Factors associated with adolescents' physical inactivity in Xi'an City, China

PURPOSE: To explore the sociodemographic and environmental factors at community, school, and household levels associated with physical inactivity. METHODS: In a cross-sectional study in 2004, physical activity level was assessed using a validated questionnaire in 1787 students. Physical inactivity was defined as less than 150 min.wk of moderate activity (4-6 METs) or less than 60 min.wk of vigorous activity (> 6 METs). Sociodemographic and environmental information was recorded on self-administered questionnaires. Hierarchical multiple logistic models were developed based on a conceptual framework of factors related to physical activity. RESULTS: Overall, girls were twice as likely to be inactive. Adolescents aged 14 yr were 30% less likely to be inactive compared with those younger than 13 yr (95% CI: 0.5-0.9). Paternal education was inversely associated with inactivity (OR: 0.6, 95% CI: 0.4-0.9). Adolescents living in neighborhoods without sidewalks were 1.3 times more likely to be inactive (95% CI: 1.0-1.6). At the school level, lack of extracurricular exercise (OR: 1.3, 95% CI: 1.1-1.6) and fewer sports meetings (OR: 2.0, 95% CI: 1.4-2.9) were associated with physical inactivity. Difficult access to community recreational facilities (moderate OR: 1.4, 95% CI: 1.0-1.9; difficult OR: 1.7, 95% CI: 1.2-2.4) and concerns about safety in the neighborhood (OR: 2.1, 95% CI: 1.1-4.1) were associated with inactivity. There were some differences associated with physical inactivity between boys and girls. CONCLUSION: Strategies to promote physical activity in Chinese adolescents should integrate associated factors at household, school, and community levels and address the important gender differences in factors associated with physical inactivity in youth.     

Correlates of physical activity in Portuguese adolescents from 10 to 18 years

This study examined the association between demographic [age, sex, socioeconomic status (SES)] and socio‐cultural [father, mother, sibling physical activity (PA); peers and physical education teacher influences] correlates and low, moderate and high levels of PA among Portuguese adolescents aged 10–18 years. A total of 3352 males and females attending basic and secondary schools, their parents and siblings were sampled across four regions of Portugal. PA was assessed with a psychometrically validated questionnaire. Multinomial logistic regression was used. Age was positively related with moderate and high PA. Boys and adolescents of high SES were more likely to participate in moderate and high PA. Adolescents were more likely to participate in high PA when theirs mother and sibling(s) also participated. Peers had a positive influence on participation in moderate and high PA, while physical education teachers did not have an influence. The results indicated that demographic and socio‐cultural correlates – in particular age, sex, SES, mother and sibling PA, and peer influence – were significantly associated with adolescent PA. These results also suggested that interventions should focus on girls and low SES adolescents who face higher risk of inactivity.     

Socioeconomic status of parents with children participating on youth club sport teams

ObjectivesTo describe the socioeconomic status, measured by household income and educational attainment, of parents with children participating on youth club sport teams.DesignCross-sectional survey.SettingLocal sport events.Participants949 parents (571 female) of youth athletes between 10 and 18 years old were recruited at club team events and practices to complete an anonymous questionnaire.Main Outcome MeasuresSES variables included total household income (THI) and educational attainment. Sport specialization was classified as low, moderate, or high using a previously utilized 3-point specialization scale. Chi-square tests were used to compare frequencies SES categories with child specialization.ResultsParents reported spending a median of 1500 [500-3000] USD per year on their children's club sports activities. Most parents reported a THI greater than 100,000 USD per year and a bachelor's degree or higher level of education. Parents in the higher THI categories were more likely to have a child that is highly specialized in one sport.ConclusionThe current youth sports system in the United States, which emphasizes year-round participation on club teams, may be limiting the participation of families without the resources to participate in this system.     

Risk factors for acute and overuse sport injuries in Swedish children 11 to 15 years old: What about resistance training with weights?

