Parental awareness and engagement in the Active Kids program across socioeconomic groups

Financial Incentives for Physical Activity and Sports Participation in Young People

Physical inactivity is a global health problem. Childhood is an opportune time to establish healthy physical activity behaviors, including the participation in organized physical activity, such as sports. We hypothesize that financial incentives can improve young people's participation in physical activity and sports. The design of the incentive and the context in which it operates are crucial to its success.

"It Goes Hand in Hand with Us Trying to Get More Kids to Play" Stakeholder Experiences in a Sport and Active Recreation Voucher Program

Vouchers that reduce the cost of sport and active recreation participation have been shown to increase children's and adolescent's physical activity levels. Yet, the influence of government-led voucher programs on the capacity of sport and active recreation organisations is unclear. This qualitative study explored the experiences of stakeholders in the sport and recreation sector that were engaged in implementing the New South Wales (NSW) Government's Active Kids voucher program in Australia. Semi-structured interviews were conducted with 29 sport and active recreation providers. Interview transcriptions were analysed by a multidisciplinary team using the Framework method. Overall, participants reported that the Active Kids voucher program was an acceptable intervention to address the cost barrier to participation for children and adolescents. Three main steps influenced the capacity of organisations to deliver their sport and recreation programs and the voucher program: (1) Implementation priming-alignment of the intervention aims with stakeholder priorities and early information sharing, (2) Administrative ease-enhanced technology use and establishment of simple procedures, and (3) Innovation impacts-enablement of staff and volunteers to address barriers to participation for their participants. Future voucher programs should include strategies to enhance the capacity of sport and active recreation organisations to meet program guidelines and increase innovation.

Participation and dropout of Hockey New South Wales participants in 2017 and 2018: a longitudinal study

Background

Sports have a focus on increasing participation, which contributes to increasing population levels of physical activity, social cohesion and longevity of the sport. The primary aim of this study was to examine reasons for drop-out of a popular team sport in Australia, Field Hockey and identify opportunities to increase participation.

Methods

This longitudinal study obtained routinely collected registered player data from Hockey New South Wales over two consecutive years, and survey data from registered players who dropped out. Logistic regression models identified demographic subgroups who were more likely to drop out of sport, and the reasons for dropping out.

Results

In 2018, 8463 (31%) of hockey players did not return to play hockey after the previous season and 805 (10%) of these completed a survey. Specific groups who were more likely to stop playing included 5–6 years (OR: 2.1, 95% CI 1.8–2.6; reference: 12–17 years), females (OR: 1.1, 95% CI 1.0–1.2; reference: males), Indigenous (OR: 1.2, 95% CI 1.1–1.4; reference: non-Indigenous), most disadvantaged (OR: 1.1, 95% CI 1.0–1.2; reference: least disadvantaged) or regional and remote (1.1, 95% CI 1.0–1.2; reference: major cities). Top reasons for drop out were medical/age (17%), change in circumstances (16%) and high cost (13%), lack of time (13%) and lack of enjoyment (7%).

Conclusions

Although Hockey successfully reaches a large proportion of underrepresented groups in sport, these groups are more likely to drop out. Sports should consult these groups to develop enjoyable, flexible, and modifiable versions of the game that are appropriate to their needs.

Fair play? Participation equity in organised sport and physical activity among children and adolescents in high income countries: a systematic review and meta-analysis

BACKGROUND

Physical activity and sport have numerous health benefits and participation is thought to be lower in disadvantaged children and adolescents. However, evidence for the disparity in physical activity is inconsistent, has not been reviewed recently, and for sport has never been synthesised. Our aim was to systematically review, and combine via meta-analyses, evidence of the socioeconomic disparities in physical activity and sport participation in children and adolescents in high income countries.

METHODS

We conducted searches of five electronic databases using physical activity, sport, and socioeconomic disparity related terms. Two independent reviewers assessed 21,342 articles for peer-reviewed original research, published in English that assessed socioeconomic disparities in physical activity and sport participation in children and adolescents. We combined evidence from eligible studies using a structural equation modelling approach to multilevel meta-analysis.

