"Girls Aren't Meant to Exercise": Perceived Influences on Physical Activity among Adolescent Girls-The HERizon Project

Gendered relations? Associations between Swedish parents, siblings, and adolescents' time spent sedentary and physically active

Introduction

The family is assumed to be fundamental in youth socialization processes and development, connected to social and cultural practices such as healthy lifestyles and physical activity. However, gender patterns in physical activity among adolescents and the structural drivers of gender inequality (e.g., parentage and siblingship) are poorly understood. The aim of this study was to explore further how gender structures relate to adolescents' time spent being sedentary and physically active, using contemporary gender theory.

Methods

This cross-sectional study involved 1,139 adolescents aged 13-14 and their parents, including 815 mothers and 572 fathers. Physical activity and time spent sedentary were assessed through accelerometry among adolescents and through a self-report questionnaire for parents validated against accelerometry.

Results

The results showed significant relationships between mothers' moderate-to-vigorous physical activity (MVPA) and girls' MVPA on weekdays and weekends, and fathers' MVPA was significantly related to girls' MVPA on weekdays. Our results imply that the relationship between Swedish parents' and adolescent girls' physical activity in higher intensities are to some extent gendered practices. However, time spent sedentary does not seem to show any patterns of being performed according to binary ideas of gender. Further, our exploratory analyses suggest that these results somewhat intersect with parents' educational level and relate to intra-categorical aspects of doing gender. The results also indicate slight gendered patterns in the "doing" of brotherhood for time spent sedentary, however, for boys only on weekends.

Discussion

The study contributes to the understanding of gender norms as constraints and enablers for adolescents' participation in physical activity. The results can spur public health and physical activity research to apply a contemporary gender theory approach, and to expand the research agenda connected to what relates to gender inequalities in physical activity practices.

Effectiveness of the Walking in ScHools (WISH) Study, a peer-led walking intervention for adolescent girls: results of a cluster randomised controlled trial

BACKGROUND

Most adolescent girls fail to meet current physical activity guidelines. Physical activity behaviours track from childhood into adulthood and providing adolescent girls with opportunities to be physically active may have health benefits beyond childhood. The effects of walking interventions on adult cardiometabolic health are known, however less is understood about the potential of walking to promote physical activity in adolescents. Following the Walking In ScHools (WISH) feasibility study, this definitive trial aimed to evaluate the effectiveness of a novel, low-cost, school-based walking intervention at increasing physical activity levels of adolescent girls (aged 12-14 years).

METHODS

Female pupils were recruited from eighteen schools across the border region of Ireland and in Northern Ireland. In intervention schools (n = 9), girls aged 15-18 years, were trained as walk leaders, and led the younger pupils in 10-15 min walks before school, at break and lunch recess. All walks took place in school grounds and pupils were encouraged to participate in as many walks as possible each week. The primary outcome measure was accelerometer determined total physical activity (counts per minutes, cpm).

RESULTS

In total, 589 pupils were recruited to the study. At baseline, pupils engaged in a median (interquartile range (IQR)) 35.7 (21.2) mins moderate-vigorous physical activity (MVPA) per day and only 12% (n = 66) of participants met physical activity guidelines (60 min MVPA per day). The intervention was delivered for a mean (standard deviation (SD)) 19.9 ± 0.97 weeks. The mean post-intervention total physical activity for the intervention group was 676 cpm and 710 cpm in the control group. Post-intervention total physical activity did not statistically differ between groups when adjusted for age, body mass index z-scores and baseline physical activity (mean difference, -33.5, 95% CI = -21.2 to 88.1; p = 0.213).

CONCLUSIONS

'Scaling-up' physical activity interventions is challenging and despite a promising feasibility study, the results of this fully powered trial suggest that in this context, the WISH intervention did not increase device measured physical activity. Since the COVID-19 pandemic, school environments have changed and although pupils enjoyed the programme, attendance at walks was low, indicating that there is a need to better understand how to implement interventions within schools.

TRIAL REGISTRATION

ISRCTN; ISRCTN12847782; Registered 2nd July 2019.

