ARTICLE

Sports Participation and Health-Related Behaviors

Among US Youth
Russell R. Pate, PhD; Stewart G. Trost, PhD; Sarah Levin, PhD; Marsha Dowda, DrPH

Objective: To examine the relationship between sports

participation and health-related behaviors among high
school students.
Design: Cross-sectional design using data from the 1997
Centers for Disease Control and Prevention Youth Risk
Behavior Survey.
Participants: A nationally representative sample of

14221 US high school students.

Main Outcome Measures: Prevalence of sports par-

ticipation among males and females from 3 ethnic groups

and its associations with other health behaviors, including diet, tobacco use, alcohol and illegal drug use, sexual
activity, violence, and weight loss practices.
Results: Approximately 70% of male students and 53%
of female students reported participating on 1 or more
sports teams in school and/or nonschool settings; rates
varied substantially by age, sex, and ethnicity. Male sports

From Department of Exercise

Science and Prevention
Research Center (Drs Pate,
Trost, and Dowda), and the
Department of Epidemiology
and Biostatistics (Dr Levin),
University of South Carolina,
School of Public Health,
Columbia.

participants were more likely than male nonparticipants to report fruit and vegetable consumption on the
previous day and less likely to report cigarette smoking,
cocaine and other illegal drug use, and trying to lose
weight. Compared with female nonparticipants, female
sports participants were more likely to report consumption of vegetables on the previous day and less likely to
report having sexual intercourse in the past 3 months.
Among white males and females, several other beneficial health behaviors were associated with sports participation. A few associations with negative health behaviors were observed in African American and Hispanic
subgroups.
Conclusion: Sports participation is highly prevalent

among US high school students, and is associated with

numerous positive health behaviors and few negative
health behaviors.
Arch Pediatr Adolesc Med. 2000;154:904-911

PORTS PARTICIPATION has long

been thought to provide

youth with a prosocial environment that fosters basic
values, such as fair play, competitiveness, and achievement.1-3 Sports
may also help protect participants against
negative influences that can lead to delinquency and drug abuse.4-6 Because sports
participation typically involves substantial amounts of physical activity, the health
benefits of regular exercise would be expected to accrue to young athletes. Also,
because team rules and guidelines often
promote health-enhancing behaviors, such
as proper nutrition and avoidance of cigarette smoking, sports participation might
promote healthy lifestyles via social environmental pathways. Indeed, there is some
evidence that youthful sports participants manifest better health habits than
nonparticipants.7 However, the health benefits of sports participation have been ques-

(REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 154, SEP 2000

904

tioned recently,8 and some studies have

found sports participation to be associated with certain risk-taking behaviors
among elementary school,9 junior high
school,10 high school,11 and college students.12,13
In the past decade it has been suggested that sports participation may have
different meanings and consequences for
different ethnic groups14,15 and that the
benefits of sports participation may have
been overestimated for minority youth.16
No previous study to date, however, has
examined the impact of sports participation on other health behaviors in a nationally representative sample of minority
youth. A further limitation of the existing literature is that few studies have examined the relationship between sports
participation and health by observing multiple health behaviors, and no studies have
examined the relationship between sports
participation and a comprehensive set of

WWW.ARCHPEDIATRICS.COM

2000 American Medical Association. All rights reserved.

Downloaded From: http://archpedi.jamanetwork.com/ by a University of Maryland User on 12/03/2014

PARTICIPANTS AND METHODS

Data for this study were taken from the 1997 YRBS. The
survey design is described in detail elsewhere.18 Briefly, a
3-stage cluster sampling procedure was used to produce a
nationally representative sample of 9th- through 12thgrade students in public and private schools in the 50 states
and District of Columbia. The 3 stages consisted of (1) large
counties or groups of smaller adjacent counties that made
up the primary sampling units, (2) schools, and (3) classes.
Schools with substantial numbers of African American and
Hispanic students were sampled at a higher rate to ensure
adequate numbers to reliably produce prevalence estimates for these ethnic groups. Response rates were 79.1%
for schools and 87.2% for students.

to sexual activity were used to create 3 variables related to

sexual behavior: having sexual intercourse during ones lifetime, having sexual intercourse in the past 3 months, and
having sexual intercourse with more than 1 partner in the
past 3 months. Weight loss practices were assessed with 3
items including (1) trying to lose weight, (2) vomiting or
using laxatives to lose weight, and (3) using diet pills to
lose weight. The latter 2 items were combined for the analyses. One survey item was used to measure frequency of participation in vigorous physical activity during the previous week. Responses to all items were dichotomized as
ever vs never except for the vigorous physical activity
item, which was dichotomized as fewer than 3 days or 3 to
7 days per week, and the multiple sexual partners item,
which was dichotomized as 1 or fewer vs 2 or more partners in the past 3 months. The YRBS has been shown to
have acceptable reliability in measuring health-related behaviors in adolescents.19

SAMPLE

DATA ANALYSES

Of 16262 survey respondents, 14221 were included in these

analyses (87.4%). Approximately 39% were white, 31% African American, and 30% Hispanic. Excluded were students with missing information for any 1 of the following
items: age (n=18), sex (n=9), ethnicity (n=118), participation in school sports (n = 167), participation in sports
teams run by organizations outside of school (n=225), and
participation in vigorous physical activities (n = 31). Also
excluded, due to small numbers, were those who described themselves as Asian or Pacific Islander (n = 641),
Native American or Alaskan Native (n = 139), or other
(n=693).

