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Citation for the original published paper (version of record): Fredriksson, I., Geidne, S., Eriksson, C. (2018)
Leisure-time youth centres as health-promoting settings: Experiences from multicultural neighbourhoods in Sweden
Scandinavian Journal of Public Health, 46(Suppl. 20): 72-79 https://doi.org/10.1177/1403494817743900
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Introduction
Adolescence is a time when the foundations for future patterns of adult health are established [1]. Adolescence is also a time when individuals outside the family become more important to the young peo-ple, and leisure time can therefore have a greater impact on the lives of adolescents [2]. Because lei-sure time comprises a large and important portion of young people’s lives, arenas where they spend their leisure time, such as sports clubs, cultural organisa-tions and youth centres, could be seen as potential settings for promoting healthy behaviours.
The importance of a meaningful leisure time for young people
According to the UN Convention on the Rights of the Child [3], it is important to respect and promote
a child’s right to participate fully in leisure activities. However, research studies have shown that young people in multicultural and socially deprived suburbs participate less in organised leisure activities, because of both the higher proportion of immigrants and lower socio-economic status (SES) [4,5]. One way to reduce social differences in health is to improve ado-lescents’ living conditions, for example by enhancing the quality of leisure-time activities [6]. Changing existing settings is an optimum way to improve health equity [7]. Participation in leisure-time activities can be of particular significance for adolescents with lower SES, including a more positive general self-worth and social self-concept [8].
Studies have also found relationships between differ-ent leisure-time activities and academic achievemdiffer-ent [9]. Moreover, leisure activities can provide an important
Leisure-time youth centres as health-promoting settings:
Experiences from multicultural neighbourhoods in Sweden
INgElA FREDRIkSSON, SUSANNA gEIDNE & CHARlI ERIkSSON Faculty of Medicine and Health, School of Health Sciences, Örebro University, Sweden
Abstract
Aims: The aim of this paper is to advocate for the importance of meaningful leisure time for young people from a
health-promotion perspective using experiences from two youth centres in multicultural neighbourhoods in Sweden. Methods: In this practice-based study, data were collected between 2012 and 2014 at two youth centres in multicultural, socially deprived suburbs in Sweden using surveys with 12- to 16-year-old adolescents (n = 207), seven individual interviews with staff and three cooperation partners in the neighbourhoods, and six group interviews with adolescents (50% girls). Quantitative, qualitative and mixed methods were used for analysis. Results: As part of the youth centres’ strategies, they are open and inclusive, foster supportive relationships, emphasise youth empowerment, and integrate family, school and community in their work. The youth centres are health-promoting settings with regard to four of the action areas in the Ottawa Charter: build healthy public policy, create supportive environments, strengthen community actions and develop personal skills.
Conclusions: There is a need for a variety and a combination of various structured and unstructured leisure-time
activities because young people’s background and life situation plays a role for their participation in leisure-time activities. We conclude that youth centres are well placed to be or to become health-promoting settings if the activities takes place in a structured environment.
Key Words: Health promotion, leisure-time activities, mixed methods, multicultural, settings based[AQ: 2]
Correspondence: Susanna geidne, Faculty of Medicine and Health, School of Health Sciences, Örebro University, SE-701 82 Örebro, Sweden. E-mail: susanna.geidne@oru.se
Date received: XX Month XXXX; revised: XX Month XXXX; accepted: XX Month XXXX [AQ: 7]
0010.1177/1403494817743900Youth centres as health-promoting settingsI. Fredriksson et al. research-article2017
2 I. Fredriksson et al.
opportunity for informal learning [10]. Studies of young people’s leisure activities often involve organised sports activities and show that participants to a greater extent are males who come from higher SES backgrounds [8,11]. Earlier studies in youth centres have shown that young people’s participation in unstructured, unsuper-vised, peer-oriented activities was related to poor adjust-ment and poorer interactions with their parents [12]. On the other hand, young people may prefer less structured leisure activities [13].