Do girls wash dishes and boys play sports? Gender inequalities in physical activity and in the use of screen-based devices among schoolchildren from urban and rural areas in Brazil

OBJECTIVE

The aim of the study was to analyze gender inequalities in types of physical activity (PA) and in the use of screen-based devices among schoolchildren from both urban and rural areas in Brazil.

METHODS

Data from two population-based surveys conducted in 2019 (urban areas: n = 2,479; 52.6% girls; age = 9.2 ± 1.51 years) and 2022 (rural areas: n = 979; 42.6% girls; age = 9.4 ± 1.52 years) were used. PA (active play, nonactive play, home chores, and structured physical activities) and the use of screen-based devices (TV, cellphone, videogame, and computer) were self-reported in a previous-day-recall online questionnaire (Web-CAAFE). Absolute gender inequalities were evaluated and presented as equiplots. Relative gender inequalities were evaluated by the prevalence ratio (PR) and respective 95% confidence intervals (95% CI), which were estimated by Poisson regression, with adjustments for age and BMI z scores.

RESULTS

Girls from urban and rural areas presented a lower prevalence of active play and a higher prevalence of home chores. The prevalence of nonactive play among girls from urban areas was also lower; however, their prevalence of structured physical activities was higher, especially among girls aged seven to nine years. Girls in both urban and rural areas presented a higher prevalence of TV viewing and lower use of video games.

CONCLUSION

The gender inequalities observed in the types of physical activities and in the use of screen-based devices could be considered potential correlates of the likelihood of girls' and boys' compliance with the physical activity guidelines.

What are the correlates of intention to be physically active in Brazilian adolescents? A network analysis

OBJECTIVE

The current study aimed to explore the association of individual characteristics, social and environmental factors - school and region - in the intention to be physically active in Brazilian adolescents.

METHODS

This is a cross sectional study based on the third edition of the National School Health Survey. The study included a total of 53,937 adolescents. To assess the intention to be physically active, only who engaged in less than 300 min of physical activity per week were included. Participants were asked: "If you had the opportunity to practice physical activity most days of the week, what would your attitude be?" Individual characteristics, physical activity domains, social factors, school, and regional environments were used as exposures. Network analysis was utilized to evaluate the associations.

RESULTS

We observed that boys had higher intentions to be physically active compared to their peers, as did adolescents who perceived themselves as fat. In addition, students from private schools show a higher intention to regularly engage in physical activities, and in general, private schools offer more extracurricular physical activities.

CONCLUSION

In conclusion, individual factors such as sex and body image perception, and environmental factors such as school administrative dependency and availability of extracurricular activities had a significant contribution to the intention to be physically active among Brazilian adolescents.

Social epidemiology of Fitbit daily steps in early adolescence

BACKGROUND

Sociodemographic disparities in adolescent physical activity have been documented but mostly rely on self-reported data. Our objective was to examine differences in device-based step metrics, including daily step count (steps d-1), by sociodemographic factors among a diverse sample of 10-to-14-year-old adolescents in the US.

METHODS

We analyzed prospective cohort data from Year 2 (2018-2020) of the Adolescent Brain Cognitive Development (ABCD) Study (N = 6460). Mixed-effects models were conducted to estimate associations of sociodemographic factors (sex, sexual orientation, race/ethnicity, household income, parental education, and parental marital status) with repeated measures of steps d-1 over the course of 21 days.

RESULTS

Participants (49.6% female, 39.0% racial/ethnic minority) accumulated an average of 9095.8 steps d-1. In mixed-effects models, 1543.6 more steps d-1 were recorded for male versus female sex, Black versus White race (328.8 more steps d-1), heterosexual versus sexual minority sexual orientation (676.4 more steps d-1), >$200,000 versus <$25,000 household income (1003.3 more steps d-1), and having married/partnered parents versus unmarried/unpartnered parents (326.3 more steps d-1). We found effect modification by household income for Black adolescents and by sex for Asian adolescents.

CONCLUSIONS

Given sociodemographic differences in adolescent steps d-1, physical activity guidelines should focus on key populations and adopt strategies optimized for adolescents from diverse backgrounds.