All analyses were performed using a SAS version of

SUDAAN.20 Males and females were analyzed separately.
Weighted percentages for sports participation (school, nonschool, and combination of school and nonschool sports)
were calculated for the total sample and for population subgroups defined by sex, ethnicity, and age. Unadjusted odds
ratios and 95% confidence intervals (CIs) were first calculated to examine the crude association between sports participation and each health behavior. Individual multiple logistic regression analyses were then used to examine the
relationship of sports participation and each health behavior while controlling for age, race/ethnicity, and days of vigorous physical activity. Vigorous physical activity was included in each model because previous studies have shown
participation in vigorous physical activity to be associated
with some other health behaviors.21,22 With the exception
of vigorous physical activity, each health behavior was coded
as a negative health behavior (eg, not eating fruits or vegetables on the previous day). Thus, an odds ratio of less
than 1 always indicated that sports participants were less
likely than nonparticipants to engage in that behavior. To
determine if the association between sports participation
and other health behaviors varied by ethnicity or age group,
interaction terms (eg, sports participation3ethnicity) were
created and added to each logistic model. To minimize the
possibility of type I errors, only interactions with associated probabilities of less than .01 were considered statistically significant. When an interaction term was statistically significant, separate logistic analyses were performed
to estimate group-specific odds ratios and 95% CIs.

SURVEY DESIGN

MEASURES
The 88-item YRBS self-report instrument was administered in school classrooms by trained administrators. Data
for the present study were obtained from a subset of 27 items
pertaining to participation on sports teams, vigorous physical activity, dietary habits, substance abuse, sexual activity, violence, and weight loss (Table 1). Sports participation was defined as playing on 1 or more sports teams, run
by the school or by organizations outside of the school, during the past 12 months. Six survey items related to dietary
habits were collapsed to create 3 measures of dietary behavior: fruit consumption, vegetable consumption, and fat
intake on the previous day. Substance abuse variables included alcohol consumption, binge drinking, tobacco use,
marijuana use, cocaine use, other illegal drug use, sniffing
glue, and anabolic steroid use. Two survey items related

health behaviors in a nationally representative sample of

male and female adolescents.
The Youth Risk Behavior Survey (YRBS) conducted by the Centers for Disease Control and Prevention provides data on a nationally representative sample
of US high school students and allows for investigation
of the relationship between sports participation and various behaviors known to influence health.17 The purposes of this investigation were to describe the rates of
sports participation among US high school students and
to explore associations between sports participation and

selected positive and negative health behaviors. These relationships were examined separately for males and females, and possible interactions with ethnicity were considered for both sexes.
RESULTS

Prevalence estimates for participation in high school

and/or nonschool sports are shown in Table 2. Nationwide, 62.4% of high school students reported participating on 1 or more school and/or nonschool sports teams

(REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 154, SEP 2000

905

WWW.ARCHPEDIATRICS.COM

2000 American Medical Association. All rights reserved.

Downloaded From: http://archpedi.jamanetwork.com/ by a University of Maryland User on 12/03/2014

Table 1. Selected Items From the 1993 Youth Risk Behavior Survey
Sports Participation
During the past 12 months, on how many sports teams run by your school did you play? (Do not include PE [physical education] classes.)
During the past 12 months, on how many sports teams run by organizations outside of your school did you play?
Dietary Habits
Yesterday, how many times did you eat fruit?
Yesterday, how many times did you drink fruit juice?
Yesterday, how many times did you eat green salad?
Yesterday, how many times did you eat cooked vegetables?
Yesterday, how many times did you eat hamburger, hot dogs, or sausage?
Yesterday, how many times did you eat french fries or potato chips?
Vigorous Physical Activity
On how many of the past 7 days did you do exercise or participate in sports activities for at least 20 minutes that made you sweat and breathe hard, such
as basketball, jogging, fast dancing, swimming laps, tennis, fast bicycling, or similar aerobic activities?
Substance Abuse
During the past 30 days, on how many days did you have at least 1 drink of alcohol?
During the past 30 days, on how many days did you have 5 or more drinks of alcohol in a row, that is, within a couple of hours?
During the past 30 days, on how many days did you smoke cigarettes?
During the past 30 days, on how many days did you use chewing tobacco or snuff, such as Redman, Levi Garrett, Beechnut, Skoal, Skoal Bandits, or
Copenhagen?
During the past 30 days, how many times did you use marijuana?
During your life, how many times have you used any form of cocaine, including powder, crack, or freebase?
During your life, how many times have you used any other type of illegal drug, such as LSD [lysergic acid diethylamide], PCP [phencyclidine], ecstasy,
mushrooms, speed, ice, or heroin?
During your life, how many times have you sniffed glue, or breathed the contents of aerosol spray cans, or inhaled any paints or sprays to get high?
During your life, how many times have you taken steroid pills or shots without a doctors prescription?
Sexual Activity
During your life, with how many people have you had sexual intercourse?
During the past 3 months, with how many people did you have sexual intercourse?
Violence
During the past 12 months, how many times were you in a physical fight in which you were injured and had to be treated by a doctor or nurse?
During the past 30 days, on how many days did you carry a weapon such as a gun, knife, or club?
During the past 12 months, did you ever seriously consider attempting suicide?
During the past 12 months, how many times did you actually attempt suicide?
Weight Loss
Which of the following are you trying to do about your weight (eg, lose weight, gain weight)?
During the past 30 days, did you vomit or take laxatives to lose weight or keep from gaining weight?
During the past 30 days, did you take diet pills to lose weight or keep from gaining weight?

