Inter-categorical intersectionality and leisure-based physical activity in Canada

Challenges and Future Directions for Promoting Intersectional Quantitative Studies in Physical Activity Research

Understanding health inequalities is essential for improving social justice. Intersectionality refers to a theoretical framework for studying the intersection of multiple social categorizations that create unique experiences and related social inequalities. Currently, the majority of the intersectional studies in the physical activity field have a qualitative design; thus, there is a need for quantitative intersectional studies. This commentary aims to explore primary obstacles impeding intersectional quantitative research and provide recommendations for overcoming these obstacles in physical activity research. In the commentary, we discuss that the lack of accessibility of large-scale and diverse data sets, and suboptimal social categorizations and intersectionality-related questions may contribute to the scarcity of intersectional quantitative research in the field. To facilitate intersectional quantitative analyses, we advocate for making large-scale data sets accessible for intersectional secondary analyses, diverse sampling, standardizing questions and categories related to intersectionality, promoting inclusive research designs and methods, and using the appropriate questions and social categorization that reflect the distinct experiences of each subgroup. By addressing these challenges, researchers may gain new insights into health disparities, making physical activity research more inclusive and contributing to more equitable health outcomes.

Aging well in an aging society: physical health in older lesbian, gay, and bisexual adults

Introduction

Older sexual minority people meet a double stigma in our society related to their sexual identity and chronological age. The present study explores how experiences of discrimination and prejudice, coming out, and personal resiliency influence physical health of older lesbian, gay, and bisexual (LGB) adults.

Methods

Respondents were recruited through online advertisements and an online-based survey. The sample included 82 Italian cisgender LGB adults over 65 years: young older adults (65-70 years; 78%) and old-old adults (over 71 years; 22%). Regarding sexual orientation, the sample was composed of sexual minority women (n = 30; 37%) and sexual minority men (n = 52; 63%).

Results

ANOVAs' findings showed that sexual minority women described lower levels of physical health compared to sexual minority men. At the same time, old-old adults reported higher experiences of discrimination and prejudice compared to young older adults. Moreover, findings from hierarchical multiple regression analysis described that coming out, higher levels of personal resiliency, and fewer experiences of discrimination were predictors of physical health, regardless of age and sexual minority categories.

Conclusion

These findings seem to align with previous studies that underline the relevance of investigating aging well in sexual minority people. Knowledge and awareness of LGBTQ+ issues are necessary for recognizing the unique needs and resources of older LGB people for promoting a healthy aging process.

Leisure-Time Physical Activity in a Southern Brazilian City (2004-2021): Applying an Equity Lens to Time-Trend Analyses

BACKGROUND

This study aimed to verify leisure-time physical activity trends over 15 years and monitor inequalities according to gender, self-reported skin color, and socioeconomic position in a Southern Brazilian city. A secondary aim is to evaluate intersectionalities in physical activity.

METHODS

Trend analysis using 3 population-based surveys carried out in 2004, 2010, and 2021. Main outcome assessed was the prevalence of physical activity according to recommendations (150 min/wk). Inequalities dimensions measured were sex, self-reported skin color, and wealth. Intersectionalities were evaluated using Jeopardy index combining all inequality dimensions. Trend analysis was performed using least-squares weighted regression.

RESULTS

We included data from 3090, 2656, and 5696 adults in 2004, 2010, and 2021, respectively. Prevalence of physical activity remains stable around 25% in the 3 years. In the 3 periods evaluated, men presented a prevalence in average 10 percentage points higher than women (SII2004 = -11.1 [95% confidence interval, CI, -14.4 to -7.8], SII2021 = -10.7 [95% CI, -13.7 to -7.7]). Skin color inequalities did not present a clear pattern. Richest individuals, in general presented a prevalence of leisure-time physical activity level 20pp higher than poorest ones (SII2004 = 20.5 [95% CI, 13.7 to 27.4]; SII2021 = 16.7 [95% CI, 11.3 to 22.0]). Inequalities were widely marked, comparing the most privileged group (represented by men, the wealthiest, and White) and the most socially vulnerable group (represented by women, the poorest, and Black/Brown). The Slope Index of Inequality for intersectionalities was -24.5 (95% CI, -31.1 to -17.9) in 2004 and -18.8 in 2021 (95% CI, -24.2 to -13.4).