To determine the 1‐year self‐reported incidence of overuse and traumatic sport injuries and risk factors for injuries in children participating in a summer sports camp representing seven different sports. 4363 children, 11 to 15 years old participating in a summer camp in seven different sports answered a questionnaire. Injury in this cross‐sectional study was defined as a sport‐related trauma or overload leading to pain and dysfunction preventing the person from participation in training or competition for at least 1 week. A number of risk factors for injury were investigated such as sex, age, number of hours spent on training in general, and on resistance training with weights. Nearly half [49%, 95% confidence interval (CI) 48–51%] of the participants had been injured as a result of participation in a sport during the preceding year, significantly more boys than girls (53%, 95% CI 50–55% vs 46%, 95% CI 43–48%; P < 0.001). Three factors contributed to increased incidence of sport injuries: age, sex, and resistance training with weights. Time spent on resistance training with weights was significantly associated with sport injuries in a logistic regression analysis. In children age 11 to 15 years, the risk of having a sport‐related injury increased with age and occurred more often in boys than in girls. Weight training was the only modifiable risk factor that contributed to a significant increase in the incidence of sport injuries.     

Association between adolescent sport activities and lumbar disk degeneration among young adults

The relationship between different sport activities and lumbar intervertebral disk degeneration (DD) is largely unknown. We evaluated whether adolescent participation in different sports is associated with lumbar DD in a population‐based birth cohort of young adults. A total of 558 young adults (325 females and 233 males) underwent magnetic resonance imaging (MRI, 1.5‐T scanner). A DD sum score, based on the Pfirrmann grading, was calculated for all lumbar levels. The sum score was categorized into no DD, 1, 2, or at least 3. Participation in different sport activities was self‐reported by postal surveys at 16, 18, and 19 years, and three groups were formed based on participation frequency in 11 sports: (a) highly active (at least twice a week), (b) moderately active (2‐4 times a month), and (c) inactive (maximum once a month). Cumulative odds ratios (COR) and their 95% confidence intervals (CI) were obtained for each sport by ordinal logistic regression, adjusting for gender, body mass index, age, socioeconomic status, smoking, and other sports. Highly active participation in jogging/running and swimming was associated with a higher DD sum score (COR: 3.0; 95% CI: 1.4‐6.3 and 5.0; 1.7‐15.2, respectively) compared to inactive participation, whereas highly active participation in skating showed low COR. In conclusion, running and swimming at least twice a week in early adulthood are potentially associated with lumbar DD. Follow‐up studies with MRI are needed to show whether frequent exposure to running or swimming has further effect on the integrity of lumbar intervertebral disks.     

Trends and determinants of organised sports participation in immigrant and Australian children: A nine-year follow-up

ObjectivesThis study aimed to examine trends and determinants of organised sports participation among children of immigrant parents from low-and-middle-income countries, high-income countries, and Australian children.DesignLongitudinal (nine-year follow-up).MethodsData were from the birth-cohort of Australian Children aged 6–15 years with follow-up between 2010 and 2018. Organised sports participation was measured using two items about regular participation in team and individual sports. Multilevel logit modelling was used to assess the determinants of organised sports participation across groups.ResultsBoth team sports participation and individual sports participation increased between 6 and 11 years and declined between 11 and 15 years across the three groups. Children of immigrant parents from low-and-middle-income countries (OR 0.65; 95 % CI 0.57–0.74) and high-income countries (OR 0.82; 95 % CI 0.76–0.89) had lower odds of team sports participation than Australian children. Children of immigrant parents from low-and-middle-income countries had lower odds of team sports participation (OR 0.79; 95 % CI 0.69–0.90) than children of immigrant parents from high-income countries. Female children, high screen time, high psychological difficulties, increased number of siblings and low socio-economic position were identified as determinants of lower team and individual sports participation.ConclusionsThe present study identified evidence of disparities in organised sports participation among children of immigrant parents and Australian children. Multilevel and multicomponent interventions to promote children’s organised sports participation should be prioritised, with a focus on children of the female sex, older children, children with lower socioeconomic status, and children with higher screen time and higher psychological difficulties.     