in the previous year. Male students (69.9%) were more

likely than female students (53.4%) to participate in sports
and this pattern was consistent across all 3 ethnic groups.
Younger students (65.6%) were more likely than older
students (58.1%) to participate in sports, while white students (65.4%) were more likely than African American
(55.2%) or Hispanic students (52.5%) to report sports
participation. The majority of sports participants played
on a school sports team (22.5% of total) or a combination of school and nonschool sports teams (29.0% of total).
Only 11.0% of all students participated solely on a team
run by an organization outside of school.
Crude odds ratios and 95% CIs for the associations
between sports participation and selected health behaviors are shown in Table 3. Female sports participants
were significantly less likely than female nonparticipants to report not eating fruits and vegetables on the
previous day and were more likely to report 3 or more
20-minute sessions of vigorous physical activity during
the previous week. In addition, female sports participants were less likely than female nonparticipants to report cigarette smoking, using marijuana or cocaine, having sexual intercourse during their lifetime, having sexual
intercourse during the past 3 months, and contemplat-

ing or attempting suicide. The only negative behavior associated with sports participation in females was reported use of chewing tobacco or snuff; however, only
1.5% of all females reported this behavior.
Male sports participants were less likely than male
nonparticipants to not report eating fruits and vegetables
on the previous day and were more likely to report 3 or
more 20-minute sessions of vigorous physical activity during the previous week. In addition, male sports participants were significantly less likely than male nonparticipants to report cigarette smoking; using marijuana, cocaine,
or other illegal drugs; sniffing glue; contemplating suicide; carrying a weapon; and trying to lose weight.
The results of the multiple logistic regression analyses are shown in Table 4. Compared with female nonparticipants, female sports participants from all ethnic
groups were less likely to report not eating vegetables on
the previous day and were less likely to report having
sexual intercourse in the past 3 months. Most other significant associations were specific to white females, among
whom there were 11 protective associations. There were,
however, several negative health behaviors associated with
sports participation. African American female sports participants were more likely than nonparticipants to re-

(REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 154, SEP 2000

906

WWW.ARCHPEDIATRICS.COM

2000 American Medical Association. All rights reserved.

Downloaded From: http://archpedi.jamanetwork.com/ by a University of Maryland User on 12/03/2014

Table 2. Weighted Percentages of Participation in High School Sports and Nonschool Sports: 1997 Youth Risk Behavior Survey
Participation, Weighted % (95% Confidence Intervals)
Characteristic
Overall
Sex
Male
Female
Race/ethnicity
White
Male
Female
African American
Male
Female
Hispanic
Male
Female
Age, y
All
#16
.16
Male
#16
.16
Female
#16
.16

High School
Sports Only

Nonschool
Sports Only

Both Sports

Total

22.5 (21.1-23.9)

11.0 (9.9-12.1)

29.0 (25.4-32.6)

62.5 (59.5-65.3)

23.3 (21.3-25.3)
21.6 (20.0-23.2)

12.8 (11.5-14.1)
8.7 (7.5-9.9)

33.8 (29.9-37.7)
23.1 (18.8-27.4)

69.9 (67.3-72.5)
53.4 (49.1-57.4)

24.0 (22.4-25.6)
24.1 (21.7-26.6)
23.9 (21.7-26.0)
17.2 (15.2-19.2)
19.3 (16.2-22.4)
15.2 (12.7-17.7)
19.5 (16.8-22.2)
21.9 (18.9-25.0)
16.7 (12.9-20.5)

10.8 (9.4-12.1)
12.1 (10.4-13.8)
9.0 (7.3-10.7)
10.8 (9.1-12.6)
14.4 (11.7-17.0)
7.5 (5.6-9.3)
12.3 (10.3-14.2)
15.5 (12.9-18.0)
8.5 (6.4-10.8)

30.6 (26.1-35.1)
34.6 (29.8-39.3)
25.5 (19.7-31.3)
27.2 (24.7-29.7)
37.3 (33.5-41.1)
17.7 (14.4-21.0)
20.7 (18.0-23.4)
25.0 (20.5-29.6)
15.6 (12.8-18.3)

65.4 (61.8-69.0)
70.8 (67.8-73.8)
58.4 (52.8-64.1)
55.2 (52.4-58.0)
71.0 (67.6-74.6)
40.4 (36.7-43.9)
52.5 (49.3-55.7)
62.4 (59.4-65.5)
40.8 (35.9-45.5)

22.3 (20.8-23.8)
22.9 (20.3-25.4)

11.7 (10.8-12.6)
9.9 (8.2-11.6)

31.6 (28.6-34.6)
25.4 (20.5-30.3)