CONCLUSIONS

Our analysis shows that women, Black/Brown, and poor present lower leisure-time physical activity level. This group is often neglected regarding other health and social outcomes.

The Epidemiology of Domain-Specific Physical Activity in New Zealand Adults: A Nationally Representative Cross-Sectional Survey

BACKGROUND

Surveillance of domain-specific physical activity (PA) helps to target interventions to promote PA. We examined the sociodemographic correlates of domain-specific PA in New Zealand adults.

METHODS

A nationally representative sample of 13,887 adults completed the International PA Questionnaire-long form in 2019/20. Three measures of total and domain-specific (leisure, travel, home, and work) PA were calculated: (1) weekly participation, (2) mean weekly metabolic energy equivalent minutes (MET-min), and (3) median weekly MET-min among those who undertook PA. Results were weighted to the New Zealand adult population.

RESULTS

The average contribution of domain-specific activity to total PA was 37.5% for work activities (participation = 43.6%; median participating MET-min = 2790), 31.9% for home activities (participation = 82.2%; median participating MET-min = 1185), 19.4% for leisure activities (participation = 64.7%; median participating MET-min = 933), and 11.2% for travel activities (participation = 64.0%; median MET-min among participants = 495). Women accumulated more home PA and less work PA than men. Total PA was higher in middle-aged adults, with diverse patterns by age within domains. Māori accumulated less leisure PA than New Zealand Europeans but higher total PA. Asian groups reported lower PA across all domains. Higher area deprivation was negatively associated with leisure PA. Sociodemographic patterns varied by measure. For example, gender was not associated with total PA participation, but men accumulated higher MET-min when taking part in PA than women.

CONCLUSIONS

Inequalities in PA varied by domain and sociodemographic group. These results should be used to inform interventions to improve PA.

Exploring the intersectionality of family SES and gender with psychosocial, behavioural and environmental correlates of physical activity in Dutch adolescents: a cross-sectional study

BACKGROUND

Examining the correlates of adolescent's physical activity (PA) and how they may differ according to the intersection of gender and family socioeconomic status (SES) can support the development of tailored interventions to more effectively promote adolescents' PA. This study explored how the associations between psychosocial, behavioural and environmental factors and adolescent's PA differed according to gender and family SES.

METHODS

This study used data from the Dutch Youth Health Survey 2015. Adolescents (n = 9068) aged 12-19 were included in the study. The associations between psychosocial, behavioural, and environmental factors and PA (days per week engaging in at least one hour of PA) were examined with multilevel linear regression analysis. Potential interactions between these correlates, gender and family SES were explored.

RESULTS

On average, adolescents engaged in at least one hour of PA for 4,2 days per week. Poor self-perceived health, low peer social support, and a weak connection with the environment were all associated with lower PA in adolescents. Daily smoking, cannabis use, risk of problematic gaming and social media use, as well as lack of daily consumption of fruit, vegetables, water and breakfast were associated with lower PA, whereas binge drinking was not. Interactions revealed that poor self-perceived health was associated with lower PA in adolescents from moderate- and high-SES families, but not in low-SES adolescents, whereas cannabis use was only associated with lower PA amongst low-SES adolescents. Low peer social support was associated with lower PA across all groups, but it was most strongly associated with lower PA amongst male adolescents from low-SES families than in other subgroups. Amongst low-SES males, low peer social support was associated with a 1.47 reduction in days engaging in sufficient PA, compared with a 0.69 reduction for high-SES males.

CONCLUSIONS

This study identified several psychosocial, behavioural and environmental factors that can be targeted to potentially increase adolescent's PA. We also found that correlates of PA differed according to the intersection of gender and family SES. Our findings suggest that PA interventions should be tailored according to gender and SES to address the specific needs, barriers and facilitators of different subgroups.