Psychobiology and behavioral strategies. Physical activity, sport participation, and suicidal behavior: U.S. high school students

PURPOSE: To evaluate the associations of physical activity and sports team participation with suicidal behavior among U.S. high school students. METHODS: Data were from the 2003 Youth Risk Behavior Survey (N = 10,530 respondents). Exposure variables included physical activity (inactive, insufficient, moderately intensive, regular vigorously intensive, and frequent vigorously intensive) and sports team participation. Outcome variables were suicide ideation (seriously considering and/or planning suicide) and suicide attempts. Hierarchical logistic regressions were run, controlling for age, race, smoking, alcohol use, drug use, geographic region, unhealthy weight-control practices, and body mass index/weight perceptions. RESULTS: Compared with inactive students or sports team nonparticipants, the odds of suicide ideation were lower among boys reporting frequent vigorous-intensity physical activity (adjusted odds ratio (AOR) = 0.48; 95% confidence interval (CI) = 0.29, 0.79) and sports team participation, respectively (AOR = 0.65; 95% CI = 0.48, 0.86). The odds of suicide attempts were also lower among frequently vigorously active boys (AOR = 0.44; 95% CI = 0.21, 0.96) and sports team participants (AOR = 0.61; 95% CI = 0.40, 0.93). The odds of suicide attempts were lower for regular vigorously active girls compared with inactive girls (AOR = 0.67; 95% CI = 0.45, 0.99) and sports team participants compared with nonparticipants (AOR = 0.73; 95% CI = 0.57, 0.94). Associations with one exposure variable generally weakened when adjustment was made for the other exposure variable, or for feeling sad and hopeless. CONCLUSIONS: The association of physical activity and sports team participation with suicide ideation and suicide attempts varied by sex. Further research is needed to clarify these different associations.     

Physical activity among adolescents: The role of various kinds of parental support

The objectives of this study were (a) to examine the association between various kinds of parental social support and adolescents' physical activity (PA) and (b) to examine whether various kinds of social support from mothers and fathers were differently associated with boys' and girls' PA. Data came from the Aarhus School Survey that included 2100 schoolchildren at 11, 13, and 15 years of age. Parental social support for PA was measured by items about encouragement to do PA, doing joint PA, parents watching PA, and talking about PA. PA was measured as at least 4 h of vigorous PA per week during leisure time. We used logistic regression analyses to estimate the associations for girls and boys separately, adjusted by age group, parents' occupational social class, family structure, and migration status. There were significant and graded associations between adolescents' PA and all four dimensions of parental support for PA. The association patterns were similar for mothers' and fathers' social support and similar for girls and boys. Social processes in the family are important for adolescents' participation in PA. It is important to continue to explore these social processes in order to understand why some adolescents are physically active and others are not.     

Community size and sport participation across 22 countries

The objective of this study was to examine, across 22 countries, the association between community size and individual sport, team sport, and exercise participation. Hierarchal non‐linear Bernoulli modeling is used to examine the association between community size (100 000–10 000; <10 000) and (a) individual sport, (b) team sport, and (c) exercise participation. After controlling for country‐level clustering and demographic variables, those residing a community with between 100 000 and 10 000 residents are more likely to participate in individual sport [odds ratio (OR) = 1.14; 95% confidence interval (CI) = 1.05–1.23] while residing in a community with less than 10 000 residents is unrelated (OR = 1.06; 95% CI = 0.96–1.19). Those residing in communities with between 100 000 and 10 000 residents were more likely to participate in team sport (OR = 1.21; 95% CI = 1.01–1.45) while residing in a community with less than 10 000 residents is unrelated (OR = 1.02; 95% CI = 0.88–1.18). Residing in a community with between 100 000 and 10 000 residents is unrelated to exercise participation (OR = 0.97; 95% CI = 0.89–1.7), while residing in a community with less than 10 000 residents is negatively related to exercise participation (OR = 0.86; 95% CI = 0.79–0.93). These findings provide novel evidence that communities between 100 000 and 10 000 residents are related to increased sport participation, particularly team sport participation.     