IMPACT

Sociodemographic disparities in physical activity have been documented but mostly rely on self-reported data, which can be limited by reporting and prevarication bias. In this demographically diverse sample of 10-14-year-old early adolescents in the U.S., we found notable and nuanced sociodemographic disparities in Fitbit steps per day. More daily steps were recorded for male versus female sex, Black versus White race, heterosexual versus sexual minority, >$100,000 versus <$25,000 household income, and having married/partnered versus unmarried/unpartnered parents. We found effect modification by household income for Black adolescents and by sex for Asian adolescents.

Assessing the Feasibility and Acceptability of a Primary Care Socio-Ecological Approach to Improve Physical Activity Adherence among People with Type 2 Diabetes: The SENWI Project

Maintaining an active lifestyle is a key health behavior in people with type 2 diabetes (T2D). This study assessed the feasibility and acceptability of a socio-ecological Nordic walking intervention (SENWI) to enhance healthy behaviors in primary healthcare settings. Participants included individuals with T2D (n = 33; age 70 (95% CI 69-74)) and healthcare professionals (HCPs, n = 3). T2D participants were randomly assigned to a SENWI, active comparator, or control group for twelve weeks. Feasibility and acceptability were evaluated based on a mixed methodology. Quantitative data reported adherence information, differences between follow-up and dropout participants and pre- and post-intervention on physical activity, sedentary behavior, and health outcomes. Qualitative data acquisition was performed using focus groups and semi-structured interviews and analyzed using thematic analysis. Thirty-three T2D invited participants were recruited, and twenty-two (66.7%) provided post-intervention data. The SENWI was deemed acceptable and feasible, but participants highlighted the need to improve options, group schedules, gender inequities, and the intervention's expiration date. Healthcare professionals expressed a lack of institutional support and resources. Nevertheless, no significant difference between the SENWI follow-up and dropout participants or pre- and post- intervention was found (only between the active comparator and control group in the physical quality of life domain). Implementing the SENWI in primary healthcare settings is feasible and acceptable in real-world conditions. However, a larger sample is needed to assess the program's effectiveness in improving healthy behaviors and its impact on health-related outcomes in the long term.

Physiological Stress Responses to Fear and Anxiety in a Height Change Experiment among Non-Labor Teenagers

Working on elevated surfaces without prior experience can be dangerous, particularly for young people, who are significantly more at risk of developing fear and anxiety, which might lead to falls and fatalities. This critical problem has, however, received limited research attention. The present study aimed to demonstrate the associations among physiological responses, fear, and anxiety in Thai teenagers at various height levels. Sixty teenagers (30 males and 30 females) between the ages of 15 and 18 who had no labor skills were recruited to perform the task at 11 levels, starting at zero meters and increasing by one meter at each level. The measurements were examined and recorded once the task at each level was finished. The main results indicated that heart rate was partially positively associated with mean arterial pressure, fear, and anxiety (with all p values < 0.001) in all teenagers (after controlling for level and sex), as well as male and female teenagers (after controlling for level). The present study suggested monitoring heart rate data in teenagers conducting activities at heights, which can be triggered by fear and anxiety, as a strategy for preventing falls from height hazards.

Contextualizing Adolescent Female Physical Activity Behavior: A Descriptive Study

Physical activity (PA) behavior tends to decline as youth get older, especially in female adolescents. The purpose of this study was to develop an understanding of female adolescent moderate-to-vigorous physical activity (MVPA) behavior. Baseline MVPA data was collected during year one of a female-specific PA related program. The Youth Activity Profile was administered to contextualize current middle school female PA levels. Data were collected on over 600 6th-8th grade youths with even distributions by grade. No significant differences between grade, race/ethnicity, and MVPA minutes were found. The average estimated value for daily MVPA across all grades was 43.93 (+/-12.97) min, which is considerably lower than the public health recommendation of 60 min per days. Similar amounts were observed for weekend days 45.03 (+/-19.98) and weekdays 45.50 (+/-13.14); however, allocations were smaller during school (9.45 +/- 5.13 min) than at home (34.04 +/- 11.15). The findings from this study highlight the need for further investigation in developing sustainable and innovative PA interventions that target adolescent females.

