Associations between the school environment and ...

HEALTH EDUCATION RESEARCH

Vol.27 no.1 2012 Pages 101–114 Advance Access publication 10 October 2011

Associations between the school environment and adolescent girls’ physical activity

Joanna Kirby*, Kate A. Levin and Jo Inchley School of Medicine, Medical and Biological Sciences Building, North Haugh, University of St Andrews, Fife, KY16 9TF, Scotland, UK. *Correspondence to: J. Kirby. E-mail: [email protected]

Abstract

Introduction

This paper explores school sports facility provision, physical education allocation and opportunities for physical activity and their association with the number of days adolescent girls participate in at least 60 min of moderate-vigorous physical activity per week (MVPAdays). Data were collected through self-administered questionnaires from Scottish secondary school girls (n 5 1978) and head teachers (n 5 123) participating in the Health Behaviour in School-aged Children 2005/06 study. The best predictor of adolescent girls’ MVPAdays was hours allocated to PE in fourth year of secondary school (b 5 0.27, 95% CI 0.06–0.48). Having shower facilities resulted in decreased MVPA (b 5 20.51, CI 20.90 to 20.12), as did providing less than two team sports clubs (b 5 20.69, CI 21.28 to 20.10), compared with schools who provided four or more. Compared with schools with no after school clubs, girls who attended schools with activities at least 1 day per week were likely to have increased MVPAdays. PE allocation and extra-curricular clubs are likely to be of greater importance to girls’ participation than school facilities per se. This study demonstrates how schools can maximize their environment to increase girls’ PA and offers encouraging findings for those with limited sports facilities.

Physical activity is recommended to adolescents in order to achieve both short- and long-term health benefits [1]. Despite continued investment in the promotion of physical activity among young people in Scotland, low levels of physical activity remain, particularly among adolescent girls [2]. Current international guidelines, adopted in Scotland [3], recommend that children and adolescents should engage in a minimum of 60 minutes of at least moderate intensity physical activity each day. The promotion of physical activity is a long-term aim for the Scottish Government, with the target that 80% of those aged 16 and under will meet the minimum level of recommended physical activity by 2022 [3]. As such, young people’s physical activity participation is often measured in relation to whether or not the target is achieved. However, with continued low levels of physical activity among young people, particularly girls, the use of a binary cut-off may mask differences in physical activity behaviour, which are important for identifying influences on physical activity participation among this group. Creating environments that encourage and support physical activity offers the greatest potential for a more active nation [4]. Adolescents spend a large proportion of time at school and, as such, schools are a fundamental setting in which to promote physical activity [5]. Participation should be considered not only in relation to the provision of

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sports provision and physical activity clubs) and physical activity among pupils from two large US studies were not uniformly strong [13]. Implementation of a school environment intervention to increase physical activity among US high school girls indicated that encouraging adaptations which address the unique characteristics of individual schools were most successful in engaging school personnel and changing instructional programmes and school environments [14]. It is well established that adolescent girls are less active than boys and that participation decreases with age [15]. Boys are more likely to be involved in extra-curricular physical activities, as well as taking part more frequently and for longer periods of time per week [16]. Investigation of British pupils’ participation in extra-curricular PE suggests that schools are an important influence on patterns of participation, particularly among girls aged 15– 16 years [17]. In addition, investigation into use of public sports facilities has indicated lower usage among girls than boys, and that more general, multifunctional facilities are used to a greater extent than specialized sports facilities, particularly among the least active [18]. A US study of girls (10–15 years) revealed that having more neighbourhood physical activity facilities was associated with higher levels of physical activity and active travel to school [19]. Knowledge in relation to school sports facilities is, however, limited. Few studies have used both school- and pupillevel data simultaneously to investigate school effects on young people’s physical activity participation, and more specifically among adolescent girls. Findings from Norway showed that outdoor facilities in secondary schools (e.g. areas for hopscotch/skipping rope, soccer field, courts for ball games) were associated with increased participation during school breaks [20]. Likewise, having open fields, outdoor obstacles equipment, playground equipment and gym equipment was associated with increased break time physical activity [21]. Schooland pupil-level characteristics associated with overweight among young people have previously been investigated in Canada [22], where school-level differences accounted for 5.4% of the variability of