Parents' experiences of having their children take part in participatory action research creating a serious game about radiotherapy

IntroductionRadiotherapy (RT) is one of several treatment modalities used for children diagnosed with cancer. Several studies have designed interventions aimed to alleviate the stress that can occur in conjunction with RT. To include children in the design of interventions is rare and dependent on the parents giving consent to participation in research on their children's behalf. The aim was to illuminate, from the parents' perspective, the experience of their children being part in the co-creation of a serious game and their previous experiences of RT.MethodsTen parents of children taking part in a participatory action research study of the development of a serious game were invited to an interview and seven parents consented. An inductive, manifest content analysis was performed.ResultsThe analysis resulted in an overarching theme: Parents' pre-understanding from their child's cancer treatment created a sensitivity to their child's wishes and a willingness to contribute to science. Four categories are presented: Intrinsic factors influenced the intent to participate, Extrinsic factors that had an effect on participation, Parents role in the game development, and Radiotherapy impinged the child and the parent.ConclusionTo be able to pay it forward to healthcare and other families with a child diagnosed with cancer was a contributing factor for parents' willingness to consent to participation after their children had undergone RT, especially since their children wanted to do so. Parents indicated interest in the developmental process and in following their children being part of the creation of a serious game about RT.Implication for practiceTo understand why parents allow their children to participate in studies creates opportunities for the research community to structure studies that facilitate participation.     

Physical activity and quality of life in schoolchildren aged 11-13 years of Cuenca, Spain

This study examined the differences in quality of life (QoL) between active and sedentary schoolchildren and analyzed these differences by gender and weight status. A total of 1409 children, aged 11-13 years, from 20 schools located in 20 municipalities of the province of Cuenca were invited to participate in a cross-sectional study; 1073 children agreed (76.15% response rate), of which 536 (49.9%) were boys. QoL was measured with Child Health and Illness Profile-Child Edition (CHIP-CE), an instrument measuring children's perception of their own health using a Likert-type scale with five dimensions: satisfaction, comfort, resilience, risk avoidance, and achievement. Multivariate analysis of variance using the scores of the different CHIP-CE dimensions as dependent variables, physical activity, gender, and body mass index (BMI) category as fixed factors, and age as co-variate showed the following: (1) the scores of active children were significantly better than the scores of sedentary children for every dimension except risk avoidance; (2) there were no significant differences in QoL by BMI category; and (3) girls had better mean scores than boys for resilience, risk avoidance, and achievement, and worse scores for comfort. These results suggest that active children have a better QoL and that gender differences favoring boys diminish or even reverse to favor active girls.     

Participation in sports clubs is a strong predictor of injury hospitalization: a prospective cohort study

The aim of this prospective cohort study was to investigate the nature and risk factors of injuries leading to hospitalization. A cohort of 57 407 Finns aged 14–18 years was followed in the Hospital Discharge Register for an average of 10.6 years, totaling 608 990 person-years. We identified 5889 respondents (10.3%) with injury hospitalization. The most common anatomical location was the knee and shin (23.9%), followed by the head and neck (17.8%), and the ankle and foot (16.7%). Fractures (30.4%) and distortions (25.4%) were the most common injury types. The strongest risk factor for injury hospitalization was frequent participation in sports clubs [hazard ratio (HR) in males 1.8; 95% confidence interval (CI): 1.7–2.0 and in females 2.3; 95% CI: 1.9–2.7], followed by recurring drunkenness (HR 1.6; 95% CI: 1.4–2.7 in males and 1.4; 95% CI: 1.2–1.6 in females) and daily smoking (HR 1.4; 95% CI: 1.3–1.5 in males and 1.43 95% CI: 1.2–1.5 in females). The association between injuries and sports clubs participation remained after adjusting for sociodemographic background, health, and health behaviors. Health behavior in adolescence, particularly sports club activity, predicted injury hospitalization. Preventive interventions directed toward adolescents who participate in sports clubs may decrease injury occurrence.     