Kinesiology, Physical Activity, Physical Education, and Sports through an Equity/Equality, Diversity, and Inclusion (EDI) Lens: A Scoping Review

Background: Equity, equality, diversity, and inclusion are terms covered in the academic literature focusing on sports, kinesiology, physical education, and physical activity, including in conjunction with marginalized groups. Universities in many countries use various EDI policy frameworks and work under the EDI headers “equality, diversity and inclusion”, “equity, diversity and inclusion”, “diversity, equity and inclusion”, and similar phrases (all referred to as EDI) to rectify problems students, non-academic staff, and academic staff from marginalized groups, such as women, Indigenous peoples, visible/racialized minorities, disabled people, and Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, and Two-Spirit (LGBTQ2S+) experience. Which EDI data, if any, are generated influences EDI efforts in universities (research, education, and general workplace climate) of all programs. Method: Our study used a scoping review approach and employed SCOPUS and the 70 databases of EBSCO-Host, which includes SportDiscus, as sources aimed to analyze the extent (and how) the academic literature focusing on sports, kinesiology, physical education, and physical activity engages with EDI. Results: We found only 18 relevant sources and a low to no coverage of marginalized groups linked to EDI, namely racialized minorities (12), women (6), LGBTQ2S+ (5), disabled people (2), and Indigenous peoples (0). Conclusions: Our findings suggest a gap in the academic inquiry and huge opportunities.

All are equal, but some are more equal than others: social determinants of leisure time physical activity through the lens of intersectionality

Background

To date, no research has investigated social determinants of leisure time physical activity through the lens of intersectionality in a low- and middle-income country. Therefore, the aim of this study was to explore the intersectionality in leisure time physical activity in a nationwide sample of Brazilian adults.

Methods

Data from the Brazilian National Health Survey conducted in 2013 were analysed (N = 58,429). Prevalence of sufficient leisure time physical activity (150+ minutes per week in moderate-to-vigorous physical activity) was estimated according to gender, racial identity, education and income, and according to multiple combinations of these sociodemographic characteristics (i.e., multiple jeopardy index).

Results

The prevalence of sufficient leisure time physical activity was 22.9% (95%CI: 22.3 to 23.6). Overall, the prevalence of sufficient leisure time physical activity was highest among men, individuals with white skin colour, and among those in the highest group of education and income. Among men, white, with a university degree and in the highest quartile of income (3% of the population), the prevalence of sufficient leisure time physical activity was 48%. Among non-white women with low education and low income (8.1% of the population), the prevalence of sufficient leisure time physical activity was 9.8%.

Conclusion

Informed by the theory of intersectionality, findings of this study have shown that intersections of gender, racial identity and socioeconomic position of the Brazilian society strongly influence leisure time physical activity at the individual level. Targeted interventions to increase leisure time physical activity should address the complexities of social status intersections.

Level of engagement of recreational physical activity of urban villagers in Luohu, Shenzhen, China

Physical activity is important for health. However, there is a lack of literature related to the physical activity levels of adults living in urban villagers, which is a vulnerable population in China. The aim of this study is to compare the physical activity and sedentary behavior engagements between urban villagers and non-urban villagers using the 2019 Luohu Shenzhen, China Community Diagnosis Questionnaire. A total of 1205 adults living in urban villages and non-urban villages were included in the analysis. Unadjusted and multiple multivariate logistic regression were conducted for the dependent variable of engagement in recreational physical activity, frequency of recreational physical activity per week, and hours spent in sedentary behaviors per day. Descriptive analysis was conducted to identify the reasons for not engaging in physical activity among urban villagers and non-urban villagers. Across the included sample, 29.05% were urban villagers and 70.95% were non-urban villagers. The results suggested that urban villagers are more likely to engage in physical activity than non-urban villager (OR = 1.90, 95% CI [1.40, 2.59], p < 0.001). However, it was also found that urban village status had no significant association for frequency in engaging in physical activity and average hours spent in sedentary behaviors. Both urban villagers and non-urban villages indicated that lack of time, lack of safe and appropriate environment, and working in labor intensive occupations as some of the reasons for not engaging in physical activity. There is a need for tailed interventions and policies for promoting physical activity among urban villagers and non-urban villagers. Additional studies are needed to further our understanding of the physical activity behaviors among urban villagers in China.