physical education (PE) but also in the context of a conducive physical activity environment through, for example, provision of sports facilities, extracurricular activities and school team sports. The implementation of health-promoting schools in Scotland during the last two decades has brought the school environment to the forefront as a stage for health promotion. The recent Schools (Health Promotion and Nutrition; Scotland) Act [6] defines a school as ‘health promoting’ if it ‘provides activities and an environment and facilities which promote the physical, social, mental and emotional health and well-being of pupils’. In Scotland, several school-based initiatives have been developed, aimed at increasing pupil physical activity participation, including the Active Schools Programme, the School Travel Co-ordinators network and the Safer Routes to School Programme. The Report of the Review Group on PE [7] highlighted the need to improve and increase participation and performance in PE, as well as improving sport and activity for life by increasing time allocated to curriculum PE, the range of activities on offer in schools and the number of PE teachers. The school physical environment is thought to influence adolescent physical activity [8]. However, findings are often inconsistent depending on the school environmental factors being assessed, school type and measurement of physical activity. Larger school campuses, school buildings and play areas (per pupil) have been associated with higher physical activity among US middle school pupils [9]. Objective measures of moderate to vigorous physical activity (MVPA; e.g. heart rate telemetry) have demonstrated increases in physical activity among UK primary school children during break time, with the presence of playground markings [10]. Likewise, research in US primary schools has shown gymnasium availability to be associated with additional overall physical activity and number of minutes spent in PE per week [11]. However, environmental and policy interventions aimed at increasing school physical activity have previously been shown to be ineffective among girls [12]. Furthermore, relationships between school physical activity environment (e.g. school PE requirements,

Associations between environment and physical activity

Materials and methods Study design This paper examines Scottish data from secondary school girls taking part in the 2006 Health Behaviour in School-aged Children (HBSC) survey. The research protocol was approved by University of Edinburgh ethics committee. The population was stratified by education authority and school type, defined as either state-funded or independent schools. A nationally representative sample of Secondary 2 (S2) and Secondary 4 (S4) year groups was selected using systematic random sampling and questionnaires were administered in schools between January and March so that the average age of the groups sampled were 13.5 and 15.5 years. Of those S2 and S4 samples included in the survey, approximately half were chosen from the same schools. The questionnaire was completed anonymously in class under teacher supervision. Response rate of schools was 76% and of pupils 89%. The study sample size was n = 1978 (S2 = 987; S4 = 991) and in the final multivariable modelling process n = 1555. Five schools were single sex (all girls only). National representativeness of schools was checked using Scottish school statistics including school roll, proportions of independent and state school pupils and proportion of pupils in receipt of free school meals. More information regarding sampling, recruitment and data collec-

tion, including the rationale for these methods and validation of measures, is available elsewhere [24]. A school-level HBSC survey was carried out alongside the pupil survey. This was sent to all 158 state-funded secondary schools that took part in the HBSC pupil survey. Senior members of staff (head or assistant/deputy head) of 123 secondary schools responded to the school-level questionnaire. The schools that did not respond had approximately the same range and average school roll (mean = approximately 920) and a not dissimilar range and mean proportion of children receiving free school meals (mean = 0.17 compared with 0.14 among those who responded).