Socioeconomic status, environmental and individual factors, and sports participation

PURPOSE: To examine the contribution of neighborhood, household, and individual factors to socioeconomic inequalities in sports participation in a multilevel design. METHODS: Data were obtained by a large-scale postal survey among a stratified sample of the adult population (age 25-75 yr) of Eindhoven (the fifth-largest city of the Netherlands) and surrounding areas, residing in 213 neighborhoods (N = 4785; response rate 64.4%). Multilevel logistic regression analyses were performed with sports participation as a binary outcome (no vs yes); that is, respondents not doing any moderate- or high-intensity sports at least once a week were classified as nonparticipants. RESULTS: Unfavorable perceived neighborhood factors (e.g., feeling unsafe, small social network), household factors (material and social deprivation), and individual physical activity cognitions (e.g., negative outcome expectancies, low self-efficacy) were significantly associated with doing no sports and were reported more frequently among lower socioeconomic groups. Taking these factors into account reduced the odds ratios of doing no sports among the lowest educational group by 57%, from 3.99 (95% CI, 2.99-5.31) to 2.29 (95% CI, 1.70-3.07), and among the lowest income group by 67%, from 3.02 (95% CI, 2.36-3.86) to 1.66 (95% CI, 1.22-2.27). CONCLUSIONS: A combination of neighborhood, household, and individual factors can explain socioeconomic inequalities in sports participation to a large extent. Interventions and policies should focus on all three groups of factors simultaneously to yield a maximal reduction of socioeconomic inequalities in sports participation.     

Adolescent elite athletes’ cigarette smoking,use of snus,and alcohol

The purpose was to examine cigarette smoking, use of snus, alcohol, and performance‐enhancing illicit drugs among adolescent elite athletes and controls, and possible gender and sport group differences. First‐year students at 16 Norwegian Elite Sport High Schools (n = 677) and two randomly selected high schools (controls, n = 421) were invited to participate. Totally, 602 athletes (89%) and 354 (84%) controls completed the questionnaire. More controls than athletes were smoking, using snus, and drinking alcohol. Competing in team sports was associated with use of snus [odds ratio = 2.8, 95% confidence interval (CI) 1.6 to 4.7] and a similar percentage of male and female handball (22.2% vs 18.8%) and soccer players (15.7% vs 15.0%) reported using snus. For controls, not participating in organized sport was a predictor for smoking (odds ratio = 4.9, 95% CI 2.2 to 10.9). Female athletes were more prone to drink alcohol than males (46.3% vs 31.0%, P < 0.001). Only, 1.2% athletes and 2.8% controls reported use of performance‐enhancing illicit drugs. In conclusion, use of legal drugs is less common among athletes, but this relationship depends on type of sport and competition level. The association between team sports and use of snus suggests that sport subcultures play a role.     

Stability of leisure-time physical activity during adolescence--a longitudinal study among 16-, 17- and 18-year-old Finnish youth