65.6 (62.3-68.8)
58.2 (54.1-62.2)

22.4 (20.1-24.7)
24.4 (21.4-27.4)

13.1 (11.8-14.5)
12.4 (10.4-14.3)

36.9 (33.1-40.5)
29.9 (25.0-34.8)

72.4 (68.6-76.2)
66.7 (63.3-70.1)

22.1 (20.2-24.1)
20.8 (17.5-24.2)

10.2 (9.0-11.3)
6.5 (4.5-8.6)

25.6 (22.5-28.7)
19.3 (12.5-26.0)

57.9 (54.3-61.6)
46.6 (43.3-53.2)

port other illegal drug use, while Hispanic female sports

participants were more likely than nonparticipants to report carrying a weapon and using steroids.
Among males, sports participants across all 3 ethnic
groups were less likely than nonparticipants to report cigarette smoking, cocaine and other illegal drug use, steroid use,
and trying to lose weight. They were also less likely to report not eating fruits and vegetables on the previous day.
Among white males there were 5 additional protective associations.Whitemaleparticipantswerelesslikelythanmale
nonparticipants to report smoking marijuana, sniffing glue,
having sexual intercourse with multiple partners, carrying
a weapon, and contemplating suicide. In contrast, in African American males, sports participants were more likely
thannonparticipantstoreporthavingsexualintercourseduring their lifetime, having sexual intercourse with multiple
partners, and contemplating suicide. No significant racespecific associations were observed among Hispanic males.
While many significant associations between
sports participation and health behavior were observed,
it is important to note that several health behaviors
were not associated with sports participation in any
population group. For example, sports participants
were equally as likely as nonparticipants to report eating foods high in fat, engaging in 1 or more episodes of
binge drinking in the previous month, being involved
in a physical fight, and vomiting or using laxatives to
lose or control weight.
COMMENT

The results of this study demonstrate that American high

school students are exposed to an enormous amount of

organized sports programming. The YRBS indicates that,

in 1997, approximately 62% of US high school students
participated on at least 1 sports team in school and/or
nonschool settings. This proportion corresponds to more
than 10 million youth. This exposure, while observed to
be large in all demographic subgroups, was unevenly distributed across age, sex, and ethnic groups. White students were more likely to report sports participation than
African American and Hispanic students, and, despite the
tremendous increase in sports programming for girls since
the passage of Title IX legislation in 1972,23 a substantially greater percentage of males than females reported
sports team participation. The sex differences were particularly dramatic in African American and Hispanic
youth, among whom only 40% of girls participated on a
sports team. Nonetheless, despite these inequities, organized sports programs clearly represent a large and influential component of American youth culture. Hence,
the potential for these programs to affect health behavior in the nations population of high schoolaged students appears to be great.
The major conclusion drawn from the analyses performed in this study is that, in the most populous demographic subgroups of US high school students, sports
participation is associated with multiple positive health
behaviors. This trend was most striking for white
females and white males, among whom sports participation was significantly associated with numerous positive
health behaviors and almost no negative health behaviors. Among African American and Hispanic students,
fewer associations with positive health behaviors and
some associations with negative behaviors were
observed. Our finding of a generally favorable relation-

(REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 154, SEP 2000

907

WWW.ARCHPEDIATRICS.COM

2000 American Medical Association. All rights reserved.

Downloaded From: http://archpedi.jamanetwork.com/ by a University of Maryland User on 12/03/2014

Table 3. Weighted Percentages and Crude Odds Ratios (ORs) for Selected Health-Related Behaviors
Among High School Students by Participation in School and Nonschool Team Sports: 1997 Youth Risk Behavior Survey
Males (n = 7033)

Females (n = 7188)

OR (95%
OR (95%
Participation* % Nonparticipation* % Confidence Interval) Participation* % Nonparticipation* % Confidence Interval)

Behavior
Dietary habits
Did not eat fruit or
drink fruit drink
Did not eat salad or
vegetables
Did eat fatty foods
Vigorous physical activity
Regular vigorous
activity
Substance abuse
Alcohol use
Binge drinking
Smoking
Marijuana use
Sniffed glue/spray
cans
Chewing tobacco/
snuff
Cocaine use
Other illegal drug use
Steroid use
Sexual activity
Sexual intercourse
ever
Sexual intercourse
in past 3 mo
Multiple partners
in past 3 mo
Violence
Physical fight injury
Carry a weapon
Consider suicide
Attempt suicide
Weight loss
Trying to lose weight
Vomit or use laxatives
or pills

3166

13.4

4014

25.3 0.46 (0.34-0.62)

4645

12.2

2382

22.5 0.48 (0.39-0.59)

3168

31.4

4017

43.4 0.59 (0.54-0.65)

4650

34.4

2379

43.9 0.67 (0.55-0.82)

3170

60.8

4016

64.9

0.84 (0.69-1.02)

4647

76.1

2382

74.2

3170

71.2

4018

35.5 4.51 (3.56-5.71)

4651

82.2

2382

49.0 4.78 (3.74-6.13)

3038
3135
2966
3142
3165

48.0
29.4
32.1
18.2
13.4

3853
3976
3757
3976
4016

49.5 0.94 (0.76-1.16)

