Examining how changes in school-level intramurals impact physical activity among Ontario youth over time: A natural experiment evaluation from the COMPASS study

Abstract

Introduction: Moderate-to-vigorous physical activity (MVPA) has many health benefits for youth. However, the majority of Canadian youth are falling short of the recommended 60 minutes of MVPA per day. Since youth spend a large proportion of time in school, regardless of socio-economic status, and evidence shows that characteristics of the school environment can influence youth MVPA, schools represent an equitable and effective setting for providing physical activity programming to youth. Intramurals are one example of inclusive school-based physical activity programs given they tend to be accessible, affordable, and less competitive compared to other school-based physical activity programs (e.g., varsity sports). Intramurals address common barriers to youth sport participation and MVPA, and are positively associated with these outcomes, however, there is limited evidence examining if offering intramurals is protective against the declining trajectory of youth MVPA. Despite this lack of evidence to inform intramural offerings, schools continue to add and remove intramurals each year as part of their real-world practice actions to promote activity among students. This research aimed to generate novel practice-based evidence on the effect of intramural offerings by using a quasi-experimental design to evaluate if changes in the number of intramurals associate with youth MVPA over time. More specifically, Study 1 examined how general changes (added, removed, no change) in intramurals were associated with youth MVPA over time, Study 2 examined how changes in the type (team and individual) of intramurals were associated with youth MVPA over time, and Study 3 examined how changes in gender-specific (female-, male-only) and co-ed intramurals were associated with youth MVPA over time. Methods: This dissertation used three years of longitudinal school- and student-level data from Ontario schools participating in year 5 (Y5: 2016-2017), year 6 (Y6: 2017-2018) and year 7 (Y7: 2018-2019) of the COMPASS study. School-level covariates and intramural data from 55 schools in Ontario, Canada were obtained from the School Programs and Policies (SPP) Questionnaire in Y5 and Y6. Baseline demographics and data on sport participation and MVPA were measured by the student COMPASS Questionnaire (Cq) in Y5, Y6 and Y7 on a sample of 4417 students. A longitudinal quasi-experimental study design was employed, as data on the outcome were measured at pre-intervention (Y5), intervention (Y6) and post-intervention (Y7) time points and were compared between non-randomized intervention and control groups. Hierarchical linear mixed regression models were used to examine if changes in intramurals in Y5 to Y6 were associated with MVPA over time separately for males and females. A novel modeling approach to program evaluation was utilized to create indicator variables representing the yearly intramural changes: (i) intramural changes in year 6 and (ii) intramural changes in year 7 for each study. These indicator variables were included in the models and allowed for the assessment of their effect at those respective years. Results: Intramural participation was positively associated with youth MVPA over time and youth MVPA decreased over the three-year study period. In Study 1, general changes in intramurals (added, removed, no change) were not associated with youth MVPA over time. In Study 2, adding team and individual intramurals was significantly and positively associated with female MVPA in Y6, regardless of intramural participation. In Study 3, gender-specific and co-ed intramurals were not associated with youth MVPA over time, however the association between adding gender-specific intramurals and female MVPA should be further explored, as the p-value of this association was at the level of significance (α=0.05). Discussion: The novel findings from this research address important gaps in the literature on intramurals and physical activity, and contribute to our understanding of how real-world changes in school-level intramurals impact the MVPA of students within these schools over time. In Study 2, we found that adding team and individual intramurals was positively and significantly associated with female MVPA in Y6, regardless of participation. This suggests an indirect association between changes in intramurals at the school-level and individual female student MVPA in those schools. This may be explained by the fact that adding a variety of intramurals creates a supportive and inclusive physical activity environment for females, by targeting female motivations for physical activity (e.g., peer socialization, inclusion and keeping fit) and important intra- and interpersonal factors for female physical activity (e.g., autonomy and self-efficacy). In Study 3, the association between adding gender-specific intramurals and female MVPA was positive, but non-significant. Gender-specific intramurals may promote a supportive physical activity environment and encourage physical activity by fostering self-efficacy, enjoyment and peer support, especially among females. This association should be examined with a larger school sample, as this analysis may have been under-powered at the school-level. Based on Study 1, 2 and 3, changes in intramurals were not significantly associated with male MVPA over time. This suggests that changes in intramurals are not effective at increasing MVPA among males, and may be explained by the fact that the inclusive and supportive nature of intramurals generally do not target male motivations for physical activity, which include competition, strength and winning. Although changes in intramurals were generally not associated with youth MVPA, intramurals are associated with several other important outcomes among youth, such as sport sampling, physical literacy, socialization, school connectedness and reduced substance use. Schools should offer intramurals as inclusive physical activity programs, in addition to other physical activity programs and policies, to encourage equitable access to sport and physical activity and to foster healthy behaviours among youth.