Leisure-time activities as health-promoting settings
This debate paper sets out from a health-promoting settings-based approach introduced in the Ottawa Charter (OC) in 1986, which states that ‘health is created and lived by people within the settings of their every-day life, where they learn, work, play and love’ [14]. A settings perspective includes several dif-ferent aspects that affect a person’s health. People are living in a complex environment in which social, cul-tural, economic and political aspects affect their health, both positively and negatively. The concept of healthy settings has been developed and applied to a variety of areas, such as for example healthy schools [15]. However, few studies have addressed how the settings-based approach applies to leisure activities or nongovernmental organisations (NgOs), despite their potential to create and maintain healthy envi-ronments [16]. This debate paper aims to advocate for the importance of meaningful leisure time for young people from a health-promotion perspective using experiences from two youth centres in multi-cultural neighbourhoods in Sweden. It is based on results from a study on leisure-time youth centres as health-promoting settings [17–20] in a special ven-ture financed by the Swedish government [21].
method
In Sweden, two main approaches to organise leisure-time activities for adolescents can be identified. There is a long-standing tradition of NgOs running leisure-time activities within, for example, sports, and munic-ipalities running youth centres. This study is based on two youth centres, which are run by two different NgOs and which are located in suburbs in Stockholm (V) and Örebro (T). Both suburbs are fairly typical public residential areas characterised by apartment blocks, low SES and a high proportion of people from immigrant backgrounds, about 55–85% compared to 20% for Sweden as a whole. The youth centres have both paid and volunteer staff. The paid staff have for-mal professional training, and the volunteer staff are
often older youth and former participants with inter-nal leadership training. Both youth centres provide structured activities such as dance groups, travel groups, excursions and leadership training, as well as unstructured activities such as playing games, watch-ing television or just hangwatch-ing out with friends.
Participants are Swedish-born youths with for-eign-born parents who live with both parents, often in crowded apartments with many siblings. Moreover, they feel healthy, enjoy school and have good contact with their parents [19]. The two youth centres have a relatively even gender distribution, with no major dif-ferences in background factors in terms of gender. However, girls tend to participate slightly more in organised regular activities. Most participants live close to the youth centres.
The study used a practice-based approach, being collaborative and methodologically diverse [22]. Close cooperation with the youth centres was emphasised, and quantitative, qualitative and mixed-methods were used [23]. The study was approved by the Swedish regional ethical review board in Uppsala in January 2012 (reg. no. 2011/475).
Data collection
Data were collected through annual surveys on three occasions: the first emphasising who participates [19], the second the motives of participation [20] and the last what the young people gained from par-ticipation. Both individual and group interviews were made, deepening the questions above, as well as focusing on the strategies used in every-day activities [17].
The study used purposive sampling, meaning that those who came to the youth centres during a defined time period were invited to participate in order to reach as many young people as possible who were taking part in these voluntary and partially unstruc-tured activities. The survey in 2012 received replies from 207 young people. The follow-ups in 2013 and 2014 used this sample and had response rates of 79% and 70% (more information in Fredriksson [18]).
A total of 16 interviews were conducted during 2013 and 2014, seven of which were individual with leaders and three with cooperation partners, and six group interviews were conducted in total with 13 boys and 13 girls aged 13–17 years.
Survey questions focused on young people’s lei-sure activities, hobbies, family life, lifestyles, living conditions and health (more information in Fredriksson [18]). They contained questions about who participates in the youth centres, why they par-ticipate and what they got out of participating. The interview guide followed the content of the survey
[AQ: 1]Youth centres as health-promoting settings 3
and further highlighted the specific strategies the youth centres use in their daily work. The same inter-view guide was used both for the leaders and the par-ticipating young people. The interview guide for cooperation partners contained questions on initia-tion, functioning and impact of collaboration and role of leisure-time activities in the local neighbour-hood. Semi-structured interviews were used for both individual and group interviews.