28.2 1.06 (0.86-1.32)
39.3 0.73 (0.60-0.90)
25.1 0.67 (0.49-0.90)
15.1 0.87 (0.71-1.08)

4377
4558
4304
4565
4645

53.7
39.1
34.8
27.4
16.0

2259
2330
2225
2347
2376

55.2 0.94 (0.80-1.10)

38.3 1.04 (0.89-1.21)
44.6 0.66 (0.57-0.77)
34.8 0.71 (0.60-0.83)
23.2 0.63 (0.51-0.79)

3156

1.9

4001

1.0 1.84 (1.03-3.28)

4604

18.2

2368

14.2

3165
3126
3164

1.3
11.9
1.6

4008
3953
4016

3.5 0.37 (0.15-0.94)

17.7 0.63 (0.50-0.79)
2.2 0.70 (0.26-1.92)

4627
4591
4640

3.1
16.3
3.6

2371
2342
2377

5.4 0.56 (0.41-0.78)

23.4 0.64 (0.49-0.84)
4.0 0.89 (0.62-1.27)

3118

41.1

3946

55.2 0.57 (0.48-0.67)

4499

48.6

2298

51.4

0.89 (0.73-1.10)

3116

31.5

3944

43.0 0.61 (0.52-0.71)

4484

33.8

2288

35.4

0.93 (0.75-1.16)

3116

5.8

3944

0.78 (0.52-1.18)

4484

10.7

2288

12.5

0.83 (0.66-1.06)

3159
3144
3129
2893

2.0
5.8
23.0
9.0

4009
3982
3996
3693

1.7 1.20 (0.71-2.04)

7.6 0.74 (0.50-1.12)
29.1 0.73 (0.62-0.85)
12.5 0.70 (0.52-0.93)

4623
4542
4604
4205

4.2
26.6
12.2
3.5

2374
2324
2366
2141

4.5 0.93 (0.55-1.56)

31.7 0.78 (0.66-0.92)
19.1 0.59 (0.49-0.71)
4.8 0.71 (0.47-1.09)

3168
3158

61.7
13.3

4011
3992

58.7
11.9

4638
4615

20.6
3.6

2376
2370

28.0 0.67 (0.61-0.73)

4.1 0.89 (0.48-1.63)

7.3

1.13 (0.94-1.37)
1.14 (0.91-1.42)

1.11 (0.93-1.31)

1.34 (1.00-1.80)

*Unweighted n.
Significant OR.

ship between sports participation and health behaviors

may be attributable, in part, to the organizational structures and cultural norms that characterize school and
community-based sports programs. For example, sports
programs may promote positive health behaviors and
deter negative health behaviors by placing a premium
on personal health and fitness as prerequisites to optimal sports performance. Also, it is possible that participation in organized sports promotes health by placing
youth in prosocial environments during time periods
that are otherwise available for participating in problem
behaviors.
School and community sports programs have the potential to help youth establish lifelong, healthy, physical
activity patterns.24-27 National organizations and physical activity experts recommend regular vigorous physical activity for youth,28-30 yet many youth do not engage
in the quality and quantity of physical activity recommended.24,31 In this study, sports participants were much

more likely to report participation in regular vigorous activity (at least 3 times per week, for 20 minutes or more
per session) than nonparticipants. These findings suggest that sports participation, through its independent
association with other selected health behaviors and its
association with increased participation in regular vigorous physical activity, may have important public health
consequences for youth.
For white students, sports participation was consistently associated with positive health behaviors. However, among African Americans and Hispanics, the relationship between sports participation and other health
behaviors was less consistent. Relative to whites, fewer
significant associations with positive behaviors were
observed among African American and Hispanic students, and all but one of the significant associations with
negative health behaviors were observed in minority students. Similar observations have been reported in previous surveys conducted with state- and school-level

(REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 154, SEP 2000

908

WWW.ARCHPEDIATRICS.COM

2000 American Medical Association. All rights reserved.

Downloaded From: http://archpedi.jamanetwork.com/ by a University of Maryland User on 12/03/2014

Table 4. Adjusted* Odds Ratios (ORs) and 95% Confidence Intervals (CIs) for Selected Health-Related Behaviors
Among High School Students by Participation in School and Nonschool Team Sports
Males

Females
Behavior

Interaction

Dietary habits
Did not eat fruit or drink juice

Did not eat salad or vegetables

Eat fatty foods
Vigorous physical activity
Regular vigorous activity
Substance abuse
Alcohol use
Binge drinking
Cigarette smoking

Chewing tobacco/snuff
Marijuana use

Cocaine use

Other illegal drug use

Sniffed glue/spray cans

Steroid use

Sexual activity
Sexual intercourse ever

Sexual intercourse in past 3 mo

Multiple partners in past 3 mo

Violence
Physical fight injury
Carry a weapon

Consider suicide

Attempt suicide

Weight loss
Trying to lose weight
Vomit or use pills to lose weight

Sports 3 ethnicity
White
African American
Hispanic
No interactions
No interactions

OR (95% CI)

0.54 (0.32-0.90)
0.75 (0.53-1.07)
1.00 (0.58-1.75)
0.73 (0.66-0.80)
1.00 (0.81-1.23)

Interaction

OR (95% CI)

No interactions

0.64 (0.52-0.78)