Sex and educational level differences in physical activity and motivations to exercise among Spanish children and adolescents

Children and adolescents worldwide, especially girls, do not meet moderate to vigorous physical activity (MVPA) guidelines, a situation which is related to obesity and other comorbidities. Sex/gender differences in the practice of MVPA and motivations to engage in physical activity have not been previously examined among Spanish students considering different educational levels. Therefore, the purpose of this study was to explore these differences and analyse if motivations mediate the relationship between educational levels and MVPA in a large sample of students. From different schools in the Madrid region (primary: 11,122; lower secondary: 12,379; upper secondary: 3228) 26,729 students (13,491 boys and 13,238 girls; 9-19 years old) were recruited to participate in this study. The short form of the International Physical Activity Questionnaire and the third version of the Behavioural Regulation in Exercise Questionnaire were used to evaluate, MVPA and motivations to exercise, respectively. Two-way ANCOVA and a mediation analysis were performed. Female students were found to be less active than males (43.4±38.7 and 58.6±45.9 min of MVPA; p < 0.001; η_p² = 0.023) and showed lower intrinsic (η_p² = 0.003), and integrated (η_p² = 0.007) motivations than their male counterparts (p < 0.001). Primary school students were more active than lower and upper secondary students (53.3±44.2, 49.9±42.3 and 48.0±42.8 min of MVPA; p < 0.001; η_p² = 0.002) and also presented higher intrinsic (η_p² = 0.011) and integrated (η_p² = 0.010) motivation than secondary school students (p < 0.001).    Conclusion:   Among Spanish children and adolescents, females showed lower levels of MVPA and intrinsic and integrated motivation across all the educational levels, and among primary school students in comparison to secondary school. This suggests that inner motivation is more determinant of increased engagement in MVPA and thus, there is need to reinforce it before the transition to secondary school and with special focus on females' preferences. What is Known: •Many children and adolescents worldwide, do not meet physical activity (PA) recommendations. • Within the self-determination theory, autonomous motivation seems to be the main responsible of greater PA levels. What is New: •This study shows for the first time sex and educational level differences in PA levels in a representative sample of Spanish students (9-19 yrs). •Autonomous motivation decreased from primary school onwards and was lower in female students than in their male counterparts.

Shaping Physical Activity through Facilitating Student Agency in Secondary Schools in the Netherlands

Schools can enable students' capability for lifelong physical activity (PA) by providing a physical, social and pedagogical context fostering students' agency. This entails allowing them to develop their autonomy and ability to shape PAs according to what they value. This paper explores whether, and, if so, how, school practices provide the conditions for developing and employing PA-related student agency. We followed a multiple case study design, partnering with six secondary schools in the Netherlands. We based our qualitative content analysis on the schools' policy documents and transcripts of interviews and focus groups with school management, teaching staff and supporting sports professionals. First, we analysed the space provided for PA-related student agency using the whole-of-school framework. Next, we used a social practice theory perspective to understand how each school practice allows for student agency. Results suggest that schools offer sufficient and varied PA opportunities but have not embedded deliberation with students on their meaningfulness and transfer to other contexts in their practices. We conclude that for schools to promote lifelong PA for students, there is a need for a pedagogical approach involving students' perspectives, participation and reflections, enabling them to transfer PAs to other (future) life settings.

The gendered playing field: Family socioeconomic status and national gender inequality in adolescents' out-of-school physical activity

Research has shown that both gender and family socioeconomic status (SES) are important determinants of adolescents' physical activity (PA). This study expands our current knowledge by exploring the moderating role of family SES on gender differences in adolescents' out-of-school PA. We also examine whether this moderating effect varies across countries with different levels of gender inequality. Based on existing empirical studies and theoretical framework, it is hypothesized that 1) gender differences in out-of-school PA would be smaller among adolescents from higher SES families due to them being more likely to share egalitarian gender norms, and 2) this SES gradient in gender differences in adolescents' out-of-school PA would be more salient in countries with lower levels of gender inequality. A total of 316,657 15-year-old adolescents in 50 countries from the 2015 Programme for International Student Assessment (PISA) survey were analyzed. Our multilevel negative binomial regression models show that the gender gap in out-of-school PA is mitigated among families with higher SES, but this moderating role of family SES is less noticeable in countries with higher levels of national gender inequality. Our findings suggest the importance of egalitarian gender culture at both individual and macro-level in understanding gender disparities in adolescents' PA.