Participation in physical activity during childhood and adolescence is frequently mentioned as one factor likely to promote a more active lifestyle in adulthood with its health benefits. We studied the changes in leisure-time physical activity pattern and self-reported fitness during a three-year period in adolescence and investigated whether the type of sports has an effect on stability of physical activity at leisure. A questionnaire with identical physical activity items was sent to Finnish twins on their 16th and 17th birthdays and 6 months after the 18th birthday. A total of 1338 boys and 1596 girls responded to all three questionnaires, with response rates of 73.6% and 86.5%. The proportions of very active adolescents and adolescents with very good self-reported fitness seem to be alike at each age. Among girls, 23.7% to 27.7% reported being very active (4-5 times a week) and 13.7% to 15.1% considered their physical fitness to be very good at the ages of 16, 17 and 18. Among boys, the comparable percentages were 31.5% to 35.5% and 30.6% to 34.4%. However, the longitudinal three-year follow up showed substantial changes over time among individuals from one physical activity group to another. Only 19.1% of boys and 11.2% of girls were persistent exercisers (i.e., very active on all three years) and 15.6% of boys and 5.1% of girls were persistently fit (i.e., very good self-reported fitness on all three years). Stability of leisure-time physical activity was highest among those who participated in several different types of sports. Among boys the proportion of persistent exercisers was highest for those who participated in cross-country skiing, jogging and body-building (22.0-41.5%) and among girls for those who participated in ball games (11.9-28.6%). Those who participated in organised sports were more often persistent exercisers than those who did not (odds ratio = 13.2 for boys (CI 9.4-18.7) and 8.9 for girls (CI 6.4-12.5)). Also, those who participated in organised sports were more often persistently fit (odds ratio = 7.3 for boys (CI 5.2-10.2) and 10.4 for girls (CI 6.4-16.9). Adolescents are recommended to participate in and try different types of sports, and especially for girls ball games would appear to favour long-term maintenance of leisure-time physical activity.     

Social neighborhood environment and sports participation among Dutch adults: Does sports location matter?

Studies on the relation between the social neighborhood environment and sports participation have produced inconsistent results. Use of generic sports outcomes may have obscured associations only apparent for sports at certain locations. This study aims to assess the association between the social neighborhood environment and three location‐specific sports outcomes. Repeated cross‐sectional data on sports participation (any type of sports, sports at indoor sports clubs, sports at outdoor sports clubs, sports on streets) were obtained from 20 600 adults using the Dutch national health survey 2006–2009. Data on neighborhood social safety and social capital were obtained using the Dutch Housing Research 2006. Over 40% of Dutch adults participated in any type of sports. Indoor sports clubs were most popular. Multilevel logistic regression analyses revealed that neighborhood social safety was positively associated with sports at indoor sports clubs [odds ratio (OR) = 1.25, 95% confidence interval (CI) = 1.06–1.48), but not with the other sports outcomes. Contrary, neighborhood social capital was positively associated with sports on streets only (OR = 1.69, 95% CI = 1.17–2.44). The results suggest that a positive social neighborhood environment enhances sports participation, but that this impact depends on the location of the sports activity. This study highlights the importance of using location‐specific sports outcomes when assessing environmental determinants.     

Perceived and actual competence among overweight and non-overweight children

Child overweight and obesity continues to be a global public health concern. The aim of this study was to investigate whether children's actual and perceived physical competence and parental perception's of their child's competence differ by weight status. Understanding these differences is important because physical activity levels are significantly lower among overweight children than their lean counterparts and children's motivation to participate in physical activity is influenced by their perceived and actual competence and their parents perceptions of their competence. Cross-sectional data were collected from 1414 9- and 11-year-old children and their parents from 20 primary schools in New South Wales, Australia. Outcomes measured included child and parental perceptions of physical competence and children's actual physical competence. Parents of overweight boys perceived them to be significantly less competent than parents of non-overweight boys. For 11-year-old girls, parent's perception of their daughter's ability to run (mean diff = 1.06 [95% CI 0.73, 1.40]), jump (mean diff = 0.54 [95% CI 0.15, 0.93]) and leap (mean diff = 0.78 [95% CI 0.41, 1.17]) was lower among parents of overweight children. Overweight children also reported lower perceived physical competence than non-overweight children. 9- and 11-year-old overweight boys had lower actual physical competence than non-overweight boys (mean diff = 1.32 [95% CI 0.29, 2.35]; mean diff = 1.26 [95% CI 0.37, 2.15], respectively). Overweight 11-year-old girls had lower actual competence than non-overweight 11-year-old girls (mean diff = 1.14 [95% CI 0.70, 2.12]). This study highlighted several differences between overweight and non-overweight children. Better understanding these differences at different stages of development may lead to identifying more specific and appropriate intervention points to promote physical activity in overweight children.     