Analyses
The quantitative data were analysed with descriptive statistics, chi-square distributions, t-tests and logistic regression [17–20]. The qualitative data were ana-lysed with inductive and deductive qualitative con-tent analyses [17–20]. The qualitative data are used to help explain initial quantitative findings as one type of mixed methods, that is, explanatory sequen-tial design [23].
In this debate paper, results are presented and dis-cussed in relation to the five health promotion action areas in the OC: build healthy public policy, create supportive environments, strengthen community actions, develop personal skills and reorient health services [14]. All of these, except for reorienting health services, can be seen as relevant for leisure-time activities, and will be used for presenting the results from a previous study according to the aim of this debate paper.
results
Build healthy public policy
Build healthy public policy focuses on legislation, organisational change and policies that foster equity and ways to ‘make the healthy choice the easy choice’.
The youth centres provide clear and explicit rules and expectations, and the young people themselves are involved in the formulation of rules and policies. There is a positive approach where love and respect are naturally transferred from older to younger youth and new participants.
I’m a bit older so I’m supposed to be a good role model for those who are younger than me who come to the centre … so maybe I start talking with them, they might start to show respect, and then I also feel happy, and they’re like new friends, maybe a bit younger but still friends. (Boy, T)
Both youth centres have well-developed strategies and rules that help the participants to make healthy choices, for example not to drink alcohol or smoke on weekends when they participate in activities.
Through a clear alcohol, narcotics, doping and tobacco (ANDT) strategy, where related issues are discussed in the daily work and are a standard feature of internal leadership training, young people are given many protective factors that increase their resilience, and they are able to take a more restrictive approach to ANDT:
I’ve learned to say ‘no’ to that, because I know the impact. I’ve taken classes; I’ve been in leadership training. I know. I see what happens. I see the consequences, and that is what I have learned here at V actually. (girl, V)
Another important part of the policy for the youth centres is the gender equality. Both youth centres have a gender perspective in their activities and show good examples of gender equality.
Create supportive environments
Create supportive environments emphasises how society and parts of society organise work and leisure to be safe, stimulating, satisfying and enjoyable.
According to both surveys and open-ended answers, the most important thing for young people’s participa-tion in these leisure activities is that they make many new friends and get to hang out with friends to experi-ence fun and educational activities (Figure 1). Also important is that it is a welcoming, safe and respectful atmosphere in which the young people are allowed to be themselves. The youth centres constitute a physi-cally and psychologiphysi-cally safe environment, free from violence, harassment and harm.
It was pointed out that everybody is welcome to par-ticipate in the youth centres. Several young people had been members since they were small children and had participated in the activities offered to the Figure 1. The proportion of young people who self-report the dif-ferent motives as ‘very important’ (n=163). From geidne et al. [20].
4 I. Fredriksson et al.
younger children and their families. Recruitment is also carried out through schools, with a special focus on young people at risk.
They’re good at converting those whom the school doesn’t manage to, they give them an environment that is quite calm with a clear framework, good peer support, a lot of discussions with adults, and these kinds of things. (Cooperation partner, V)
Young people experience a strong need for a place where they can just relax and hang out with friends. They sometimes need less demanding and more easily accessible activities that do not have the same require-ments as other organised recreational activities.
…but mostly it just spreads happiness down here, like after a tough day at school or something, then you come down here and just relax, take it easy. (Boy, V)
Supportive relationships are crucial within a sup-portive environment. The leaders’ role and impor-tance to young people’s development is central, and the relationships between young people and leaders at the centres were reported to be positive and friendly. The young people described the older lead-ers as role models or counsellors. They felt that the leaders are there for them, listening to them, and can be trusted. They felt they receive support and guid-ance in every-day matters and that they can trust the leaders with more sensitive issues or situations. Certain activities are youth led, giving them utmost control while the adult leaders have a supportive role as mentors or coaches when necessary.
I think my most important role is to provide guidance. To be there, so they feel secure … so there’s someone they look up to who’s older, so they know we’re here. To be like a brother and a sister and a friend to everybody. (leader, V)
The youth centres give young people a sense of both belonging and connectedness. Many expressed how the youth centre is their second home and they feel like a big family.