RESULTS

From the 104 eligible studies, we meta-analysed 163 effect sizes. Overall, children and adolescents living in higher socioeconomic status households were more likely to participate in sport (OR: 1.87, 95% CIs 1.38, 2.36) and participated for a longer duration (d = 0.24, 95% CIs 0.12, 0.35). The socioeconomic disparity in the duration of sport participation was greater in children (d = 0.28, 95% CIs 0.15, 0.41) compared with adolescents (d = 0.13, 95% CIs - 0.03, 0.30). Overall, children and adolescents living in higher socioeconomic status households were more likely to meet physical activity guidelines (OR: 1.21, 95% CIs 1.09, 1.33) and participated for a longer duration (d = 0.08, 95% CIs 0.02, 0.14). The socioeconomic disparity in the duration of total physical activity between low and high socioeconomic status households was greater in children (d = 0.13, 95% CIs 0.04, 0.21) compared with adolescents (d = 0.05, 95% CIs - 0.05, 0.15). There was no significant disparity in leisure time physical activity (d = 0.13, 95% CIs - 0.06, 0.32).

CONCLUSIONS

There was evidence of socioeconomic disparities in sport participation and total physical activity participation among children and adolescents. Socioeconomic differences were greater in sport compared to total physical activity and greater in children compared with adolescents. These findings highlight the need importance of targeting sport programs according to socio-economic gradients, to reduce inequities in access and opportunity to organised sport.

Enabling Better Physical Activity and Screen Time Behaviours for Adolescents from Middle Eastern Backgrounds: Semi-Structured Interviews with Parents

The unrelenting obesity pandemic in Middle Eastern (ME) adolescents living in Australia warrants culturally responsive and locally engineered interventions. Given the influence of parents on the lifestyle behaviours of adolescents, this qualitative study aimed to capture the opinions of ME parents on the barriers and enablers to sufficient physical activity and limiting screen time behaviours in adolescents. Semi-structured interviews were conducted with 26 ME parents (female) aged 35–59 years old, most of whom resided in lower socioeconomic areas (n = 19). A reflexive thematic analysis using the Theoretical Domains Framework and the Capability, Opportunity, Motivation-Behaviour model was performed for coding. Parents voiced confidence in their knowledge of the importance of physical activity and limiting screen time but were less optimistic in their ability to enable change in behaviours, especially for older adolescents without outside support. Despite adolescents having the necessary skills to engage in a wide array of sports, the parents admitted deep fears regarding the safety of the social environment and restricted their children’s independent mobility. Gender differences were noted, with parents reporting older girls expressing disinterest in sports and having limited physical opportunities to participate in sports at school. It may be that a community-based participatory framework is needed to improve physical activity opportunities and to address specific physical, social, and cultural barriers.

The Use of a Nonrefundable Tax Credit to Increase Children's Participation in Physical Activity in Alberta, Canada

BACKGROUND

Potential income disparities were examined in the (1) awareness and uptake of the Children's Fitness Tax Credit (CFTC), and (2) physical activity (PA) of children from families who did and did not claim the credit in Alberta, Canada in 2012 and 2014.

METHODS

Secondary analyses of 3 cross-sectional data sets of grade 5 students (10-11 y) were performed, including Alberta Project Promoting healthy Living for Everyone Schools 2012 (N = 1037), and Raising healthy Eating and Active Living Kids Alberta 2012 (N = 2676), and 2014 (N = 3125). Parents reported whether they claimed the CFTC in the previous year, their education and household income, and their child's gender and PA. Children self-reported their PA from the previous 7 days. In Alberta Project Promoting healthy Living for Everyone Schools, children also wore pedometers. Analyses adjusted for clustering within schools and demographic factors.

RESULTS

Higher income families (≥$50,000/y) were more likely to be aware of and to have claimed the CFTC compared with low-income families (<$50,000/y). The CFTC was associated with organized PA with larger associations for higher-income families (odds ratio = 9.03-9.32, Ps < .001) compared with lower-income families (odds ratio = 3.27-4.05, Ps < .01). No associations existed for overall PA or pedometer steps with the CFTC.