Barriers to Physical Activity in Spanish Children and Adolescents: Sex and Educational Stage Differences

According to worrisome childhood obesity and inadequate physical activity (PA) levels worldwide, especially exacerbated in adolescents girls, this work aimed to identify sex and educational stage differences in barriers to meet PA requirements and international guidelines in Spanish children and adolescents considering the entire educational pathway (primary, secondary, and college). The Short Form of the International PA Questionnaire and the Scale of Perceived Barriers were administered to primary, secondary, and college education students (13,491 boys and 13,238 girls, 9–19 yrs). Two-way ANOVA was performed to analyze barriers to PA according to sex and educational stage with physical status as covariate. Higher disliking and time barriers were reported by females (1.5 ± 1.2 and 3.2 ± 1.5 points) in comparison to males (1.2 ± 1.0 and 2.8 ± 1.4), while primary students showed lower disliking and time (1.2 ± 1.0 and 2.8 ± 1.5) and higher safety (3.1 ± 1.8) constraints in comparison to secondary (1.4 ± 1.1, 3.1 ± 1.4, and 2.8 ± 1.7) and college (1.5 ± 1.2, 3.2 ± 1.5, and 2.8 ± 1.6; p < 0.05 for all comparisons). College females showed higher disliking (1.7 ± 1.2) and time (3.5 ± 1.4) barriers than secondary females (1.5 ± 1.2 and 3.3 ± 1.4; p < 0.05). Sex and educational stage were determinant for time and dislike of PA barriers, which were rated higher by female students in comparison to their male counterparts and from primary education onwards. Altogether this, suggests promotion strategies should carefully consider girls and the step into secondary school.

School climate-related determinants of physical activity among high school girls and boys

INTRODUCTION

In the United States, physical activity (PA) among adolescents is declining; 75% of high school students do not meet daily PA guidelines. Low rates of PA are more prevalent among high school girls. Schools provide an optimal environment to target and promote PA. However, school climate has not yet been studied for its importance in promoting PA among high school students, particularly girls.

METHODS

A cross-sectional analysis was conducted using the Georgia Student Health Survey (GSHS) 2.0 data on perceptions of different school climate measures and self-reported weekly PA levels to study gender differences in the association of PA with school climate.

RESULTS

Data from a total of 362,926 students (48% males and 52% females) were analyzed. For both genders, the odds of being physically active increased with a more positive report of supportive school environments, school connectedness, peer social support, school physical environments, cultural acceptance, school safety, and adult social support. Peer victimization was associated with increased odds of PA among females but lower odds for males.

CONCLUSION

Results suggest that improving school climate can increase PA among adolescents. As new or existing school-based interventions and policies are considered by states and local governments, improving the school climate should be part of the overall strategy. Future research is needed on peer victimization among physically active females.

IMPLICATIONS AND CONTRIBUTIONS

This study evaluated gender differences in the association between measures of school climate and PA among high school students. School climate or policies fostering positive environments including feelings of safety, connectedness, and peer support may increase adolescent PA; addressing peer victimization and fights may reduce gender disparities in PA.

Co-design of a school-based physical activity intervention for adolescent females in a disadvantaged community: insights from the Girls Active Project (GAP)

BACKGROUND

Globally, adolescents' physical activity (PA) participation rates are low, particularly among lower socioeconomic groups, with females consistently the least active. The aim of this study was to co-design, with adolescent females, a school-based PA intervention in a single-sex, females-only designated disadvantaged post-primary school in Ireland. This involved using the Behaviour Change Wheel (BCW) and Public and Patient Involvement (PPI). This paper outlines the novel methodological approach taken.