Hierarchical Analysis of Disparities in Suicidal Outcomes With Intersection of Sexual Minority and Gender Among U.S. Youth, 2017

Sexual minority youth have a higher risk of suicidal behaviors than their straight peers. Despite this alarming trend, there is limited information on how health-risk factors are systematically associated with suicidal outcomes in relation to the intersection of sex and sexual orientation identity. Data from the 2017 Youth Risk Behavior Survey (Grades 9-12, N = 14,108) were analyzed to examine three distinct suicidal outcomes (i.e., suicidal ideation, suicide planning, and suicide attempt). Separate hierarchical logistic regression models were performed to gradually adjust for influencing factors in examining the association between suicidal outcomes and sexual orientation identity (i.e., heterosexual, gay/lesbian, bisexual, and unsure), stratified by self-reported sex. There exist significant differences in youth suicidal behaviors based on sexual orientation identity and sex: lesbians (adjusted odds ratio [AOR] = 2.7, 95% CI [1.5, 5.0]), bisexual girls (AOR = 1.9, 95% CI [1.3, 2.6]) and bisexual boys (AOR = 2.6, 95% CI [1.3, 5.2]) had higher odds of suicide attempts than their straight peers. Unsure boys and girls also reported higher risks of suicidal ideation and suicide plan as compared with their straight peers. Having a very short sleep duration, reporting ever use of illicit drugs, being bullied, and feeling sad/hopeless were associated with elevated risks of suicidality across males and females. This study identified potential disparities in suicidal outcomes by sexual orientation identity as well as factors that attenuate or strengthen this relationship in a representative sample of adolescents across the United States. An improved understanding of the differences in suicidal outcomes will serve as an opportunity to ameliorate any potential inequalities and improve sexual minority youth' health outcomes.

Poverty in Lesbian, Gay, Bisexual, Transgender, Queer, Two-Spirit, and Other Sexual and Gender Minority (LGBTQ2S+) Communities in Canada: Implications for Social Work Practice

In this article, we draw on a recent review of the Canadian literature on poverty in lesbian, gay, bisexual, transgender, queer, two-spirit, and other sexual and gender minority (LGBTQ2S+) communities to conceptualize social work interventions that may be used to address material inequities among these groups. Our literature review, which was based on a total of 39 works, revealed distinctive expressions of poverty among younger and older LGBTQ2S+ groups, as well as racialized, newcomer, and Indigenous sexual and gender minorities. Drawing on these insights, together with theoretical frameworks grounded in intersectionality and relational poverty analysis, we conceptualize these expressions of material inequity as salient sites of social work practice and propose interventions targeting these manifestations of LGBTQ2S+ poverty at various levels. Given the centrality of anti-poverty work as part of the social work profession's commitment to social justice, and the dearth of social work literature on LGBTQ2S+ poverty, this article promises to make significant contributions to social work scholarship and professional practice.

Operationalization of intersectionality in physical activity and sport research: A systematic scoping review

Participation in and opportunities for physical activity (PA) and sports (PA inclusively hereafter) are known to vary across individuals with different social positions. Intersectionality theory may help us to better understand the complex processes of multiple interlocking systems of oppression and privilege shaped by intersections of individuals’ social categories. The objectives of this systematic scoping review were (1) to summarize the findings of articles examining PA claimed operationalization of intersectionality and (2) to identify the scope and gaps pertaining to the operationalization of intersectionality in PA research. A search was conducted in September 2019 in seven electronic databases (e.g., SPORTDiscus, Scopus, Web of Science) for relevant research articles written in English. Key search terms included “intersectionality” AND “physical activity” OR “sport”. Database searches, data screening and extraction, and narrative synthesis were conducted between September 2019 and May 2020. Of 16564 articles identified, 45 articles were included in this review. The majority of included articles used qualitative methods (n = 41), with two quantitative and two mixed-methods articles. The most frequently observed intersectional social position was sex/gender + race/ethnicity (n = 11), followed by sex/gender + race/ethnicity + sexuality (n = 6) and sex/gender + race/ethnicity + religion (n = 6). Most qualitative studies (n = 38) explicitly claimed operationalization of intersectionality as a key theoretical framework, and over half of these studies (n = 27) implicitly used intra-categorical intersectionality. Two quantitative studies were identified which examined a number of intersections simultaneously using inter-categorical intersectionality. Complex processes of individual and social-structural level factors that drive inequalities in PA opportunities and participation could be better elucidated with the operationalization of intersectionality theory. Intersectionality theory may serve as a useful framework in both qualitative and quantitative investigations. Advancement in quantitative intersectionality is critical in order to produce knowledge that could inform more inclusive PA promotion efforts.