CONCLUSIONS

Income disparities exist in the awareness, uptake, and potential impact of the CFTC. Tax credits are not effective in promoting overall PA.

Body mass Index of children and adolescent participants in a voucher program designed to incentivise participation in sport and physical activity: A cross-sectional study

There has been limited population-level success in tackling overweight and obesity. The Active Kids program is a universal intervention that aims to increase participation in structured physical activity and sport among children and adolescents in New South Wales (NSW), Australia. This study examined the prevalence of overweight and obesity across subgroups and by social disadvantage in this large broadly representative sample. A cross-sectional study was conducted including all children (n = 671,375) who registered for an Active Kids Program voucher in 2018. The child's height and weight were obtained from an online registration form. Among children and adolescents who registered in the Active Kids Program, the prevalence of overweight and obesity was 17.2% and 7.6%, respectively. A large number of children and adolescents who lived in the most disadvantaged areas (n = 99,583; 14.8%) registered for the program. There was a clear socio-economic gradient for obesity prevalence across areas of increasing disadvantage, with children and adolescents living in the most disadvantaged area being 1.87 (95% CIs 1.82, 1.93) times more likely to be overweight or obese. The Active Kids program successfully reached a substantial proportion of children who are overweight and obese from socio-economically disadvantaged areas, providing financial support and opportunities for these children to participate in structured sport and physical activity. However, the program did not reach all children, and additional physical activity promotion strategies may be needed in a comprehensive approach. Nonetheless, these findings support government investment in reaching children who are overweight or obese with large-scale programs.

Evaluation of a voucher scheme to increase child physical activity in participants of a school physical activity trial in the Hunter region of Australia

BACKGROUND

Global population data suggest that physical activity levels in children remain unacceptably low. Improved participation in organised sport has been recommended by the WHO as one strategy to improve population levels of physical activity. In 2018, in the state of New South Wales, Australia, the government introduced the Active Kids scheme, to help families meet the cost of getting children into organized sport. The aim of this study is to describe the uptake of Active Kids and assess the impact of the scheme on organized sport participation and child physical activity in a region of New South Wales.

METHODS

A pragmatic longitudinal study was undertaken of parents/carers from primary school aged children (5-12 years) in the Hunter region of NSW, Australia. Baseline data were collected between Oct-Dec 2017, with follow-up 12 months later. A telephone survey occurred at both time points, asking questions regarding registration and redemption of an Active Kids voucher for their child, child participation in organised sports and child physical activity levels.

RESULTS

Of the 974 parents/carers who consented to participate, 511 (52.5%) completed the telephone surveys at both time points. A very large proportion of children (n = 454, 89.0%) were reported by their parents/carers at baseline as meeting the minimum physical activity guideline of 60 min per day. Of participating parents/carers in this study, 407 (96.0%) reported redeeming an Active Kids voucher. Children who redeemed a voucher had three times the odds to participate in organized team sports from baseline to follow-up (p = 0.009). Sub group analyses identified that females who redeemed a voucher had four times the odds to participate in organized team sports (p = 0.012).

CONCLUSIONS

Given the already active nature of this sample, no significant improvements in physical activity levels were noted, but the positive contribution community sport can have on health and wellbeing amongst children is reinforced. Whilst voucher schemes can address financial burdens across all socio-economic groups, more population targeting is needed to deliver voucher schemes to the most disadvantaged and inactive segments of the population in order to increase physical activity.

'One hundred dollars is a big help, but to continue, it's a challenge': A qualitative study exploring correlates and barriers to Active Kids voucher uptake in western Sydney

INTRODUCTION

The Active Kids voucher is a universal, state-wide voucher program, provided by the New South Wales (NSW) Government, Office of Sport. All school-aged children in NSW are eligible to receive a voucher to reduce registration costs of structured physical activity programs. This study explores reasons behind lower uptake among children who are overweight or obese, from cultural and linguistically diverse families and those living in low socio-economic areas.