METHODS

The three stages 1) understand the behaviour, 2) identify intervention options, and 3) identify content and implementation options of the BCW guide is described. A student PPI Youth Advisory Group (YAG) (n = 8, aged 15-17) was established. Mixed-methods were used with students (n = 287, aged 12-18) and teachers (n = 7) to capture current self-reported PA levels and to identify factors influencing adolescent females' PA behaviour in their school setting. The intervention options, content and implementation options were identified through discussion groups with the YAG. The Template for Intervention Description and Replication (TIDieR) checklist was used to specify details of the intervention.

RESULTS

Just 1.4% of the students in this sample reported meeting the recommended PA guidelines. Students identified having more 'time' as the strongest predictor to becoming more active in school (Mean = 4.01, 95% CI 3.91 to 4.12). Social influences, environmental context and resources, behavioural regulation, beliefs about capabilities, goals, and reinforcement emerged from the qualitative data as factors influencing PA behaviour at school. The BCW co-design process resulted in the identification of seven intervention functions, four policy categories and 21 Behaviour Change Techniques. The Girls Active Project (GAP) intervention, a peer-led, after-school PA programme was proposed.

CONCLUSIONS

This paper describes how the BCW, a comprehensive, evidence-based, theory-driven framework was used in combination with PPI to co-design a school-based intervention aimed to increase adolescent females' PA levels. This approach could be replicated in other settings to develop targeted behavioural interventions in populations with specific demographic characteristics.

What Happened in 'The HERizon Project'?-Process Evaluation of a Multi-Arm Remote Physical Activity Intervention for Adolescent Girls

This mixed-methods process evaluation examines the reach, recruitment, fidelity, adherence, acceptability, mechanisms of impact, and context of remote 12-week physical activity (PA) interventions for adolescent girls named The HERizon Project. The study was comprised of four arms-a PA programme group, a behaviour change support group, a combined group, and a comparison group. Data sources included intervention deliverer and participant logbooks (100 and 71% respective response rates, respectively), exit surveys (72% response rate), and semi-structured focus groups/interviews conducted with a random subsample of participants from each of the intervention arms (n = 34). All intervention deliverers received standardised training and successfully completed pre-intervention competency tasks. Based on self-report logs, 99% of mentors adhered to the call guide, and 100% of calls and live workouts were offered. Participant adherence and intervention receipt were also high for all intervention arms. Participants were generally satisfied with the intervention components; however, improvements were recommended for the online social media community within the PA programme and combined intervention arms. Autonomy, sense of accomplishment, accountability, and routine were identified as factors facilitating participant willingness to adhere to the intervention across all intervention arms. Future remote interventions should consider structured group facilitation to encourage a genuine sense of community among participants.

Gender Stereotypes among Teachers and Trainers Working with Adolescents

Previous scientific literature has not determined the influence exerted by trainers and teachers of adolescents on the development of gender stereotypes in sport. For this reason, the aims of the present research were to establish differences in gender stereotypes in sport among teachers and trainers as a function of profession and sex and to analyze the influence of age and years of experience of male and female trainers and teachers on the gender stereotypes in sport. For this purpose, 127 teachers and trainers completed the questionnaire "gender beliefs and stereotypes towards physical activity and sport". The results showed a significantly higher score of the teachers in "beliefs about physical activity and gender" (p = 0.048) and of the trainers in "physical education classes and gender" (p = 0.006). Concerning sex, women showed higher scores in "sport and gender" (p = 0.005), and men in "beliefs about physical activity and gender" (p = 0.045). Regarding covariates, age showed significant differences in "sport and gender" (p = 0.029), with female teachers showing higher values with respect to female trainers and male teachers, while years of experience showed differences in "beliefs about sport and gender" (p = 0.044), with male teachers showing higher values than male trainers and female teachers.