No interactions
Sports 3 age group
Younger
Older

0.80 (0.65-0.97)
1.29 (0.96-1.72)
0.80 (0.62-1.02)

No interactions

4.21 (3.29-5.38)

No interactions

4.74 (3.71-6.06)

No interactions
No interactions
Sports 3 ethnicity
White
African American
Hispanic
Sports 3 age group
Younger
Older
Sports 3 ethnicity
White
African American
Hispanic
Sports 3 ethnicity
White
African American
Hispanic
Sports 3 ethnicity
White
African American
Hispanic
Sports 3 ethnicity
White
African American
Hispanic
Sports 3 ethnicity
White
African American
Hispanic

0.90 (0.72-1.13)
0.95 (0.76-1.18)

No interactions
No interactions
No interactions

1.02 (0.84-1.22)
1.06 (0.88-1.29)
0.73 (0.60-0.89)

No interactions

1.19 (0.93-1.54)

Sports 3 ethnicity
White
African American
Hispanic
No interactions

0.70 (0.59-0.84)
1.38 (0.80-2.38)
0.65 (0.35-1.19)
0.62 (0.41-0.94)

No interactions

0.68 (0.53-0.87)

Sports 3 ethnicity
White
African American
Hispanic
No interactions

0.60 (0.41-0.89)
2.05 (0.96-4.36)
0.72 (0.31-1.68)
0.87 (0.57-1.33)

0.27 (0.09-0.85)
1.91 (0.37-9.80)
3.42 (1.34-8.73)

Sports 3 ethnicity
White
African American
Hispanic
No interactions

0.57 (0.45-0.74)
0.88 (0.62-1.23)
1.14 (0.69-1.90)
0.70 (0.57-0.85)

No interactions

No interactions
Sports 3 ethnicity
White
African American
Hispanic
Sports 3 ethnicity
White
African American
Hispanic
Sports 3 ethnicity
White
African American
Hispanic
No interactions
Sports 3 age group
Younger
Older

0.64 (0.53-0.77)
0.96 (0.59-1.53)
1.04 (0.63-1.70)
0.61 (0.31-1.19)
3.58 (1.15-11.13)
0.63 (0.41-0.96)
1.16 (0.69-1.94)
0.69 (0.51-0.95)
0.19 (0.06-0.66)
4.46 (0.71-28.09)
1.26 (0.36-4.37)
0.48 (0.36-0.65)
4.51 (1.36-14.98)
1.11 (0.52-2.37)
0.63 (0.46-0.87)
1.74 (0.93-3.22)
1.24 (0.67-2.26)

0.83 (0.49-1.39)

1.21 (0.61-2.40)
0.50 (0.25-0.97)
1.29 (0.89-1.87)
1.89 (1.04-3.43)
0.64 (0.51-0.81)
0.84 (0.55-1.30)
1.41 (0.87-2.28)

Sports 3 ethnicity
White
African American
Hispanic
Sports 3 ethnicity
White
African American
Hispanic
Sports 3 ethnicity
White
African American
Hispanic
No interactions
Sports 3 ethnicity
White
African American
Hispanic
Sports 3 ethnicity
White
African American
Hispanic
No interactions

0.78 (0.55-1.10)
2.08 (1.29-3.35)
1.24 (0.85-1.80)
0.77 (0.52-1.12)
1.98 (1.19-3.29)
1.25 (0.92-1.72)
0.59 (0.36-0.96)
1.31 (0.81-2.12)
0.68 (0.37-1.24)
0.85 (0.52-1.38)
0.66 (0.49-0.90)
1.57 (1.00-2.47)
0.80 (0.45-1.42)
0.65 (0.49-0.86)
2.01 (1.19-3.40)
0.56 (0.29-1.10)
0.86 (0.54-1.38)

0.47 (0.32-0.68)
1.12 (0.65-1.93)
1.00 (0.65-1.55)
0.97 (0.80-1.18)

No interactions
No interactions

0.76 (0.68-0.85)
0.98 (0.53-1.83)

1.24 (0.80-1.91)
0.68 (0.40-1.14)

*Adjusted for age, race, and vigorous physical activity (the vigorous physical activity variable was adjusted for age and race only). Boldface indicates significant.
Interactions are significant at P,.01.

(REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 154, SEP 2000

909

WWW.ARCHPEDIATRICS.COM

2000 American Medical Association. All rights reserved.

Downloaded From: http://archpedi.jamanetwork.com/ by a University of Maryland User on 12/03/2014

