Screen Time

It is known that the home environment, including parental influence and socioeconomic status (SES), impacts screen time for children (Lauricella, Wartella, & Rideout, 2015; Tandon et al., 2012). Parent screen time is the strongest predictor of child screen time (Lauricella et al., 2015). Children from lower SES homes tend to have more access to media in their bedrooms, but less to equipment for physical activity (e.g., bikes, jump ropes), demonstrating the role of access and environment on children’s screen time (Tandon et al., 2012). Additionally, screen time during adolescence seems to predict screen time in adulthood for men, while soda consumption appears to influence screen time in adulthood for women (Busschaert et al., 2015). Interventions have been shown to be effective in decreasing screen/ media time for youth.

An intervention involving parental counseling, texts, phone calls, and home visits resulted in a reduction of television time for preschool children on both weekdays and weekends (Haines et al., 2013). For older children (ages 5 to 12), a screen time reduction intervention included a home visit, five monthly telephone calls, and television locking devices. Parents were encouraged to set goals for TV viewing time and limits on the use of phones and small screens. This plan produced a significantly different amount of television viewing hours for children in the intervention group from that of those in the control (1.7 vs. 2.6 hours per day; French et al., 2016). Another screen-based intervention targeting children ages 9 to 12 incorporated electronic TV time monitors and advice to restrict TV watching to 1 hour per day or less (Mhurchu et al., 2009). Participants reduced time spent watching television by 4.2 hours per week, while the control group showed no change.

Dietary Outcomes

Research has shown fairly positive effects of SEM-based interventions on dietary outcomes in youth. In the previously described Memphis GEMS study, the parent and child informational sessions resulted in a 34 percent reduction of sweet beverage consumption and an increase in water consumption for the pre-adolescent participants (Beech et al., 2003).

A series of randomized control trials using individualized counseling to reduce fat intake and increase fruit and vegetable intake followed children from 7 months to 14 years of age (Niinikoski et al., 2007; Rasanen et al., 2004; Talvia et al., 2004; Talvia et al., 2006). The consistent counseling over the course of several years, which involved the parents, resulted in lower fat intake (Niinikoski et al., 2007) and higher vegetable consumption for the children (Talvia et al., 2006).

For younger children, researchers employed a telephone intervention to improve diet by calling preschoolers’ parents for a period of four weeks, implementing parental role modeling strategies, and teaching about supportive food routines (Fletcher et al., 2013; Wyse et al., 2012). Participants’ non-core (not required for health) food intake was significantly lower at two months, but not at the longer-term follow up of six months (Fletcher et al., 2013). The children’s fruit and vegetable intake increased by 1.6 fruits and vegetables a day at two months and by 1.1 fruits and vegetables a day at six months (Wyse et al., 2012).

Substance Use

SEMs have long been applied to the area of substance use (Sallis et al., 2015). A number of empirically based programs have been proven to work better when multiple systems are involved rather than providing substance interventions solely to the youth or adolescent. One such intervention is family behavioral therapy. Family behavioral therapy provides therapy with the client as well as the parent. It teaches families behavioral strategies and encourages them to practice them at home (NIDA, 2020a). A review conducted by Hogue and Liddle (2009) cited the myriad of randomized control trials of family behavioral therapy and touted it as an “efficacious” intervention exceeding over other treatment options (i.e., group and individual CBT, psychoeducation, drug court, and usual care) in reducing adolescent substance use. Multisystemic therapy is another social/health ecological approach that addresses not only family factors but also characteristics of the child, peers, school, and neighborhood (NIDA, 2020b). Treatment occurs in a variety of natural environments, including schools and has been shown to reduce substance use in adolescents. A meta-analysis of effective adolescent substance use interventions found that multisystemic therapy was effective in reducing adolescent alcohol use (Tripodi, Bender, Litschge, & Vaughn, 2010).

Risky Sexual Behavior

SEMs have been applied to the prevention of risky sexual behaviors through the development of frameworks that identify protective factors at various levels of the ecological systems models (DiClemente, Salazar, Crosby, & Rosenthal, 2005). For example, a model developed by Svanemyr, Amin, Robles, and Greene (2015) identifies individual factors such as empowemient and asset development; relationship factors including parental support and communication as well as peer support networks; community strategies such as civic engagement to transfomi gender nonns; and policy approaches including the promotion of human rights and awareness of sexual and reproductive health. The effectiveness of social/health ecological models has also been proven by empirical research. For example, a study conducted by Cooper and Guthrie (2007) with 137 African American adolescent females found that relationships with families and peers that are more positive, as well as more positive neighborhood experiences, were associated with increased engagement with health promotive behaviors and less engagement in risky sexual behavior.

The SEM has also been applied to a number of interventions at various levels of the ecological framework. The Strong African American Fanrilies-Teen (SAAF-T) program is a family-centered intervention with a unit that focuses on teaching condom skills (Kogan et al., 2012). This program has been found to reduce unprotected sex and increase condom efficacy in a sample of (n = 502) 16-year-old African American adolescents. A community level intervention (Be Proud! Be Responsible!) provided through the prevention marketing initiative (PMI) focused on increasing youth awareness of STIs in a sample of 1,364 adolescents (Baume & Strand, 2000). Results of this study found that this community level intervention decreased the likelihood of risky sexual behavior. Overall, ecological models appear to be a very effective way to reduce risky sexual behavior.