Gender Stereotypes among Teachers and Trainers Working with Adolescents

Previous scientific literature has not determined the influence exerted by trainers and teachers of adolescents on the development of gender stereotypes in sport. For this reason, the aims of the present research were to establish differences in gender stereotypes in sport among teachers and trainers as a function of profession and sex and to analyze the influence of age and years of experience of male and female trainers and teachers on the gender stereotypes in sport. For this purpose, 127 teachers and trainers completed the questionnaire "gender beliefs and stereotypes towards physical activity and sport". The results showed a significantly higher score of the teachers in "beliefs about physical activity and gender" (p = 0.048) and of the trainers in "physical education classes and gender" (p = 0.006). Concerning sex, women showed higher scores in "sport and gender" (p = 0.005), and men in "beliefs about physical activity and gender" (p = 0.045). Regarding covariates, age showed significant differences in "sport and gender" (p = 0.029), with female teachers showing higher values with respect to female trainers and male teachers, while years of experience showed differences in "beliefs about sport and gender" (p = 0.044), with male teachers showing higher values than male trainers and female teachers.

The Food and Health Environment in Junior Secondary Schools in Urban Burkina Faso: A Cross-Sectional Study of Administrators, Food Vendors and Early Adolescents

School enrolment rates have increased globally, making the school environment a unique setting to promote healthy nutrition and eating outcomes among early adolescents. In this cross-sectional study, we describe the food and health environment of junior secondary schools in Ouagadougou (Burkina Faso, West Africa). We evaluated the food and health environment using three components: (1) the implementation of health-related policies or guidelines in the schools, (2) the provision of health, nutrition and water, sanitation & hygiene (WASH) services in the schools, and (3) the quality of the school food environment, including foods sold by vendors. We used stratified random sampling to recruit 22 junior secondary schools from the five Ouagadougou districts in 2020. Trained fieldworkers collected standardized questionnaire data from 19 school administrators, 18 food vendors, and 1059 in-school adolescents. We report that only 7 out of 19 school administrators were aware of existing health-related policies and guidelines at their school and only 3 schools had a school health and nutrition curriculum in place. The overall provision of health, nutrition and WASH services was low or inadequate. Likely because of the lack of school canteens, 69% of the students bought snacks and unhealthy foods from food vendors. There is a critical need to improve the food and health environment of junior secondary schools in urban Burkina Faso.

Barriers and Facilitators of Physical Activity Participation in Adolescent Girls: A Systematic Review of Systematic Reviews

Background: Persistent low physical activity (PA) levels among adolescent girls constitute a public health concern that calls for immediate and evidence-based policy action. This systematic review (SR) aimed to summarize evidence from SRs examining the barriers and facilitators of PA participation in adolescent girls. The objectives were to provide a synthesis of the available evidence and identify key areas for fostering gender-responsive action and policy implications. Methods: A comprehensive search of relevant SR and meta-analyses were performed in PubMed and Cochrane Library, until February 2021. Studies were included if they were SRs or meta-analyses, included adolescent girls aged between 10 and 19 years, and described barriers or facilitators of PA. Two independent authors performed the screening of potentially eligible studies and both assessed the methodological quality of included studies using the AMSTAR 2 tool. The barriers and facilitators were synthesized at environmental, interpersonal, and individual levels. Results: A total of eight SRs were included in the qualitative synthesis. The most frequent barriers identified were the lack of support from peers, family, and teachers, and the lack of time. The most reported facilitators were weight loss, and support from peers, family, and teachers. Key areas for action and policy implementation include an inclusive approach to curriculum development to address gender norms; adequate training of professionals so they have a range of skills to ensure inclusion of adolescent girls; environmental changes in and out of schools to stimulate participation, to allow adolescent girls to be active in a safe and attractive environment; multistakeholder support at local, regional, and national level in incorporating a gender-responsive approach toward PA participation. Conclusion: The results highlight a variety of factors that influences the PA participation of adolescent girls. For the attainment of effective policies that increase PA levels in adolescent girls, it is essential to engage several stakeholders at different levels in incorporating a gender-responsive approach toward PA participation. Systematic Review Registration: PROSPERO, identifier: CRD42020204023.