METHODS

Participants were recruited through a convenience sample of parent/carers who participated in the NSW Health Go4Fun program. Qualitative data were collected using focus groups. The Framework method was adapted for the analysis, taking an interpretive phenomenological approach.

RESULTS

Study participants (n = 54) were all parents of children who were overweight or obese from both low and high socio-economic status (SES). Most reported speaking a primary language other than English at home (65%). Parents were mostly aware of the Active Kids program (91%) and reported that the voucher had a positive impact on their children's participation in structured physical activity. A range of socio-ecological factors, in addition to activity cost, influenced whether parents were able to use an Active Kids voucher and participate in structured physical activity.

CONCLUSIONS

The Active Kids voucher does not alleviate all barriers, particularly for families living in low socio-economic areas. Engagement of this population in structured physical activities using the Active Kids vouchers could be strengthened through the implementation of effective interventions which comprehensively address the remaining barriers, such as access and flexibility of programs with local stakeholders and activity providers.

Effects of the Active Kids voucher program on children and adolescents' physical activity: a natural experiment evaluating a state-wide intervention

BACKGROUND

There is an urgent need for scaled-up effective interventions which overcome barriers to health-enhancing physical activity for children and adolescents. In New South Wales (NSW), Australia, the state government implemented a universal voucher program, 'Active Kids' to support the cost of structured physical activity registration for school-enrolled children aged 4.5-18 years old. The objective of this study was to understand the effects a financial incentive intervention delivered in a real-world setting has on children and adolescent's physical activity participation.

METHOD

In 2018, all children and adolescents registered for an Active Kids voucher provided sociodemographic characteristics, physical activity and research consent. This prospective cohort study used an online survey with validated items to measure physical activity and other personal and social factors in children and adolescents who used an Active Kids voucher. Generalized linear mixed models were used to examine changes from registration to after voucher use at ≤8 weeks, 9-26 weeks and ≥ 6 months.

RESULTS

Study participants reported increasing their days achieving physical activity guidelines from 4.0 days per week (95%CI 3.8, 4.2) at registration (n = 37,626 children) to 4.9 days per week (95%CI 4.7, 5.1) after 6 months (n = 14,118 children). Increased physical activity was observed for all sociodemographic population groups. The voucher-specific activity contributed 42.4% (95%CI 39.3, 45.5) to the total time children participated in structured physical activities outside of school. Children and adolescents who increased to, or maintained, high levels of activity were socially supported to be active, had active parent/caregivers, had better concentration and were overall happier than their low-active counterparts.

CONCLUSION

The Active Kids program significantly increased children's physical activity levels and these increases continued over a six-month period. The Active Kids voucher program shows promise as a scaled-up intervention to increase children and adolescents' physical activity participation.

TRIAL REGISTRATION

Australian New Zealand Clinical Trial Registry ACTRN12618000897268 , approved May 29th, 2018 - Retrospectively registered.

Physical Activity Behaviors of Children Who Register for the Universal, State-Wide Active Kids Voucher: Who Did the Voucher Program Reach?

Active Kids is a government-led, universal voucher program that aims to reduce the cost of participation in structured physical activity for all school-enrolled children in New South Wales (NSW), Australia. As part of the Active Kids program evaluation, this cross-sectional study examined the Active Kids' program's reach to children in NSW and their physical activity behaviors, before voucher use. Demographic registration data from all children (4.5-18 years old) who registered for an Active Kids voucher in 2018 (n = 671,375) were compared with Census data. Binary and multinomial regression models assessed which correlates were associated with meeting physical activity guidelines and participation in the sessions of structured physical activity. The Active Kids program attracted more than half (53%) of all eligible children in NSW. Children who spoke a primary language other than English at home, were aged 15-18 years old, lived in the most disadvantaged areas, and girls, were less likely to register. Of the registered children, 70% had attended structured physical activity sessions at least once a week during the previous 12 months, whilst 19% achieved physical activity guidelines. Active Kids achieved substantial population reach and has the potential to improve children's physical activity behaviors.