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Intra-categorical intersectionality is commonly used in most qualitative investigations.

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Inter-categorical intersectionality is used in quantitative research.

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Utilizing multiplicative statistical models may advance quantitative intersectionality.

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Investigating varying axes of marginalization beyond sex/gender + race/ethnicity is important.

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Intersectionality is useful in better understanding disparities in physical activity.

College Student Aerobic and Muscle-Strengthening Activity: The Intersection of Gender and Sexual Orientation Among United States Students

The purpose of the study was to examine differences in aerobic and muscle-strengthening activity participation based on the intersection of gender and sexual orientation among cisgender college students. Data from the American College Health Association National College Health Assessment collected between Fall 2015 and Fall 2018 were analyzed. Differences from the population average for meeting aerobic and muscle-strengthening activity (separately) recommendations were computed for each gender and sexual orientation intersection. The likelihood of meeting aerobic and muscle-strengthening activity (separately) recommendations were calculated using a series of logistic regression analyses to determine odds ratios controlling for age, year of enrollment, race/ethnicity, and health status. Overall, more men and those identifying as straight met activity (aerobic and muscle-strengthening) recommendations. Asexual and straight women were less likely to meet activity recommendations compared to men, and bisexual and questioning women were less likely to meet muscle-strengthening recommendations compared to men. Bisexual, pansexual, and questioning individuals were less likely to meet activity recommendations compared to straight individuals among both genders, as were queer and gay men and women who identified as pansexual or another identity. Men who identified as pansexual or another identity, as well as lesbian and queer women were less likely to meet muscle-strengthening recommendations compared to straight individuals. In summary, findings demonstrate that aerobic and muscle-strengthening activity participation disparities are evident based on the intersection of gender and sexual orientation. The intersection of socio-demographic characteristics should be considered by researchers and physical activity promoters in order to better understand and address disparities.

The Power of Recognition: A Qualitative Study of Social Connectedness and Wellbeing through LGBT Sporting, Creative and Social Groups in Ireland

The broad research consensus suggesting substantial vulnerabilities among lesbian, gay, bisexual and transgender (LGBT) communities may fail to recognize the protective factors available to these populations. The sparse literature on mental health promotion highlights the importance of understanding strengths-based community approaches that promote LGBT wellbeing. Informed by the Ottawa Charter for Health Promotion, underpinned by Honneth’s Theory of Recognition, this paper outlines the findings of a qualitative Irish study on LGBT social connectedness through a diverse range of sporting, creative and social interests. Ten in-depth interviews were conducted with 11 people (including one couple) who self-identified as lesbian (5), gay (4), bisexual (1) and transgender (1) aged between 22 and 56 years. A university Research Ethics Committee granted approval. The data were transcribed and coded using thematic analysis, enhanced through a memo-writing approach to reflexivity. The theme of ‘connecting’ emphasized the shared nature of activities, with like-minded others through groups established by, and for, LGBT communities. Messages from the study reinforce the central role of LGBT communities in the promotion of mental health and social wellbeing, with important policy and practice implications. This requires the contextualization of the contribution of LGBT communities within understandings of social justice, identity and recognition.