Participation in sports,body composition,and fitness characteristics in children according to ethnic background

Participation in sports has important implications, being associated with health and social features. The objectives of this study were to verify whether there were any differences in sport participation between immigrant and Italian children and whether there was any relation with their body composition and fitness characteristics. A survey was conducted on 1432 children attending primary school in the Emilia‐Romagna (northern Italy). Anthropometric measurements, fitness characteristics, and data about participation in sports were considered. Italian children were more likely to participate in sports than immigrants and boys than girls. Among immigrants, the lowest values were observed in Asians. Eastern European males and Latin American females displayed the widest dimensions. Eastern Europeans generally showed the highest values of strength, while Latin Americans had the highest values of flexibility. Asian children showed the highest values of centripetal fat, and a high percentage of them exceeded the %F reference. These aspects, together with the low frequency of practicing sports, place Asians at greater risks for health. Sex and ethnic group are the most informative variables associated with participation in sports by children. Interventions including health education lessons and promoting the participation in sports for immigrant children attending schools need to be encouraged.     

Recreational sports participation is associated with enhanced physical fitness in children

The purpose of this study was to examine the association between seasonal participation in recreational sports and its influence on physical fitness measures in children. A total of 44 children (20 boys and 24 girls) all in the fifth grade (11.2 +/- 0.3 yr) were tested for flexibility, upper body strength, upper body power, and lower body power. Activity questionnaires examined seasonal participation rates in recreational sports. Spearman rank correlations showed significant correlations between sport participation rates and performance on selected physical fitness tests (p range between 0.34 and 0.55). Subjects participating in recreational sport programs throughout the year (fall, winter, and spring) performed significantly better in tests of upper body strength, upper body power, and lower body power than subjects who did not participate in any sport or subjects who participated in only one sport. These findings suggest that regular participation in recreational sports throughout the year may be associated with higher levels of muscular strength and anaerobic power in children.     

Use of protective equipment by adolescents in inline skating, skateboarding, and snowboarding

OBJECTIVES: Determine the frequency of personal protective equipment (PPE) use in adolescent inline skaters, skateboarders, and snowboarders; explore factors influencing PPE use; identify factors that would influence use; and examine the association of high-risk behaviors and PPE use. DESIGN: Cross-sectional survey. SETTING: Central/southeast Wisconsin. PARTICIPANTS: Participants 13-18 years-old. INTERVENTIONS: None. Independent variables = age, gender, sport. MAIN OUTCOME MEASUREMENTS: None. Dependent variables = PPE use, factors influencing use, and frequency of other high-risk behaviors. RESULTS: The mean age of 333 participiants was 14.9 years. Adolescents wore considerably less PPE than recommended. Inline skaters wore the most; snowboarders the least. The most common reasons adolescents wore PPE were parents, peers, and rule/requirement. Younger adolescents cited parents more often than older adolescents as a factor for PPE use. Discomfort and lack of perceived need were the most common reasons for nonuse. Sustaining/witnessing an accident was the most common reason that would convince adolescents to wear PPE. Almost half of adolescents reported nothing would convince them to wear PPE. Younger adolescents wore more PPE than older adolescents. An association was seen between PPE use in all sports and bicycle helmets. An inverse relationship was found for tobacco and helmet use among skaters, as well as alcohol and helmet use in skateboarders. CONCLUSIONS: Adolescents underuse PPE. PPE reinforcement by parents/peers, encouraging bike helmets, manufacturing more comfortable gear, educating adolescents, and instituting PPE requirements in public areas may increase compliance. This could lead to decreased injuries. Physicians should discuss PPE with their patients/families. There may be an association between PPE use in extreme sports and decreased high-risk health behaviors.