samples of youth.7,22 The less positive findings observed

among African American and Hispanic students may be
explained by cultural and/or socioeconomic factors.
Exposure to less favorable social and environmental
influences may offset the protective effects of sports
participation. In support of this hypothesis, Jessor et
al32 found adolescents involvement in problem behaviors to be a function of the balance between exposure to
risk factors and protective factors. Future studies in this
area should consider the potentially important role of
socioeconomic and cultural factors in mediating the
relationship between sports participation and health
behaviors.
The results of this study have important implications for physicians and other health professionals who
provide health care services to young athletes. The generally positive relationships between sports participation
and health behaviors suggest that physicians should
actively encourage young people to take advantage of
the opportunity to join sports teams. Indeed, the American Medical Association has published guidelines that
recommend that physicians and other health professionals encourage youth to engage in physical activities such
as organized sports.33 Nevertheless, health care providers
should be aware that some negative health behaviors are
more common among athletes than nonathletes, particularly in certain ethnic groups. Consequently, primary care physicians, with the assistance of parents,
coaches, and athletic trainers, should routinely screen
young athletes for health-risk behaviors and provide
appropriate health information and counseling. Preparticipation physical examinations, which are typically
mandatory for high school athletes, provide a unique
opportunity to perform such a service. Traditionally
these examinations have focused on identification of
medical exclusions to sports participation.34 Our findings support the view that the preparticipation physical
examination be broadened to include screening for
health behaviors.35 A recently completed trial with high
school football players provides evidence that education
programs designed to deter health risk behaviors in high
school athletes are feasible and effective in reducing
problem behaviors such as anabolic steroid use, alcohol
consumption, and illegal drug use.36
The results of this study should be interpreted with
consideration of certain methodological limitations.
First, the cross-sectional study design precludes establishing a causal relationship between sports participation
and health behaviors. Second, because YRBS does not
provide information on participation in specific sports
(eg, basketball, swimming), we were unable to assess the
possibility that the relationship between sports participation and health behaviors varies across sports. This is
likely since certain negative behaviors are known to be
particularly prevalent in specific sports (eg, smokeless
tobacco use in baseball players). 3 7 Furthermore,
although the YRBS protocol ensures subject confidentiality, we cannot exclude the possibility that some
respondents may have underreported participation in
socially undesirable health behaviors. Also, because we
were interested in examining the relationship between
sports participation and several health behaviors, mul-

tiple statistical comparisons were performed. Hence, a

small percentage of the observed significant associations
may have been due to chance. Nonetheless, we conclude
that analyses of this nationally representative sample of
US high school students suggest that participation in
organized sports is associated with an array of health
benefits for most students, but also with some negative
health behaviors in certain subgroups. These findings
suggest that prospective, longitudinal and/or experimental studies of the relationship between sports participation and health behaviors are needed to fully delineate
the public health impact of youth sports participation.
Accepted for publication March 10, 2000.
This study was supported by grant U48/CCU409664
from the Centers for Disease Control and Prevention, Atlanta, Ga.
Reprints: Russell R. Pate, PhD, Department of Exercise Science, University of South Carolina, Columbia, SC
29208 (e-mail: rpate@sph.sc.edu).
REFERENCES
1. Waller W. The Sociology of Teaching. New York, NY: Russell & Russell; 1961.
2. Evans J, Davies B. Sociology of schooling and physical education. In: Evans J,
ed. Physical Education, Sport and Schooling: Studies in Sociology of Physical
Education. London, England: Falmer Press; 1986:11-37.
3. Fejgin N. Participation in high school competitive sports: a subversion of school
mission or contribution to school goals? Soc Sport J. 1994;11:211-230.
4. Kandel D. Final Report: Family Processes in Adolescent Drug Use. Rockville, Md:
National Institute on Drug Abuse; 1978.
5. Jessor R, Chase JA, Donavan JE. Psychological correlates of marijuana use and
problem drinking in a national sample of adolescents. Am J Public Health. 1980;
70:604-613.
6. Hastad DN, Segrave JO, Pangrazi R, Peterson G. Youth sport participation and
deviant behavior. Soc Sport J. 1984;1:366-373.
7. Winnail SD, Valois RF, Dowda M, McKeown RE, Saunders RP, Pate RR. Athletics and substance abuse among public high school students in a southern state.
Am J Health Stud. 1997;13:187-194.
8. Skolnick AA. Studies raise doubts about benefit of athletics in reducing unhealthy behavior among adolescents. JAMA. 1993;270:798-799.
9. DElio MA, Mundt DJ, Bush PJ, Iannotti RJ. Healthful behaviors: do they protect
African-American, urban preadolescents from abusable substance use? Am J
Public Health. 1993;7:354-363.
10. Aaron DJ, Dearwater SR, Anderson R, Olsen T, Kriska AM, LaPorte RE. Physical
activity and the initiation of high-risk health behaviors in adolescents. Med Sci
Sport Exerc. 1995;27:1639-1645.
11. Smith EA, Caldwell LL. Participation in high school sports and adolescent sexual
activity. Pediatr Exerc Sci. 1994;6:69-74.
12. Kokotailo PK, Henry BC, Koscik RE, Fleming MF, Landry GL. Substance use and
other health risk behaviors in collegiate athletes. Clin J Sport Med. 1996;6:183189.
13. Nattiv A, Puffer JC, Green GA. Lifestyles and health risks of collegiate athletes: a
multi-center study. Clin J Sport Med. 1997;7:262-272.
14. Snyder EE, Spreitzer E. High school athletic participation as related to college
attendance among black, Hispanic, and white males. Youth Society. 1990;21:
390-398.
15. Sabo DF, Melnick MJ, Vanfossen BE. High school athletic participation and postsecondary educational and occupational mobility: a focus on race and gender.
Soc Sport J. 1993;10:44-56.
16. Melnick MJ, Sabo DF, Vanfossen B. Educational effects of interscholastic athletic participation on African-American and Hispanic youth. Adolescence. 1992;
27:295-308.
17. Kolbe LJ. An epidemiological surveillance system to monitor the prevalence of
youth behaviors that most affect health. Health Educ. 1990;21:44-48.
18. 1997 National School-Based Youth Risk Behavior Survey: Data Documentation
Manual. Atlanta, Ga: Division of Adolescent and School Health, National Center
for Chronic Disease Prevention and Health Promotion;1997.
19. Brener ND, Collins JL, Kenn L, Warren CW, Williams BL. Reliability of the Youth
Risk Behavior Survey Questionnaire. Am J Epidemiol. 1995;41:575-580.

(REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 154, SEP 2000

910

WWW.ARCHPEDIATRICS.COM

2000 American Medical Association. All rights reserved.

Downloaded From: http://archpedi.jamanetwork.com/ by a University of Maryland User on 12/03/2014

20. Shah BV, Barnwell, BG, Brieler GS. SUDAAN Users Manual, Release 7.5. Research Triangle Park, NC: Research Triangle Institute; 1997.
21. Pate RR, Heath GW, Dowda M, Trost SG. Associations between physical activity
and other health behaviors in a representative sample of US adolescents. Am J
Public Health. 1996;86:1577-1581.
22. Winnail SD, Valois RF, McKeown RE, Saunders RP, Pate RR. Relationship between physical activity level and cigarette, smokeless tobacco use, and marijuana use among public high school adolescents. J Sch Health. 1995;65:438442.
23. Thein LA, Thein JM. The female athlete. J Orthop Sports Phys Ther. 1996;23:
134-148.
24. Centers for Disease Control and Prevention. Guidelines for school and community programs to promote lifelong physical activity among young people. MMWR
Morb Mortal Wkly Rep. 1997;46(No. RR-6):1-36.
25. Luepker RV, Perry CL, McKinlay SM, et al. Outcomes of a field trial to improve
childrens dietary patterns and physical activity: The Child and Adolescent Trial
for Cardiovascular Health (CATCH). JAMA. 1996;275:768-776.
26. Sallis JF, McKenzie TL, Alcaraz JE, Kolody B, Faucette N, Hovell MF. The effects
of a 2-year physical education program (SPARK) on physical activity and fitness
in elementary school students. Am J Public Health. 1997;87:1323-1334.
27. Simons-Morton BG, Parcel GS, Baranowski T, Forthofer R, OHara NM. Promoting physical activity and a healthful diet among children: results of a schoolbased intervention study. Am J Public Health. 1991;81:986-991.
28. US Department of Health and Human Services. Healthy People 2000: National
Health Promotion and Disease Prevention Objectives. Washington, DC: Dept of

29.

30.
31.
32.

33.

34.
35.
36.

37.

Health and Human Services, Public Health Service, US Government Printing Office; 1991.
US Department of Health and Human Services. Physical Activity and Health: A
Report of the Surgeon General. Atlanta, Ga: US Dept of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic
Disease Prevention and Health Promotion; 1996.
Sallis JF, Patrick K. Physical activity guidelines for adolescents: consensus statement. Pediatr Exerc Sci. 1994;6:302-314.
Pate RR, Long BJ, Heath GW. Descriptive epidemiology of physical activity in
adolescents. Pediatr Exerc Sci. 1994;6:302-314.
Jessor R, Van Den Bos J, Vanderryn J, Costa FM, Turbin MS. Protective factors
in adolescent problem behavior: moderator effects and developmental change.
Dev Psychol. 1995;31:923-933.
Elster AB, Kuznets NJ, eds. AMA Guidelines for Adolescent Preventive Services
(GAPS): Recommendations and Rationale. Baltimore Md: Williams & Wilkins;
1994.
Bratton RL. Participation screening of children for sports: current recommendations. Sports Med. 1997;24:300-307.
American Medical Association, Council on Scientific Affairs. Ensuring the health
of the adolescent athlete. Arch Fam Med. 1993;2:446-448.
Goldberg L, Elliot D, Clarke GN, et al. Effect of a multidimensional anabolic steroid prevention intervention: The Adolescent Training and Learning to Avoid Steroids (ATLAS) program. JAMA. 1996;276:1555-1562.
Davis TC, Arnold C, Nandy I, et al. Tobacco use among male high school athletes. J Adolesc Health. 1997;21:97-101.

Correction
Errors in Table. In the original article by Douglas et al titled T-Lymphocyte
Subsets in HIV-Infected and High-Risk HIV-Uninfected Adolescents: Retention of Naive T Lymphocytes in HIV-Infected Adolescents, published in the
April issue of the ARCHIVES (2000;154:375-380), 2 errors occurred in the Table
on page 377. The total CD4+ cell count, 3109/L, for human immunodeficiency
virus (HIV)negative females should have read 0.879 (0.281) [0.487-1.393];
for HIV-positive males, it should have read 0.432 (0.211) [0.090-0.837]. These
data are given as the mean (SD) [5th and 95th percentiles].

(REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 154, SEP 2000

911

WWW.ARCHPEDIATRICS.COM

2000 American Medical Association. All rights reserved.

Downloaded From: http://archpedi.jamanetwork.com/ by a University of Maryland User on 12/03/2014