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Her life depends on it:  Sport, physical activity and the health and well-being of American...

Key Message

Sport and physical activity provide conditions that help to assure girls’ health and well-being, including  reducing the risk of breast cancer, smoking, drug use, depression, suicide and sexual risk.

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.


The Women’s Sport Foundation. (2004). Her life depends on it: Sport, physical activity and the health and well-being of American girls. Eisenhower Park, East Meadow, New York: Author.


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 (American Cancer Society, 2003).
• 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).

This report is divided into six sections. Section I focuses on several major diseases of later life for which physical activity in youth are a key preventive factor. Section II examines how sports and exercise influence patterns of substance use among female adolescents. Section III explores ways that athletic participation lowers young women’s sexual risks and teen pregnancy rates. Section IV discusses research on links between sports, exercise and educational outcomes. Section V focuses on research on the interfaces of sports and exercise with girls’ mental health and psychological well-being. Finally, Section VI examines patterns and trends in female participation in sports and fitness activities.



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.


This report shows that physical activity and sport favorably influence girls’ health and well-being in many ways. Getting more girls up and moving through exercise and sport, therefore, makes practical sense as a social and economic investment for the nation. Put simply, it makes sense to invest in girls’ health and well-being now rather than paying high health costs later. This report discusses of a variety of health problems for which physical activity and sport have been identified as a preventive factor.

In this context, consider the following estimated costs of failing to invest in exercise and sport: (The Women’s Sports Foundation Report: Her Life Depends On It: Sport, Physical Activity and the Health and Well-Being of American Girls)
• Cardiovascular Disease: The estimated direct and indirect costs of cardiovascular disease and stroke in the United States in 2003 are $351.8 billion (American Stroke Association, American Heart Association, 2003).
• Cancer: In the year 2002, the National Institutes of Health estimated the overall annual costs for cancer at $189.5 billion (National Institutes of Health, 2002).
• Obesity-Related Diseases: An increase in physical activity among children and adults would substantially reduce the $92.6 billion in U.S. healthcare expenditures that are spent on treating obesity-related diseases (Colditz, 1999).
• Diabetes: The 2002 national estimated cost of diabetes in the United States was $132 billion (Centers for Disease Control and Prevention, 2003).
• Osteoporosis: Regular exercise beginning in childhood and carried on through adolescence and young adulthood helps to prevent osteoporosis (Kannus, 1999).
• Alzheimer’s Disease: The annual cost of caring for persons with Alzheimer’s disease is estimated at $100 billion per year (National Institute on Aging, 2002).
• Tobacco Use: Estimates show that smoking caused over $150 billion in annual health-related economic losses from 1995 to 1999 (Centers for Disease Control and Prevention, 2002).
• Alcohol Use: The estimated annual cost of drug abuse to the U.S. economy in 1998 was $185 billion (Harwood, 2000).
• Illicit Drug Use: The estimated annual cost of drug abuse to the U.S. economy in 1998 was $143 billion, most of which was associated with drug-related crime (Office of National Drug Control Policy, 2001).
• Sexually Transmitted Diseases: Of the estimated 18.9 million Americans with new cases of STDs in 2000, about half (48%) were aged 15-24 (Weinstock, Berman and Wang, 2004), costing an estimated $6.5 billion overall. This estimate includes medical costs, productivity losses and intangible costs such as pain and suffering (Chesson et al, 2004.)
• Teen Pregnancy: One third (34%) of all U.S. adolescent girls get pregnant at least once before their 20th birthdays; of these 820,000 pregnancies annually, 80% are unintended. Nearly half a million result in a live birth. The associated costs, including health care, foster care, criminal justice, public assistance and lost tax revenues, are estimated at more than $7 billion annually (Henshaw, 2003; National Campaign to Prevent Teen Pregnancy, 2002).
• Suicide: The estimated annual costs associated with suicide are $15.5 billion in the United States (Miller et al, 1998).