Outcome variable Young people were asked how often they took part in at least 60 minutes physical activity a day in the past 7 days with optional responses 0–7 days. Physical activity was described as ‘any activity that increases your heart rate and makes you out of breath some of the time’ and included physical activity done in sports, school activities, playing with friends or walking to school. Examples of types of physical activity were provided, e.g. running, walking quickly, dancing, football. This item is a shortened version of the original, developed by Prochaska et al. [25] and has previously been shown to be reliable and correlate with accelerometer data from US adolescents. The outcome variable in the analysis described below was the number of days per week girls achieved at least 60 minutes of physical activity (MVPAdays). The distribution of MVPAdays among girls is shown in Fig. 1. This is approaching normality with a slight second peak where MVPAdays = 7. The Kurtosis and Skewness [and Standard Error (SE)] measures calculated for this distribution, 0.72 (0.11) and 0.199 (0.05), respectively, were relatively small but significant. Transformations of the measure such as log of MVPAdays, 1/MVPAdays and the square root of MVPAdays resulted in larger kurtosis and considerably larger skewness and were therefore not suitable. Removing response ‘7 days’ resulted in insignificant skewness and a reduced 103


a pupil being overweight versus normal weight. Investigation of school influences on UK primary school children’s physical activity also suggests a significant effect of the school attended [23]. With persistent low levels of physical activity among girls, it is important to understand the potential influence of the school on participation, particularly if continued investment is to be made in school-based programmes. This paper aims to explore the extent to which school initiatives, provision of school sports facilities, time spent in PE and opportunities to be physically active are associated with participation in weekly MVPA among adolescent girls in Scotland.

J. Kirby et al.

Kurtosis of 0.59 (0.12). All analyses were therefore rerun after removal of these cases and findings compared.

Explanatory variables Pupil variables Pupil’s age (continuous variable) and family affluence were included as explanatory variables in the models. The Family Affluence Scale (FAS), used extensively with adolescents [26], was calculated from responses to questions of car ownership, own bedroom, family holidays and computer ownership, combined using categorical principal components analysis, as recommended [27], to produce tertiles of low, medium and high family affluence.

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School variables The school-level questionnaire examined variables in relation to involvement in national initiatives, provision of school sports facilities, opportunities for extra-curricular physical activity and allocation of time to PE. Table I presents the school variables and response categories used in this paper. Only school variables with less than 20% missing were included in the univariate or multivariable analyses. The majority of variables had less than 1% missing. Demographic school-level statistics were also included in the model including school roll and the 2001 Carstairs score, a standardized measure of area deprivation, assigned according to school postcode. The proportion of free school meals for each school was also included in the


Fig 1. The distribution of MVPAdays among adolescent girls

Associations between environment and physical activity Table I. School-level questionnaire variables and response categories Variable

Response categories

Is your school actively involved in the following national initiatives? Health-promoting school Active schools Are you currently working towards a health promoting schools award? Is your school involved in any safer routes to schools activities? Does your school have a school travel plan? Which of the following sports facilities does your school have on-site? (please tick all that apply)

Yes/No

Yes/No Yes, currently/Yes, previously/No Yes/No

How much time is allocated each week for Secondary 2/Secondary 4 pupils at your school? How many of the following types of extra-curricular clubs/activities are offered to pupils at your school? Team sports Individual sports/physical activities Does your school organize physical activity during the school day outside PE classes? Before school hoursa In lunchtime In breaksa After school Other times during the daya

None/One/2–3/4 or more

No/Yes, 1–2 days a week/Yes, 3–4 days a week/Yes, everyday

a

Not included in the univariate or multivariate analysis due to >20% missing.

analyses. These measures of school-level socioeconomic status (SES) have previously been found to be significantly associated with adolescent health [28], also acting as moderators of the relationship between school initiatives and adolescent health [29].

Data analysis Preliminary analyses described the data, presenting frequencies for each of the pupil and school variables. Univariate linear multilevel regression models were fitted with outcome variable MVPAdays, using the statistical software MlWin [30]. Multilevel

modelling methods took account of the clustered nature of the data, pupils clustered within schools, clustered within stratum (education authority and school type). However, the stratum level was not significant for any of the models and was therefore omitted. ‘Univariate’ models adjusted for one explanatory school variable at a time, adjusting for age and FAS of the pupil, and parameter estimates and 95% Confidence intervals (CIs) were calculated. To avoid multicollinearity several models were made, including backward and forward stepwise regressions including only explanatory variables in the univariate analyses with P < 0.15. The best fitting multivariable linear model was then

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Gym/games hall/multi purpose hall used for gym/ playground markings for games/ playing field/ football pitch/ astro-turf pitch/ running track/ tennis court/ swimming pool/ basketball or netball courts or hoops/ other .Hours . minutes

J. Kirby et al. presented, establishing the explanatory variables most important in predicting adolescent physical activity. Unexplained variance at each stage of modelling was presented and discussed. The Akaike Information Criterion (AIC) was calculated at each stage as a measure of model fit with a lower AIC value being favoured. Two-way interaction terms between explanatory variables were also fitted but these were found to be insignificant.

