Health and Economic Value of Eliminating Socioeconomic Disparities in US Youth Physical Activity.

Importance: There are considerable socioeconomic status (SES) disparities in youth physical activity (PA) levels. For example, studies show that lower-SES youth are less active, have lower participation in organized sports and physical education classes, and have more limited access to PA equipment. Objective: To determine the potential public health and economic effects of eliminating disparities in PA levels among US youth SES groups. Design and Setting: An agent-based model representing all 6- to 17-year-old children in the US was used to simulate the epidemiological, clinical, and economic effects of disparities in PA levels among different SES groups and the effect of reducing these disparities. Main Outcomes and Measures: Anthropometric measures (eg, body mass index) and the presence and severity of risk factors associated with weight (stroke, coronary heart disease, type 2 diabetes, or cancer), as well as direct and indirect cost savings. Results: This model, representing all 50 million US children and adolescents 6 to 17 years old, found that if the US eliminates the disparity in youth PA levels across SES groups, absolute overweight and obesity prevalence would decrease by 0.826% (95% CI, 0.821%-0.832%), resulting in approximately 383 000 (95% CI, 368 000-399 000) fewer cases of overweight and obesity and 101 000 (95% CI, 98 000-105 000) fewer cases of weight-related diseases (stroke and coronary heart disease events, type 2 diabetes, or cancer). This would result in more than $15.60 (95% CI, $15.01-$16.10) billion in cost savings over the youth cohort's lifetime. There are meaningful benefits even when reducing the disparity by just 25%, which would result in $1.85 (95% CI, $1.70-$2.00) billion in direct medical costs averted and $2.48 (95% CI, $2.04-$2.92) billion in productivity losses averted. For every 1% in disparity reduction, total productivity losses would decrease by about $83.8 million, and total direct medical costs would decrease by about $68.7 million. Conclusions and Relevance: This study quantified the potential savings from eliminating or reducing PA disparities, which can help policymakers, health care systems, schools, funders, sports organizations, and other businesses better prioritize investments toward addressing these disparities.

Benefits of Meeting the Healthy People 2030 Youth Sports Participation Target.

INTRODUCTION: Healthy People 2030, a U.S. government health initiative, has indicated that increasing youth sports participation to 63.3% is a priority in the U.S. This study quantified the health and economic value of achieving this target. METHODS: An agent-based model developed in 2023 represents each person aged 6-17 years in the U.S. On each simulated day, agents can participate in sports that affect their metabolic and mental health in the model. Each agent can develop different physical and mental health outcomes, associated with direct and indirect costs. RESULTS: Increasing the proportion of youth participating in sports from the most recent participation levels (50.7%) to the Healthy People 2030 target (63.3%) could reduce overweight/obesity prevalence by 3.37% (95% CI=3.35%, 3.39%), resulting in 1.71 million fewer cases of overweight/obesity (95% CI=1.64, 1.77 million). This could avert 352,000 (95% CI=336,200, 367,500) cases of weight-related diseases and gain 1.86 million (95% CI=1.86, 1.87 million) quality-adjusted life years, saving $22.55 billion (95% CI=$22.46, $22.63 billion) in direct medical costs and $25.43 billion (95% CI= $25.25, $25.61 billion) in productivity losses. This would also reduce depression/anxiety symptoms, saving $3.61 billion (95% CI=$3.58, $3.63 billion) in direct medical costs and $28.38 billion (95% CI=$28.20, $28.56 billion) in productivity losses. CONCLUSIONS: This study shows that achieving the Healthy People 2030 objective could save third-party payers, businesses, and society billions of dollars for each cohort of persons aged 6-17 years, savings that would continue to repeat with each new cohort. This suggests that even if a substantial amount is invested toward this objective, such investments could pay for themselves.

International consensus statement on the design, delivery and evaluation of sport-based interventions aimed at promoting social, psychological and physical well-being in prison.