Reconceptualising precision public health

As currently conceived, precision public health is at risk of becoming precision medicine at a population level. This paper outlines a framework for precision public health that, in contrast to its current operationalisation, is consistent with public health principles because it integrates factors at all levels, while illuminating social position as a fundamental determinant of health and health inequities. We review conceptual foundations of public health, outline a proposed framework for precision public health and describe its operationalisation within research and practice. Social position shapes individuals' unequal experiences of the social determinants of health. Thus, in our formulation, precision public health investigates how multiple dimensions of social position interact to confer health risk differently for precisely defined population subgroups according to the social contexts in which they are embedded, while considering relevant biological and behavioural factors. It leverages this information to uncover the precise and intersecting social structures that pattern health outcomes, and to identify actionable interventions within the social contexts of affected groups. We contend that studies informed by this framework offer greater potential to improve health than current conceptualisations of precision public health that do not address root causes. Moreover, expanding beyond master categories of social position and operationalising these categories in more precise ways across time and place can enrich public health research through greater attention to the heterogeneity of social positions, their causes and health effects, leading to the identification of points of intervention that are specific enough to be useful in reducing health inequities. Failure to attend to this level of particularity may mask the true nature of health risk, the causal mechanisms at play and appropriate interventions. Conceptualised thus, precision public health is a research endeavour with much to offer by way of understanding and intervening on the causes of poor health and health inequities.As currently conceived, precision public health is at risk of becoming precision medicine at a population level. This paper outlines a framework for precision public health that, in contrast to its current operationalization, is consistent with public health principles because it integrates factors at all levels, while illuminating social position as a fundamental determinant of health and health inequities. We review conceptual foundations of public health, outline a proposed framework for precision public health and describe its operationalization within research and practice. Social position shapes individuals' unequal experiences of the social determinants of health. Thus, in our formulation, precision public health investigates how multiple dimensions of social position interact to confer health risk differently for precisely defined population subgroups according to the social contexts in which they are embedded, while considering relevant biological and behavioural factors. It leverages this information to uncover the precise and intersecting social structures that pattern health outcomes, and to identify actionable interventions within the social contexts of affected groups. We contend that studies informed by this framework offer greater potential to improve health than current conceptualizations of precision public health that do not address root causes. Moreover, expanding beyond master categories of social position and operationalizing these categories in more precise ways across time and place can enrich public health research through greater attention to the heterogeneity of social positions, their causes and health effects, leading to identification of points of intervention that are specific enough to be useful in reducing health inequities. Failure to attend to this level of particularity may mask the true nature of health risk, the causal mechanisms at play and appropriate interventions. Conceptualized thus, precision public health is a research endeavour with much to offer by way of understanding and intervening on the causes of poor health and health inequities.

Low Family Support and Risk of Obesity among Black Youth: Role of Gender and Ethnicity

Most studies on the role of family environment in developing risk of obesity among youth have focused on parenting behaviors that are directly involved in energy balance in regional, non-representative White samples. Using a national sample of ethnically diverse Black youth, the current study tested the association between low family support and risk of obesity. We also tested the heterogeneity of this association based on gender, ethnicity, and their intersection. We used data from the National Survey of American Life-Adolescent Supplement (NSAL-A), a national survey of Black adolescents in the United States. The study enrolled 1170 African American and Caribbean Black 13-17 year old youth. Obesity was defined based on the cutoff points of body mass index (BMI) appropriate for age and gender of youth. Family support was measured using a five-item measure that captured emotional and tangible social support. Age, gender, and ethnicity were also measured. Logistic regressions were utilized in the pooled sample, and also based on gender, ethnicity, and their intersection, to test the link between low family support and risk for obesity.

RESULTS

In the pooled sample, low family support was not associated with an increased risk of obesity (OR = 1.35, 95% Confidence Interval (CI) = 0.96-1.89). The association between low family support and risk of obesity was, however, significant among African American females (OR = 1.60, 95% CI = 1.01-2.55). There was no association for African American males (OR = 1.26, 95% CI = 0.82-1.92), Caribbean Black males (OR = 0.68, 95% CI = 0.01-54.85), and Caribbean Black females (OR = 0.78, 95% CI = 0.42-1.44). In conclusion, policies and programs that enable African American families to provide additional family support may prevent obesity among African American female youth. Future research should test the efficacy of promoting family support as a tool for preventing obesity among African American female youth.