Participant descriptives Descriptive statistics for participant physical activity and SES are presented in Table II. Findings showed mean MVPAdays to be 3.72. SES, as measured by FAS, showed similar proportions of participants from low, medium and high FAS.

School physical activity environment Table III displays a description of school-level variables. The most commonly reported initiatives were the health-promoting school award and active schools. The mean number of on-site sports facilities for schools was 6.31, with almost all (99.2%) schools having an on-site gym or multipurpose hall, which could be used for PE. With the exception of football pitches, the most commonly reported onsite sports facilities were basketball or netball courts/hoops. The majority of schools reported providing shower facilities for their pupils, with fewer providing secure bicycle storage. School activities, both during and after school, were common. Schools were most likely to provide physical activity at lunchtime and after school on 3–4 days a week. The average amount of time allocated to PE was slightly higher in S2 than S4.

Linear regression analyses Preliminary linear regression analyses revealed significant differences in MVPAdays among adolescent girls according to provision of shower facilities, team sport clubs, physical activities after school and time allocated to PE each week in S4 (Table IV). All

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Results

variables were adjusted for age and FAS. Provision of shower facilities at school was associated with a negative effect on MVPAdays ( = 0.49, CI 0.92 to 0.05). A pupil attending a school with shower facilities achieved on average, half a day a week fewer MVPAdays than a pupil attending a school with no shower facilities. Providing physical activity after school once to four times a week increased the likelihood of increased MVPAdays on average by almost half a day, while providing physical activity everyday after school was associated with an increase of 0.26 MVPAdays among girls at these schools. Compared with schools with four team sports clubs or more, girls attending schools with fewer than two team sports clubs achieved 0.74 fewer MVPAdays. For each additional hour of PE in S4, a pupil increased their MVPAdays by an average of 0.29. Furthermore, when the datasets were split and modelled for each grade independently, hours of PE in S4 remained significant for S2 pupils. Table V presents the final multivariable model for the association between pupil and school characteristics and physical activity. Compared with girls with low FAS, those from medium or high FAS achieved on average approximately a quarter or half a day extra of MVPAdays respectively. After adjusting for age and FAS, the best school-level predictor of MVPAdays among adolescent girls was ‘hours of allocated PE in S4’ ( = 0.27, 95% CI 0.06–0.48). This variable explained the greatest proportion of residual variance of all the explanatory variables included. For every extra hour of PE in S4, adolescent girls were likely to achieve an extra 0.27 MVPAdays. The next best predictor was shower facilities. However, having shower facilities at school reduced MVPAdays by half a day ( = 0.51, CI 0.90 to 0.12) for girls attending these schools compared with girls who attend schools without shower facilities. Provision of team sports was the next best predictor. Girls achieved 0.69 fewer MVPAdays if they attended schools with fewer than two team sports clubs ( = 0.69, CI 1.28 to 0.10) compared with schools who provide four or more team sports clubs. The next best school-level predictor of adolescent MVPAdays was the proportion of free school meals. The final predictor of MVPAdays was physical

Associations between environment and physical activity Table II. Participant age, physical activity level and SES Participant measure Number Age (years) [mean (SE)] MVPAdaysa [mean (SE)] FAS [% (n)] Low FAS Medium FAS High FAS

1978 14.49 (0.02) 3.72 (0.04) 34.1 (675) 33.6 (664) 32.3 (639)

a

Mean number of days where at least 60 minutes of physical activity are achieved.