Strengthen community actions
Strengthen community actions involves setting pri-orities, making decisions and using strategies that empower a certain community through self-help and social support.
Both youth centres have good contact with the young people’s families, the local schools and the surrounding community. They have regular contact with the parents who are often present and involved
in activities. The youth centres complement gaps in society, for example by being open on evenings, weekends and holidays when other important venues for young people such as school are closed. One leader reported how the centre’s activities are ramped up during holidays and weekends, and when the town shuts down. Another example is by encourag-ing and supportencourag-ing young people’s education, for example through support with homework. They give young people the support and the time that the schools and parents are sometimes unable to give.
In addition to the internal work with young people about ANDT and its adverse effects, one of the youth centres plays a very active role in the local commu-nity through neighbourhood watch groups and spon-taneous walks in the area and through collaboration in different networks to combat the criminal drug trade in the area. According to cooperation partners, their activities contribute to security and comfort in the neighbourhood:
…cool to see how V’s activity in some way gives effects to an entire area. (Cooperation partner, V)
Cooperation partners appreciate these youth centres and experience them as key players for both the youth and the community. They create trusting rela-tionships in these types of segregated residential areas which it is more difficult for authorities to do, which contributes to integration in society. In addi-tion to confirming much of what both leaders and young people at the youth centres say about the activities, they also emphasise the importance of the continuity and stability and that they are always pre-sent and active in the residential area.
…V is good, continuous activities, stable over time; they are like something to hold in your hand. (Cooperation partner, V)
Develop personal skills
Develop personal skills is about supporting personal and social development through information, educa-tion and the development of life skills.
The youth centres have a clear strategy for young people’s participation and influence and for strength-ening their empowerment. They use a variety of methods to encourage and support the participants’ engagement and the exercise of democracy, both within their own activities and in the local commu-nity. The activities also provide many opportunities for leadership and skill development for young people that support their personal and social development. Young people are given responsibility in different
Youth centres as health-promoting settings 5
activities and leadership roles that strengthen them and make them feel that they contribute in a mean-ingful way. One of the youth centres has a clear lead-ership strategy in which youth lead youth.
And then they come into a situation and act as leaders, and how they continue growing and how they receive the new members. And how seriously they take their role of being leaders … They feel like ‘I matter to this’. They have a mission that they are proud of. (leader, V)
The young people confirmed that they have gained knowledge and life skills that will benefit them in their future life. They emphasise social skills, respect and attitude, loyalty, solidarity and everybody’s equal val-ues. The young people have learned to take responsi-bility and gained greater self-reliance. They have also received specific skills such as swimming, dancing, arranging activities and knowledge of risks of using alcohol and drugs and the importance of an active leisure time, as well as developing leadership skills.
I have learned to be social, to hang out with people and to be strong, and I have developed strong self-confidence
and leadership. Thanks to V, I would probably not have if I hadn’t come here. (girl, V)
In summary
According to our research, youth centres as health-promoting settings comprise four elements: open and inclusive target group, supportive relationship, youth empowerment and integration of family, school and community (Figure 2). The youth centres in this study integrate health into their routines and core business, and they have a good local knowledge of what context they operate in, which is seen as a pre-requisite for effective health promotion.
Discussion
In this study, it is argued that youth centres are health-promoting settings according to four out of five of the action areas of the OC [14]. A setting involves complex interactions between environ-mental, organisational and personal factors, and this is why the health aspect needs to be integrated Figure 2. Strategies used in the youth centre’s every-day activities.
6 I. Fredriksson et al.
into all of the setting’s routines and core activities [24].
One way to work for equal health and for child rights is to increase participation in leisure-time activities for young people in socio-economically dis-advantaged neighbourhoods [6,7]. To do this, it is important to have local knowledge about young peo-ple’s needs and interests. Our results emphasise that motives for participation are closely connected to who the participants are and in what neighbourhoods the leisure activities are located and also to the char-acteristics of the leisure-time activities [20].