Enabling Better Nutrition and Physical Activity for Adolescents from Middle Eastern Backgrounds: Focus Groups

The obesity epidemic in adolescents from Middle Eastern (ME) backgrounds necessitates co-designed and culturally-responsive interventions. This study's objective was to gather the opinions, attitudes, capabilities, opportunities and motivations of ME adolescents residing in Australia on healthy eating and physical activity (PA) behaviours to inform a future prevention program. Five focus groups were conducted, with 32 ME participants, aged 13-18 years, recruited via purposive and snowball sampling. More participants were female (n = 19) and from lower socioeconomic areas (n = 25). A reflexive thematic analysis was performed using the Capability, Opportunity, Motivation-Behaviour (COM-B) model as the coding framework. Limited nutritional knowledge and cooking skills accompanied by a desire to make dietary changes were reported. Local and school facilities provided adolescents with PA opportunities, but participants declared safety concerns and limited opportunities for females and older grade students. Social support from family and friends were enablers for both healthy eating and PA. Cravings and desire for cultural foods influenced food choices. Individual and/or group approaches using social media and face-to-face format were recommended for future programs. To enable PA and dietary behaviour changes, interventions should be specifically tailored for ME adolescents to improve their nutrition literacy and skills, along with providing safe environments for sport in conjunction with social support.

Integrating needs-supportive delivery into a laboratory-based randomised controlled trial for adolescent girls with overweight and obesity: Theoretical underpinning and 12-week psychological outcomes

When designing efficacy trials, researchers have a responsibility to "do no harm" and to "do good". Given the psychological vulnerability of adolescent girls with overweight and obesity, it is important to consider the implications of participating in weight-related research studies. We investigated psychological outcomes from a 12-week laboratory-based randomised controlled trial aimed at improving body composition and bone health in adolescent girls with overweight and obesity. Sixty-three participants were randomised to three groups (Recommended dairy diet plus exercise (RDa, n = 24); Low dairy diet plus exercise (LDa, n = 25); no-intervention control (n = 14)). Self-Determination Theory-informed strategies were applied in both intervention groups to foster motivation and enhance psychological wellbeing. Motivation, perceived competence and self-perceptions were measured at 0 and 12 weeks. Fifty-four participants (24 RDa, 23 LDa, 7 Control) provided complete psychological data. There were no between group differences in 0- to 12-week change in motivation, perceived competence or global self-worth. Both intervention groups showed significant improvements in physical self-worth (p = 0.001), body satisfaction (p = 0.002) and perceived physical conditioning (p = 0.002), compared with the control group. A theory-informed, laboratory-based diet and exercise intervention produced favourable psychological outcomes for adolescent girls with overweight and obesity.

Formative Evaluation of a Home-Based Physical Activity Intervention for Adolescent Girls-The HERizon Project: A Randomised Controlled Trial

BACKGROUND

This is a formative evaluation study of the HERizon Project, a home-based multi-component physical activity (PA) intervention for adolescent girls in the UK and Ireland. Although not intended, this study coincided with the initial COVID-19 lockdown restrictions.

METHODS

A total of 42 female participants, aged 13 to 16 years old (mean = 14.2, SD = 1.1), were randomly allocated to: (i) the HERizon group (n = 22) or (ii) the wait-list control group (n = 20). Participants in the six-week HERizon group were asked to complete three PA sessions each week and engage in weekly behaviour change support video calls. The primary outcome measure was self-reported habitual PA. Secondary outcomes measures included cardiorespiratory fitness (20 m shuttle run), muscular strength (standing long jump), muscular endurance (push up test), and psychosocial outcomes (Perceived Competence Scale, Body Appreciation Scale, Self-Esteem Questionnaire, Behavioural Regulation in Exercise Questionnaire). Quantitative and qualitative process evaluation data were also collected. Outcome measures were assessed at baseline and after the six-week intervention.

RESULTS

There was no significant change in habitual PA between groups (LMM group*time interaction: p = 0.767). The HERizon group had significantly increased cardiorespiratory fitness (p = 0.001), muscular endurance (p = 0.022), intrinsic motivation (p = 0.037), and body appreciation (p < 0.003) in comparison to the wait-list control group. All participants in the intervention group completed the intervention and compliance to the intervention was high (participants completed 18 ± 2 sessions).

CONCLUSIONS

Although no change in PA was observed, HERizon resulted in improved physical fitness and psychosocial outcomes. These preliminary findings, alongside positive findings for feasibility and acceptability, highlight potential benefits from the home-based intervention, thus further investigation is warranted.