School variables N (Number of schools included in the study) School measures School roll Carstairs scorea Proportion of free school meals Reported measure School awards and national initiatives Health-promoting school Award Yes/working towards one No Active schools Yes No Safer routes to school Currently/previously involved in this initiative No School travel plan Yes No School activities Team sports clubs 4 or more 2–3 Less than 2 Individual sports/activity clubs 4 or more 2–3 Less than 2 Physical activities at lunchtime No Yes, 1–2 days a week Yes, 3–4 days a week Yes, everyday Physical activities after school

123 Mean (SE) 955.80 (27.38) 0.30 (0.29) 0.14 (0.01) % (N)

% missing (N) 0.8 (1)

82.8 (101) 17.2 (21) 13.8 (17) 84.0 (89) 16.0 (17) 3.3 (4) 36.1 (43) 63.9 (76) 3.3 (4) 23.5 (28) 76.5 (91) 0.8 (1) 68.0 (83) 29.5 (36) 2.5 (3) 0.8 (1) 58.2 (71) 33.6 (41) 8.2 (10) 4.9 (6) 10.3 (12) 27.4 (32) 36.8 (43) 25.6 (30) 0.8 (1)

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Table III. Description of school-level variables used in analysis

J. Kirby et al. Table III. Continued School variables 6.6 (8) 27.0 (33) 43.4 (53) 23.0 (28) 99.2 (122) 22.8 (28) 80.5 (99) 76.4 (94) 31.7 (39) 37.4 (46) 13.8 (17) 33.3 (41) 65.0 (80) 95.1 (117) 59.0 (72) 25.2 (31) 6.31 (0.16)

0.8 (1)

1.79 (0.03) 1.60 (0.04)

a

Assigned to school using school postcode. School has this facility on-site.

b

activity after school. Compared with schools with no provision of after-school clubs, girls who attended schools with activities 1–2 days a week, 3–4 days a week or everyday were likely to have an increase in MVPAdays of 0.46, 0.40 and 0.21, respectively. Multivariable analyses were rerun for only those pupils who responded that they were physically active less than 7 days per week. In this instance, findings revealed that after-school activities and shower facilities were no longer significant. However, effect sizes for team clubs and hours of PE in S4 remained approximately the same, with an additional hour of PE per week, increasing girls’ MVPAdays on average by 0.27. Table VI presents the residual variance at the school and child levels on addition of each set of models, including the constant model with only the constant term. The constant model had significant residual variance at both the school and child level under the one sided Wald test. When age and FAS were included, the AIC, directly comparable between models, reduced, indicating an improved 108

model fit. However, the unexplained variance at the school level remained significant. When school variables were added, the AIC again decreased and unexplained variance at the school level became insignificant.

Discussion This study sought to investigate the extent to which school initiatives, provision of school sports facilities, time spent in PE and opportunities to be physically active are associated with participation in weekly MVPA among adolescent girls in Scotland. The strongest school-level predictor of MVPA was time allocated to PE in S4. Interaction analyses showed that this was irrespective of school SES. This is particularly encouraging for schools striving to meet the Scottish Government recommendation of at least 2 hours of quality PE a week [7]. Furthermore, when split by school grade, this was found to be a more important predictor for S2 pupils than hours of PE in S2. This suggests that schools


No Yes, 1–2 days a week Yes, 3–4 days a week Yes, everyday School facilitiesb Gym/multipurpose hall used for gym Playground markings for games Playing field: Football pitch Astro-turf pitch Running track Tennis court Swimming pool Basketball or netball court or hoops Shower facilities for pupils Secure bicycle storage Other on-site sports facilities Total number of on-site sport facilities [mean (SE)] Time allocated to PE Hours per week for S2 pupils [mean (SE)] Hours per week for S4 pupils [mean (SE)]

Associations between environment and physical activity Table IV. ‘Univariate’a linear regression analyses of the associations between school characteristics and MVPAdaysb School Variable

