Her Life Depends On It

May 2004

Sport, Physical Activity and the Health and Well-Being of American Girls

“Her Life Depends On It,” is the most comprehensive compilation of research to date about the impact of physical activity on the physical, psychological and cultural health of girls. The report points to physical activity and sport as fundamental solutions for many of the serious health and social problems faced by girls. These include obesity, heart disease, substance abuse, teen pregnancy and depression – which accounts for much of the more than $1 trillion spent on healthcare for treating these issues.

This report is a comprehensive compendium of research that points to physical activity and sport as fundamental solutions for many of the serious health and social problems faced by American girls.

An appreciable mass of evidence-based knowledge about girls’ involvement with sport and physical activity has been generated during the last decade. The amount and quality of this research are uneven and varied.

For example, a good deal of research examines the associations between physical activity and risk for coronary heart disease, but studies that focus on risk for Alzheimer’s disease are just beginning to issue. Researchers have verified links between high school athletic participation and teen pregnancy prevention, although more longitudinal research is needed to thoroughly confirm the connections.

Overall, however, this report shows that the current state of knowledge on the relationship of physical activity to the health and social needs of American girls warrants the serious attention of public health officials, educators and sport leaders. American girls are confronted by a daunting array of health risks in their youth and in later life:

• Obesity: In 1970, only one out of every 21 girls was obese or overweight; today that figure is one in six
  (National Center for Health Statistics, 2002).

• Heart Disease: Cardiovascular disease is the number-one cause of death among American women (44.6% of
  all deaths), and the death rate is 69% higher for black women than for white women (American Heart
  Association, 2003).

• Cancer: Breast cancer is the most common cancer among women, accounting for nearly one of every three cancers diagnosed in American women (Jemal et al, 2004).

• Osteoporosis: Of the 10 million Americans estimated to have osteoporosis, eight million are women
  (National Osteoporosis Foundation, 2003).

• Tobacco Use: In grades 9-12, 29.5% of female students report current tobacco use (Centers for Disease Control and Prevention, 2002).

• Drug Use: Thirty-eight percent of 12th-grade girls and 18% of eighth-grade girls have used an illicit drug at least once during the past year (Johnston, O’Malley and Bachman 2002).

• Sexual Risk: About 1/4 of sexually active adolescents are infected with a sexually transmitted disease each year (Kirby, 2001).

• Teen Pregnancy: The United States has the highest teen pregnancy and birth rates in the industrialized world. About 80% of teen pregnancies are unintended (National Campaign to Prevent Teen Pregnancy, 2002).

• Depression: By age 15, girls are twice as likely as boys to have experienced a major depressive episode. This gender gap continues for the next 35 to 40 years, until menopause (Cyranowski et al, 2000).

• Suicide: In 2001, about one in four U.S. high school girls seriously considered suicide, and one in 10 actually
  attempted to kill herself (National Center for Health Statistics, 2003).

• Pathogenic Weight Loss Behavior: Over 90% of victims of eating disorders are female, and 86% report onset by age 20 (National Association of Anorexia Nervosa and Associated Disorders, 2004).

The U.S. Institute of Medicine has defined the mission of public health as “fulfilling society’s interest in assuring conditions in which people can be healthy” (Committee for the Study of the Future of Public Health, 1988). This research compiled in this report strongly suggests that sport and physical activity provide conditions that help to assure girls’ health and well-being. Some findings identified in this report include:

• Breast Cancer Risk: One to three hours of exercise a week over a woman’s reproductive lifetime (the teens to about age 40) may bring a 20-30% reduction in the risk of breast cancer, and four or more hours of exercise a week can reduce the risk almost 60% (Bernstein et al, 1994).

• Smoking: Female athletes on one or two school or community sports teams were significantly less likely to smoke regularly than female non-athletes. Girls on three or more teams were even less likely to smoke regularly (Melnick et al, 2001).

• Illicit Drug Use: Two nationwide studies found that female school or community athletes were significantly less likely to use marijuana, cocaine or most other illicit drugs, although they were no less likely to use crack or inhalants. This protective effect of sports was especially true for white girls (Miller et al, 2000; Pate et al, 2000).

• Sexual Risk: Female athletes are less likely to be sexually active, in part because they tend to be more concerned about getting pregnant than female non-athletes (Dodge & Jaccard, 2002).

• Depression: Women and girls who participate in regular exercise suffer lower rates of depression (Nicoloff and Schwenk, 1995; Page and Tucker, 1994).

• Suicide: Female high school athletes, especially those participating on three or more teams, have lower odds
  of considering or planning a suicide attempt (Sabo et al, 2004).

• Educational Gains: The positive educational impacts of school sports were just as strong for girls as for boys including self-concept, educational aspirations in the senior year, school attendance, math and science enrollment, time spent on homework, and taking honors courses (Marsh, 1993).

Despite the growing research evidence, girls do not have enough encouragement or opportunity to participate in sports and fitness activities. Nearly one out of every two high school boys plays sports, while only one in three high school girls participates. (National Federation of State High School Associations, 2003) Special interventions aimed at increasing the physical activity level of girls are essential (National Women’s Law Center & Harvard School of Public Health, 2004).

Every girl deserves the opportunity to be healthy, happy and herself. But the solutions to meeting girls’ health needs stretch far beyond education and individual choice. There has been a serious erosion of infrastructural supports for physical fitness and athletics.

• Sedentary School Life: Recess and physical education are disappearing from urban schools, and only about one-third of students nationwide attend physical education class daily.

• Safety Concerns: Parents worry about the safety of their young daughters who attend after-school exercise or sport programs.

• Lack of Women in Leadership: The majority of youth programs and drop-in centers for older children and adolescents have male-oriented, if not male-dominated cultures.

• Persistent Inequalities: Gender inequalities remain a feature of the sport and physical activity landscape. In many towns and cities, the parks and recreation departments are serving more boys than girls. Very few high schools and universities are providing participation opportunities for female athletes in proportion to the number of women in the general student body.

• Lack of Space and Facilities: In urban areas the amount of available space for exercise and athletics is often limited. Advocates for girls’ programs, moreover, often have to compete with politically entrenched male administrators of boys’ programs for a share of the available courts, swimming pools and fields.

This report shows that this backsliding is not just about failing to provide more girls with athletic and fitness opportunities—it’s about endangering the public health. Health processes and outcomes are influenced by a multitude of factors. While researchers have made admirable progress identifying links between physical activity and girls’ health, the scientific journey has just begun.

And researchers are also learning more about the negative health outcomes associated with sport and exercise: e.g., overtraining can lead to permanent injury; female athletes in certain sports are especially prone to develop eating disorders; female college athletes binge drink more often than female non-athletes. Research findings that pertain to both favorable and unfavorable health impacts from sport and exercise are included in this report.

Economic inequalities exert powerful influences on health and illness. Not all girls have the same sports and fitness opportunities due to the economic circumstances of their families, schools, and communities. As some of the findings in this report suggest, the fitness and athletic experiences of poor girls and many girls of color are often mediated by poverty and racial discrimination.

The knowledge that physical activity and sport can help to prevent illness and problem behaviors is only the first step in enhancing the health and well-being of American girls. Knowledge must be transformed into policies and practice. Meeting the challenge of inactivity among girls will require a consistent, diverse and multifaceted commitment.

To read the entire report and citations in PDF, click here.