infância (UNICEF). O uso da internet por adolescentes. Brasília: UNICEF; 2013., which is different from boys, who prefer electronic games¹¹11. Brown HS, Perez A, Mirchandani GG, Hoelscher DM, Kelder SH. Crime rates and sedentary behavior among 4th grade Texas school children. Int J Behav Nutr Phys Act 2008; 5(28). DOI: 10.1186/1479-5868-5-28.
https://doi.org/10.1186/1479-5868-5-28.... ^,3131. Salmon J, Timperio A, Telford A, Carver A, Crawford D. Association of family environment with children's television viewing and with low level of physical activity. Obes Res 2005; 13(11): 1939-51. DOI: 10.1038/oby.2005.239
https://doi.org/10.1038/oby.2005.239... .

There was a positive association between the perception regarding crime-related safety and playing videogames. This result is contrary to the hypothesis of the present study. In a survey conducted in Texas, in the United States, different results were obtained, and the high crime rate in the neighborhood was associated with more time devoted to videogames¹¹11. Brown HS, Perez A, Mirchandani GG, Hoelscher DM, Kelder SH. Crime rates and sedentary behavior among 4th grade Texas school children. Int J Behav Nutr Phys Act 2008; 5(28). DOI: 10.1186/1479-5868-5-28.
https://doi.org/10.1186/1479-5868-5-28.... . However, a survey of a large sample of Brazilian schoolchildren found no association between neighborhood characteristics and time spent watching television³²32. Martins MO, Cavalcante VLF, Holanda GS, Oliveira CG, Maia FES, Meneses Júnior JR, et al. Associação entre comportamento sedentário e fatores psicossociais e ambientais em adolescentes da região nordeste do Brasil. Rev Bras Ativ Fis e Saúde 2012; 17(2): 143-50. DOI: 10.12820/RBAFS.V.17N2P143-150
https://doi.org/10.12820/RBAFS.V.17N2P14... . The use of self-reported measures regarding public safety may present limitations, and suggests the need to improve the understanding of the phenomenon of violence in young people’s perception of safety.

There was an inverse association between the understanding of pedestrian, traffic-related safety and adolescents playing videogames. Generally, older adolescents spend more time away from home and have greater independence with regard to mobility¹⁵15. Santos MP, Pizarro AN, Mota J, Marques EA. Parental physical activity, safety perceptions and children's independent mobility. BMC Public Health 2013; 13: 584. DOI: 10.1186/1471-2458-13-584
https://doi.org/10.1186/1471-2458-13-584... . As such, these factors can contribute so that they spend less time on activities such as video games. Nevertheless, the perception of safety related to pedestrian traffic was not associated with TV and Internet use. It is believed that these activities, in this age group, are tied to individual preferences. The Internet is a communication tool that is an integral part of adolescents’ daily life³⁰30. Brasil. Fundo das Nações Unidas para a Infância (UNICEF). O uso da internet por adolescentes. Brasília: UNICEF; 2013.. Thus, neighborhood environment aspects may have less relation to these behaviors.

Finally, it is important to emphasize that this study approached adolescents’ perception of safety, since evidence obtained through the parents’ perceptions tend to differ³³33. Kerr J, Norma GJ, Sallis JF, Patrick K. Exercise aids, neighborhood safety, and physical activity in adolescents and parents. Med Sci Sports Exerc 2008; 40(7): 1244-8. DOI: 10.1249/MSS.0b013e31816b8797
https://doi.org/10.1249/MSS.0b013e31816b... . This may be related to the adolescent’s lack of awareness about the reality of the neighborhood, or to the fact that the family can transmit a sense of safety. Moreover, this subjective evaluation does not allow us to identify the reality of the neighborhood nor the exact amount of screen time. Another limitation related to the measurement of screen time is the lack of information considering the weekends, which could imply different results for the investigation. Thus, future research related to the topic is suggested, which includes other control variables, such as the caregiver’s perceptions of safety and the adolescents’ practice of physical activity. In addition, these investigations should include objective ways of assessing screen time, in addition to different study designs, so that it is possible to identify cause and effect relationships between neighborhood safety and time adolescents spend in front of screens.

Some factors should be considered when interpreting these results. The self-reported measurements represent another limitation, since they reflect perceptions about behaviors and environments, and are not a direct measure of such attributes. Therefore, a classification error cannot be completely ruled out in interpreting the results. Still, approximately 30% of the initial sample did not contribute a complete set of data for analysis, which resulted in a smaller testing pool. In addition, the fact that the neighborhood is not perceived to be unsafe does not mean that there are no crimes or traffic accidents. However, these measurements have been used in several national and international studies and present valid results. This study was carried out with adolescents aged 11 to 18 years, who are students from public and private schools in Curitiba, Paraná. Thus, it is not possible to extrapolate these results to other populations.

Despite these limitations, the issues addressed here are extremely important for the implementation of policies aimed at reducing the time spent by adolescents in front of screens. Although only one expected association was found, other important information must be considered. The results in this study allow us to observe the characteristics in the profile of the adolescents who use television, videogames and the Internet, thus enabling future interventions aimed at reducing these activities in this age group. In addition, different outcomes related to screen time and more specific characteristics related to the perception of neighborhood safety were considered. In low- and middle-income countries like Brazil, this type of research involving adolescents is still scarce.

CONCLUSION

The association between perceived safety and time spent by adolescents in front of screens is complex and varies according to sociodemographic characteristics and the type of equipment used during screen time (television/videos/DVDs, videogames and the Internet). The prevalence of screen time among adolescents over two hours daily is high. Greater perception of crime in the neighborhood was associated with more time spent playing videogames by older adolescents. Thus, new research is recommended that may include objective measurements of safety in the neighborhood, and also that investigate the perception of parents, in order to better understand this complex relationship. Furthermore, it is suggested that interventions that reduce screen time should be priorities in the health agenda for adolescents.

ACKOWLEDGMENTS

We would like to thank Mr. Alex Vieira Lima, who coordinated the research, and the members of the Research Group on Physical Activity and Quality of Life that performed the data collection.

References

Publication Dates

History