95% CI

0.02 0.02 0.97

0.07–0.12 0.05–0.01 2.01–0.07

0.07

0.32–0.18

0.04

0.34–0.26

0.11

0.32–0.10

0.08

0.16–0.32

0.14

0.62–0.91

0.11

0.35–0.12

0.04

0.20–0.29

0.02

0.22–0.26

0.04

0.25–0.18

0.06

0.26–0.14

0.23

0.51–0.06

0.10

0.30–0.11

0.02

0.23–0.19

0.02

0.25–0.21

0.49

0.92 0.05

0.12 0.04

0.32–0.09 0.09–0.02

0.02 0.74

0.21–0.25 0.14 1.34

0.02 0.06

0.24–0.20 0.42–0.29

0.26

0.13–0.65

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School measure School roll Carstairs scorec Proportion of free school meals Reported measure School awards and national initiatives (ref: not involved) Health-promoting school award Yes/no but working towards one Active School Actively involved in this initiative Safer routes to school Currently/previously involved in this initiative School travel plan Have a school travel plan On-site school facilities (ref: no) Gym/multipurpose hall used for gym Yes Playground markings for games Yes Playing field Yes Football pitch Yes Astro-turf pitch Yes Running track Yes Tennis court Yes Swimming pool Yes Basketball or netball court or hoops Yes Other on-site sports facilities Yes Shower facilities for pupils Yes Secure bicycle storage Yes Total number of on-site sport facilities [mean (SE)] School activities Team sports clubs (ref: 4 or more) 2–3 Less than 2 Individual sports/activity clubs (ref: 4 or more) 2–3 Less than 2 Physical activities at lunchtime (ref: no) Yes, 1–2 days a week

Beta

J. Kirby et al. Table IV. Continued School Variable

Beta

Yes, 3–4 days a week Yes, everyday Physical activities after school (ref: no) Yes, 1–2 days a week Yes, 3–4 days a week Yes, everyday Time allocated to PE Hours per week for S2 pupils [mean (SE)] Hours per week for S4 pupils [mean (SE)]

95% CI

0.24 0.13

0.13–0.61 0.26–0.52

0.43 0.44 0.26

0.01–0.87 0.02–0.86 0.18–0.71

0.15 0.29

0.14–0.45 0.07–0.52

Table V. The final multivariable linear regression analysis of the association between pupil and school characteristics and MVPAdaysa Pupil/school measure Age Family affluence scale Proportion of free school meals (ref: low FAS) Medium FAS High FAS Shower facilities for pupils: (ref: no) Yes Team sports clubs: (ref: 4 or more) 2–3 Less than 2 Physical activities after school (ref: no) Yes, 1–2 days a week Yes, 3–4 days a week Yes, everyday Time allocated each week to PE for S4 pupils

Beta

95% CI

0.21

0.30 0.12

1.34 0.27 0.41

2.49 0.19 0.05–0.49 0.19–0.63

0.51

0.90 0.12

0.04 0.69

0.19–0.27 1.28 0.10

0.46 0.40 0.21 0.27

0.06–0.87 0.01–0.79 0.21–0.63 0.06–0.48

a

Number of days per week where at least 60 minutes of physical activity are achieved.

allocating more time to PE in S4 may differ in their whole school approach to PE. Recent figures suggest that in 2010, 60% of schools in Scotland met this recommendation during the first 4 years of secondary school, but only one in seven for fifth and sixth years [31]. Furthermore, recent findings from the 2010 Scottish HBSC study [32] identified that 11% of girls aged 11–15 years taking part in the study, currently met the Scottish Government’s rec110

ommended physical activity guidelines, indicating that there is still some way to go in increasing girls’ participation levels. While increasing demands are placed on the school timetable as pupils move through their secondary school years, the importance of including PE in the later secondary years is highlighted by the current study findings. Previously, pupils have been found to be more active in the after-school period on days when they have PE


Betas and CIs in bold included in multivariable analyses. a All analyses were adjusted for age and FAS. b Number of days per week where at least 60 minutes of physical activity are achieved. c Assigned to school using school postcode.

