The European Journal of Public Health Advance Access originally published online on July 13, 2005
The European Journal of Public Health 2005 15(4):386-388; doi:10.1093/eurpub/cki084
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Youth Health |
Persistent socio-demographic differences in physical activity among Scottish schoolchildren 1990–2002
Joanna C. Inchley, Dorothy B. Currie, Joanna M. Todd, Patricia C. Akhtar and Candace E. Currie** Child and Adolescent Health Research Unit (CAHRU), University of Edinburgh
Correspondence: Jo Inchley, MSc, Child and Adolescent Health Research Unit, University of Edinburgh, St Leonard's Land, Holyrood Road, Edinburgh EH8 8AQ, UK, Email: jo.inchley{at}ed.ac.uk
Received August 20, 2003, accepted January 30, 2004
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Abstract |
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Background: Regular participation in physical activity can have significant health gains in terms of physical and psychological wellbeing but there is evidence to suggest that many young people are not sufficiently active to benefit their health. This paper examines the socio-demographic patterning of leisure-time vigorous physical activity among Scottish schoolchildren between 1990 and 2002. Methods: The Health Behaviour in School-Aged Children survey of 11-, 13- and 15-year-old schoolchildren has been carried out in Scotland since 1990 at four-yearly intervals. Levels of vigorous physical activity were measured in relation to gender, age and socio-economic status (SES). Results: Girls reported lower levels of vigorous physical activity than boys and this gender difference persisted throughout the four survey years, irrespective of changes in overall levels of physical activity. Vigorous physical activity was also consistently lower among lower SES groups and older adolescents. The effect of gender was greatest, with high-SES girls reporting lower levels of vigorous activity than low-SES boys, and low-SES girls being the least active overall. Conclusion: Scottish adolescent females, especially those from low SES groups, may be at particular risk of the adverse health effects associated with low levels of physical activity. Health promotion programmes to promote physical activity need to address these persistent gender and socio-economic inequalities.
Keywords: adolescents, physical activity, gender, age, socio-economic status
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Introduction |
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Physical inactivity is associated with increased risk of chronic disease and premature mortality1 and has been identified as a major public health challenge in many developed countries.2,3 Increasingly sedentary lifestyles are also thought to have played a key role in rising levels of obesity. Among children and adolescents, physical activity appears also to facilitate optimal growth and development and enhance emotional wellbeing by reducing stress and anxiety and improving self-esteem.4
Research has consistently shown that females are less active than males and that activity levels decrease with age,5 typically peaking in early adolescence and declining into early adulthood. Socio-economic status (SES) is positively associated with physical activity in adults but data from children and adolescents are inconclusive.
From a public health perspective it is important to monitor trends in physical activity in order to inform development of appropriate policies and programmes and assess progress towards health targets. However, comparison of physical activity data collected at different time points is often problematic if different sampling and measurement methods are employed. The Health Behaviour of School-aged Children: WHO Collaborative Cross-National Study (HBSC) provides an important dataset of health behaviours among 11-, 13- and 15-year-olds in an increasing number of countries throughout Europe, Israel and North America.6,7 Using data from the four Scottish HBSC surveys conducted to date, this paper aims to describe the socio-demographic patterning of leisure-time vigorous physical activity between 1990 and 2002 and to explore the inter-relationships between gender, age and SES in relation to physical activity participation.
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Methods |
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HBSC surveys are conducted at four-yearly intervals in all participating countries and provide a range of information on health behaviours and health outcomes as well as demographic, family, peer and school contexts. Four national HBSC surveys have been conducted in Scotland (1990, 1994, 1998 and 2002) in accordance with the study's international protocols.8–11
Survey items
The Scottish HBSC questionnaire includes two items about vigorous physical activity (VPA) outside of school hours. One concerns frequency of activity: how often do you usually exercise in your free time so much that you get out of breath or sweat? (categorized responses: every day, 4–6 times a week, 2–3 times a week, once a week, once a month, less than once a month and never) and the other concerns duration of activity: how many hours a week do you usually exercise in your free time so much that you get out of breath or sweat? (categorized responses: none, about half an hour, about 1 hour, about 2–3 hours, about 4–6 hours, 7 hours or more).
The SES of children is measured using the Family Affluence Scale (FAS).11,12 This scale is a validated measure of material affluence derived from the characteristics of a child's household [car ownership, own bedroom, telephone ownership (1990, 1994)/family holidays (1998, 2002)].
Sample
For each survey, a nationally representative random probability cluster sample of school classes was drawn from mainstream schools including both the state (public) and independent sectors. Data were collected from three school year groups such that the mean age of pupils was 11.5, 13.5 and 15.5 years.
Data analysis
The two items measuring VPA were combined into a single measure of VPA. To do this, responses to the two items were recoded to reflect more accurately the magnitude of the differences between the ordinal responses. A VPA score was then calculated by summing the recoded responses, producing a potential range of 0–14 for individual VPA scores.
FAS scores were calculated by summing the responses to the three component items giving four FAS groups, where 1 indicates lowest and 4 indicates highest family affluence.