Anti-Social Behaviour

Educational and Social Dimensions:
American girls faced gender bias in education throughout most of the 20th century. High school and college females were expected to depend on their husbands’ achievements to succeed within the larger economy. Certain academic subjects and careers in science and mathematics (like sport itself ) were labeled “masculine” by many educators and school advisors (Damarin, 2000). Recently, however, girls are emerging out of feminine stereotypes and excelling in education. One survey of 1,000 high schools in 26 states found that 84% of the females said it was important to continue their education beyond high school, 70% thought it would be useful to do well in school achieve life goals and 67% try to do their best in school. The pro-education orientation of young females is further demonstrated by the fact that 74% of girls graduate from high school compared to 67% of boys (USA Today, 2003). Women’s percentage of earned college degrees went from 24% in 1950 to 56% in 1996 (U.S. Bureau of the Census, Statistical Abstract of the United States, 2000).

A variety of research findings suggest that for many girls athletic participation is a positive component of their academic aspirations and achievement.

Student-athletes in high school tend to do better academically over time (Crosnoe, 2002; Eccles and Barber, 1999; Marsh and Kleitman, 2003; Videon, 2002).
• High school female athletes expressed a greater interest in graduating from college (Melnick, Vanfossen and Sabo, 1988).
• A longitudinal study of 22,696 high school students in 1,052 schools found that both female and male athletes had higher grades, higher educational aspirations and less school-related discipline problems than non-athletes (Fejgin, 1994).
• A nationwide sample of high school students was followed between the sophomore and senior years. 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).

A nationwide sample of young people was studied between their sophomore and senior years in high school and for four years after high school (1988-1994). Students involved with school sports had higher grades, more Carnegie units and higher educational aspirations. Athletes spent more time on homework and applied to more universities. Two years after high school, former athletes were more likely to be enrolled in university and to hold higher educational aspirations Marsh and Kleitman, 2003).

Exercise and Learning - BACKGROUND
Exercise itself may be associated with increased cognitive energy and learning. At a time when physical education classes are being dropped from many school curriculums, evidence suggests that physical activity and learning go hand-in-hand (Action for Healthy Kids, 2003).
• Physical exercise may boost brain function, improve mood and otherwise increase learning (King, 1999)
• A review of almost 200 studies on the links between exercise and cognitive functioning reported that physical activity buttresses learning (Etnier et al, 1997).
• Several studies document links between physical activity programs to favorable academic outcomes such as better test scores, increased concentration and enhanced performance in math and reading (Shephard et al, 1984; Shephard, 1997; Symons et al, 1997).

Facts and Research Findings
Ironically, as research findings emerge that show favorable linkages between exercise and classroom learning, participation in school physical education classes is decreasing—and the decline appears to be steeper for girls than boys.
• The percentage of students taking daily physical classes dropped from 42% to 29% between 1991 and 1999 (Centers for Disease Control and Prevention, 2003).
• Overall, male students (87.7%) in physical education (PE) class are significantly more likely than female students (78.8%) to have exercised 20 or more minutes during an average PE class (Centers for Disease Control and Prevention, 2002).
• Nationwide 51.7% of students are enrolled in PE class. Approximately one-third (32.2%) of students nationwide attend PE class daily. There are no significant sex differences in participation in ninth- and 10th-grade, but male students in grade 11 (30%) are significantly more likely than female students (15.6%) to have attended PE classes daily. In grade 12, males (26.1%) are significantly more likely than female students (14.7%) to have attended daily PE class (Centers for Disease Control and Prevention, 2002).

The bulk of research findings cited in this report show that physical activity and sport can enhance the health and well-being of American girls and young women, and at a time when public health experts estimate that obesity and sedentary lifestyles are responsible for 400,000 deaths per year in the United States. Inactivity and obesity in the current generation of girls will yield a substantial burden of disease for women in the future. The preventive health message is clear: girls and young women deserve and need full access to opportunities for participation in physical activity and sport.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.

Additional Information

EXSUM | © 2004, Women’s Sports Foundation, All Rights Reserved

Benefit Statements / Outcomes

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  • Leisure Information Network (LIN)
  • Alberta Recreation and Parks Association

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  • Canadian Parks and Recreation Association (CPRAA)

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