Associations between environment and physical activity Table VI. Variance structure of the linear modelling processes: unexplained residual variance at school and child levels Model

School

Child

Total

Constant model Age + FAS Age + FAS + school variables

0.078 (0.042) 0.060 (0.038) 0.000 (0.000)

3.209 (0.119) 3.145 (0.117) 3.139 (0.113)

3.287 3.205 3.139

6257.963 6220.265 6191.593

AIC 6263.963 6232.429 6219.593

school environment due to a reluctance to use school showers. At a time when girls may be undergoing physical changes associated with puberty, feelings of self-consciousness and negative body image are often enhanced [38, 39]. Thus, using communal showers and getting changed may put girls off from being physically active. Indeed, previous qualitative explorations have highlighted a dislike among many adolescent girls in using school showers [37, 40]. However, girls have described not wanting to get hot and sweaty or having to sit in the same clothes after PE [41]. Provision of more private showering facilities may therefore be important in increasing participation. There was no association between having more school sports facilities and increased MVPA levels. Rather, provision of sports clubs and extra-curricular activities appear to be of greater importance in increasing physical activity among adolescent girls. This suggests that opportunities to be physically active may be more important than facilities themselves. This is not to say that having sports facilities is unimportant. This study investigated only one dimension of physical activity, namely MVPA. Other outcome measures such as vigorous physical activity may produce different findings. Indeed, previous research in Norwegian secondary schools found that pupils attending schools with many facilities had 4.49 times higher odds of being physically active compared with pupils attending schools with fewer facilities [20]. However, findings from the current study suggest that lack of on-site facilities need not be a barrier to physical activity participation and therefore offer some encouragement to those schools that are not able to provide sports facilities due to spatial, geographical (e.g. city centre) or financial constraints. In relation to after-school physical activity, although provision 1–4 days a week, appeared to increase MVPAdays among girls, when comparing

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than when this opportunity is deprived [33]. Likewise, participation of physical activity during PE lessons can contribute directly to total participation [34]. However, previous research suggests that actual levels of activity reached during PE lessons are low. In a UK study of 11–14 year olds, for example, heart rate monitoring estimated that pupils engaged in MVPA for only 34% of the lesson [35]. Pupils were found to participate in most MVPA during team games and least during movement activities [35]. Similarly, Wilkin et al. [36] suggest that PE taking place within the school day explains little of the total variance in physical activity levels among young children (4–10 years). Instead, they argue that physical activity among this group is under central biological variation. The current study, however, suggests that PE in school may increase overall MVPA among adolescent girls and therefore confirms the potential for PE to make an important contribution to current health improvement goals. More time spent in PE may help to foster positive factors associated with physical activity participation, such as increased confidence in performing physical activity out of school. Indeed, development of a school PE programme in England, which included giving young people control and choice over their lessons and uniform, as well as improving the physical environment, was found to have a positive effect on participation, resulting in increased self-confidence and acquiring the psychological resources to participate in community-based activities [37]. Having school shower facilities had a negative association with girls’ MVPA. This apparently surprising finding may be due to confounding characteristics at the school or neighbourhood level not included in the analyses. Alternatively, it could be that adolescent girls are deterred from taking part in PE lessons or extra-curricular sport within the