OBJECTIVE: To develop an international consensus statement to advise on designing, delivering and evaluating sport-based interventions (SBIs) aimed at promoting social, psychological and physical well-being in prison. DESIGN: Modified Delphi using two rounds of survey questionnaires and two consensus workshops. PARTICIPANTS: A multidisciplinary panel of more than 40 experts from 15 international jurisdictions was formed, including representation from the following groups and stakeholders: professionals working in the justice system; officials from sport federations and organisations; academics with research experience of prisons, secure forensic mental health settings and SBIs; and policy-makers in criminal justice and sport. RESULTS: A core research team and advisory board developed the initial rationale, statement and survey. This survey produced qualitative data which was analysed thematically. The findings were presented at an in-person workshop. Panellists discussed the findings, and, using a modified nominal group technique, reached a consensus on objectives to be included in a revised statement. The core research team and advisory board revised the statement and recirculated it with a second survey. Findings from the second survey were discussed at a second, virtual, workshop. The core research team and advisory board further revised the consensus statement and recirculated it asking panellists for further comments. This iterative process resulted in seven final statement items; all participants have confirmed that they agreed with the content, objectives and recommendations of the final statement. CONCLUSIONS: The statement can be used to assist those that design, deliver and evaluate SBIs by providing guidance on: (1) minimum levels of competence for those designing and delivering SBIs; (2) the design and delivery of inclusive programmes prioritising disadvantaged groups; and (3) evaluation measures which are carefully calibrated both to capture proposed programme outcomes and to advance an understanding of the systems, processes and experiences of sport engagement in prison.

The Homeless World Cup through storytelling: The narratives of Street Soccer players from Scotland and the USA.

OBJECTIVES: The purpose of this paper was to explore: (a) What stories do the Street Soccer players draw upon to construct meaning around their experiences of trauma, social exclusion, and homelessness? and (b) What stories are linked to the subjective sport programming experience and resulting future orientations? DESIGN: A longitudinal narrative approach was adopted with semi-structured interviews conducted with players from Scotland and the United States (n = 16, 7 female, 9 male, M age = 27.5) across three time points. Interviews were also conducted with significant others (n = 13) at time point three. All data were analyzed using thematic narrative analysis and represented in creative non-fiction approaches through three composite narratives. RESULTS: These narratives depicted visceral accounts of complex and developmental trauma, along with consequential experiences that unfolded before, during, and after the Homeless World Cup. While both preparing for and attending the event, players recalled concurrent feelings of anxiety and pride which manifested in various resilient and maladaptive coping behaviors. As the stories progressed, players battled a post event crash by engaging in support seeking and/or self-destructive behaviors before positive implications of the Homeless World Cup materialized. CONCLUSIONS: Through creative narrative approaches, this study presents novel and engaging accounts of players' experiences before, during, and after the event. We also identify potential safeguarding concerns that can be addressed through trauma-informed practices.

Sport-based youth development interventions in the United States: a systematic review.

BACKGROUND: The growing number of sport-based youth development interventions provide a potential avenue for integrating sport meaningfully into the U.S. public health agenda. However, efficacy and quality must be reliably established prior to widespread implementation. METHODS: A comprehensive search of databases, peer-reviewed journals, published reviews, and both published and unpublished documents yielded 10,077 distinct records. Title and abstract screening, followed by full-text screening using 6 criteria, resulted in 56 distinct studies (coalescing into 10 sport-based youth development intervention types) included in the synthesis. These studies were then independently assessed and critically appraised. RESULTS: Limited efficacy data were identified, with the quality of methods and evidence largely classified as weak. Processes likely to contribute to the outcomes of sport-based youth development interventions were identified (e.g., predictors of ongoing engagement, alignment between target population and intervention, intervention design), although more rigorous research is needed on these and other processes. Physical health outcomes were only studied in 3 of the 10 intervention types. CONCLUSIONS: The evidence base does not yet warrant wide-scale implementation of sport-based youth development interventions for public health goals within the U. S., although there is promising research that identifies areas for further exploration.