Data was analysed using SPSS version 11.5. Mean and standard errors of VPA scores were tabulated by gender for each survey year, age group and FAS group. A four-way factorial analysis of variance was used to gauge the significance of differences in mean VPA scores between groups. Post-hoc multiple comparison of means were carried out.
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Results |
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Table 1 presents mean VPA score for boys and girls by age group, FAS group and survey year. A clear relationship between VPA and gender was found, with girls consistently reporting lower VPA scores than boys. For all ages combined, this gender difference remained constant across the survey years, despite changes in overall levels of VPA participation. Girls consistently had a mean VPA score two points lower than boys, which is equivalent to VPA participation on two fewer occasions or for two fewer hours per week.
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Among boys, the relationship between VPA score and age varied between survey years. In girls, however, there was a steady decrease in VPA score with increasing age. Overall, the difference in mean VPA score between boys and girls at age 11 was 1.4 but this increased to 2.7 at age 15. This corresponds to 15-year old girls participating in VPA 2–3 times or 2–3 hours per week less than boys.
A positive relationship between VPA score and FAS was seen in both boys and girls. The lowest VPA score was found in girls in the lowest FAS group and the highest VPA score was in boys in the highest FAS group, as would be predicted from the results from each factor alone. Mean VPA scores in girls were significantly lower than those in boys for each FAS group. Furthermore, girls in the highest FAS group (FAS=4) had a significantly lower mean VPA score than boys in the lowest FAS group (FAS=1) (P<0.001).
A four-way factorial analysis of variance was carried out to assess the significance of the differences in mean VPA score between age, gender and FAS groups with survey year included as a fourth factor. Table 2 shows the results from the analysis of variance with main effects and significant interaction effects.
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The main effects all reached statistical significance. Significant differences in mean VPA score were observed between genders, age groups and FAS groups, with gender having the strongest effect. Mean VPA score also varied significantly between survey years. There was a significant increase in VPA score with increasing FAS score. Post-hoc tests indicated the difference in mean VPA score between FAS groups were all significant with the exception of the lowest two groups (where FAS=1 or 2). The other main effects must be considered in the light of the two significant interaction effects in the analysis of variance. There was a significant difference in VPA score with increasing age. Although this relationship varied slightly between survey years, with the exception of 1990, VPA score decreased significantly between ages 11 and 15. The gender difference in VPA score was significant at all ages and increased with age.
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Discussion |
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Gender differences in physical activity are well-established, but the data presented here show that these differences have persisted for over a decade in Scotland and have, on the whole, been unaffected by changes in overall levels of physical activity. Girls consistently report lower levels of VPA than boys and this gender difference increases with age. The data also provide evidence for a relationship between SES and physical activity in children and adolescents, with children from lower SES groups consistently reporting lower levels of VPA.
Overall, gender is the most significant factor contributing to differences in physical activity participation. However, the finding that girls from the highest SES groups participate in less leisure-time VPA than boys from the lowest SES groups suggests that there is an additive effect of gender and SES putting girls from low socio-economic backgrounds at particular risk of low physical activity.
Without longitudinal studies tracking into adulthood, it is difficult to determine the long-term health impact of lower levels of physical activity among the female adolescent population. However, the persistent gender differential suggests that, even in the short-term, many girls may be missing out on the psychological and social benefits associated with physical activity participation. They may also be more susceptible to weight gain, which itself has implications for current and future health and wellbeing. Thus, efforts to promote physical activity among the Scottish adolescent population must seek to address these gender inequalities and focus particularly on girls from lower SES groups. This will require an understanding of the determinants of physical activity among girls in order to provide appropriate, targeted interventions. Potential barriers to participation need to be identified and addressed if current trends are to be reversed.
Key points
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Acknowledgments |
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We are very grateful to Sonja Hunt, Leslie Alexander and to anonymous reviewers for comments on earlier drafts of this paper. The HBSC survey in Scotland is funded by NHS Health Scotland (previously the Health Education Board for Scotland). HBSC is an international study conducted in collaboration with the WHO Regional Office for Europe. The current International Coordinator is Candace Currie, CAHRU, University of Edinburgh and the Data Bank Manager is Oddrun Samdal, University of Bergen.
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References |
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1 US Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta: National Center for Chronic Disease Prevention and Health Promotion, 1996.
2 Sparling PB, Owen N, Lambert EV, Haskell WL. Promoting physical activity: the new imperative for public health. Health Ed Res 2000;15:367–76.
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7 Currie C, Roberts C, Morgan A, et al. Editors. Young People's Health in Context. Health Behaviour in School-aged Children: International Report from the 2001/2002 survey. WHO Policy Series: Health Policy for Children and Adolescents, Issue 4. Copenhagen: WHO Regional Office for Europe, 2004.
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11 Currie C, Samdal O, Boyce W, Smith R, Editors. Health Behaviour in School-Aged Children: A WHO Cross-National Study (HBSC): Research Protocol for the 2001/2002 Survey. Edinburgh: Child and Adolescent Health Research Unit, University of Edinburgh, 2001.
12 Currie C, Elton RA, Todd J, Platt S. Indicators of socioeconomic status for adolescents: the WHO Health Behaviour in School-aged Children Survey. Health Ed Res 1997;12:385–97.
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