2 Loglikelihood

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relative importance of time spent in PE and physical activity opportunities for adolescent girls. School ethos surrounding physical activity and the opportunities provided in relation to PE time and extra-curricular clubs are likely to be of greater importance to girls than the school’s physical environment, when choosing to be physically active. When multivariable analyses were rerun for only those pupils who responded that they were physically active fewer than 7 days per week, findings revealed that after-school activities and shower facilities were no longer significant. This may suggest that these are of particular importance for those who are more highly active. Effect sizes for team clubs and hours of PE in S4 remained approximately the same, suggesting that incremental increases are associated with these explanatory measures in much the same way across the range of MVPA. While providing new insights into the importance of the school environment for physical activity, these findings should be considered in the context of the study limitations. Thirty-five of the 158 state-funded schools (22%) did not respond to the school-based questionnaire. These were spread across the 32 local authorities. Average school roll and proportion of pupils receiving free school meals did not differ between those schools that responded and those that did not. Nevertheless, the omission of these schools may have resulted in some bias although it is difficult to make assertions on the direction and size of this potential bias. Furthermore, as this study was crosssectional, assertions on the direction of association cannot be made. However, it is unlikely that individuals’ increased MVPA would, for example, result in increased hours of PE in S4 or fewer shower facilities. Nevertheless, relationships may be indirect and due to a common factor unaccounted for in the current analysis. Furthermore, the measure of physical activity was subjective. Vigorous activity is often overreported in self-report surveys [46], whereas moderate physical activity is often under-reported [47]. This said, the measure of physical activity used in this study has previously been demonstrated as valid and reliable [25]. Study findings are specific to adolescent girls attending school in Scotland, and as such, are likely to be context specific. Further examination of these relationships in different countries and among


no days provision with everyday, there was no significant difference, although the effect size was in a similarly positive direction. This may be due to smaller sample sizes, or the fact that schools providing more days of after-school clubs may offer more activities orientated towards participation among boys. Previous research on after-school interventions and physical activity confirm that they have the potential to increase participation, but results are mixed [42]. With the current study highlighting the importance after-school clubs play in increasing adolescent girl physical activity, future studies which identify the types of after-school clubs, which are most successful would be beneficial. Girls who attended schools providing 2–3 sports clubs or fewer were less likely to be physically active than those in schools providing four or more. Providing a wide variety of options is therefore likely to facilitate higher participation levels. Previous evidence has shown that less active girls are more likely to take part in physical activity if they consider it to be fun, informal and unstructured in nature [43]. However, findings from the current study suggest that the emphasis placed on activities being informal and unstructured may not always hold true. Instead, greater provision of team sports clubs was found to have a positive impact on adolescent girls’ participation. A recent US study identified a trend towards greater participation in team sports among 14 year olds [44]. Providing a greater number of team sports may allow adolescent girls to choose an activity, which they feel matches their skill level, increasing confidence and continued participation. Previous findings have shown that an alternative option to competing against other adolescent girls for a place in the good team was to choose a sport that was not as popular [45]. Thus, choice may be the critical factor allowing girls to opt into activities, which provide an appropriate level. Providing a suitable range of activities within extra-curricular provision has a positive influence on increasing physical activity levels among girls, particularly those from lower SES [17]. This study analysed school- and pupil-level data simultaneously to examine the influence of the school environment on adolescent girls’ physical activity participation. In doing so, it has identified the

Associations between environment and physical activity

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Funding 12.

National Health Service Health Scotland. Acknowledgements The HBSC study is an international survey conducted in collaboration with the World Health Organization Regional Office for Europe. The authors would like to acknowledge the HBSC international research network in 41 countries that developed the study’s research protocol.

Conﬂict of interest statement

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None declared. References 1. Hallal PC, Victoria CG, Azevedo MR et al. Adolescent physical activity and health: a systematic review. Sports Med 2006; 36: 1019–30. 2. Scottish Government. Scottish Health Survey 2008 Supplementary Web Tables. Available at: http://www.scotland.gov.

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different cultural groups would be beneficial. However, the findings may be used to inform schools in the planning of strategies to increase physical activity participation among this group, specifically in relation to those aspects of the school environment, which may help to maximize physical activity participation among adolescent girls. Five of the schools taking part in the study were single sex schools (all independent, girl only). Although independent schools were, therefore, skewed towards a female population, this constituted only a few pupils relative to the overall population. As such, comparisons between co-educational schools and girl only schools cannot be made in this study. The effect of a girl only school environment on physical activity participation is an area of consideration for future research. Overall, the results suggest that providing more opportunities to be active within the school setting can have a positive effect on girls’ physical activity levels, even in schools where availability of sports facilities may be limited.

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