In line with earlier research [25], our research shows that youths live and develop in a socioecologi-cal context where family, peers, neighbourhood soci-ety and culture all have an impact on their leisure. Even if peers are important during youth, as also reported in other studies [2,26], our research shows that parents are important for leisure activities. good communication and collaboration with school is also important for reaching young people.
Strategies used to recruit young people to the youth centres seem to have an impact on who participates [19]. One way to succeed in having an equal gender and ethnic distribution is to offer youth activities as a natural step after participating in activities for chil-dren. The proximity to leisure activities is also impor-tant for participation in these kinds of neighbourhoods. good communication between the different settings where youth are and a shared understanding of their needs is crucial for young people’s development. To have good contact with parents is important for all lei-sure activities, but it is perhaps even more important when it comes to getting young people to participate in neighbourhoods with many immigrants with differ-ent experiences and understanding society’s functions and institutions [17].
The activities constitute a supportive environment that is safe and stimulating for young people where they feel valued and respected and where they are challenged in a positive way. The activities allow young people to increase their capacity and develop their independence with respect to health. Through the leisure activities, they develop their personal skills through information, education and development of life skills. The young people’s empowerment is cen-tral, and a youth centre can be an important setting for skill-building and training in practical democracy, as documented in the qualitative interviews.
Partnerships, collaboration and participation are central and fundamental principles for the health-promoting settings perspective and are regarded as fundamental to sustained health-promotion initia-tives [27]. Both youth centres prioritise participa-tion and interacparticipa-tion with several different actors,
which is appreciated by the community. leaders, young people and cooperation partners acknowl-edge each other’s statements in terms of both the-ory and practice, which suggests that their strategies work well.[AQ: 3]
Unlike Persson et al. [12] who concluded that par-ticipation in unstructured, unsupervised, peer- oriented activities was related to poor adjustment and poorer interactions with their parents, this study shows that unstructured and peer-oriented leisure activities can be positive when they occur as part of a broader strategy, with a structured and supervised environment which includes good cooperation with parents.
Peer norms can have both positive and negative effects on adolescents [28,29]. Social norms can therefore be crucial in a leisure activity. The activities in this study seem to have succeeded in creating and maintaining positive social norms. This is reflected in both the formal structure of the organisations and the informal culture that arises in the daily interac-tion. The young people maintain the positive social norms by teaching new and younger members how to behave and how to interact with others in a respect-ful way.
A variety of unstructured and structured activities of partially undemanding character is something that is wanted and appreciated by young people. An important aspect is that there are adults and leaders in the youth centres who create and maintain a wel-coming, safe and respectful atmosphere. The young people in this study also tend to stay in the activities, which other structured activities, such as sport clubs [30], have a harder job of achieving among older adolescents.
Data for this study were gathered both quantita-tively and qualitaquantita-tively, and interpretations were drawn based on the combined strengths of both sets of data to understand our research questions [23]. Moreover the practice-based research approach, the longitudinal design as well as the long-term collaboration between NgOs and public-health researchers are strengths [21]. There are, however, also limitations. Only two NgO youth centres were studied. In addition, more in-depth analysis of the youth centres could have been done to study the micro-environment and interaction pattern among participant and leaders. More exten-sive analysis of the collaboration between youth cen-tres and their neighbourhoods could have been included in the study.
conclusion
Increasing participation in meaningful leisure activities for young people, especially young people
Youth centres as health-promoting settings 7
in multicultural and socially deprived neighbour-hoods, can help to reduce social inequalities in health. To accomplish this, there is a need for a variety and a combination of various structured and unstructured leisure-time activities because young people’s background and life situation play a role in their participation in leisure activities. Active and deliberate recruiting, local knowledge and integration of family, school and leisure time are prerequisites to increase participation in lei-sure-time activities for different target groups. leisure-time activities must be organised to fit the young people, not the other way around. Unlike previous studies on youth-centre activities, we con-clude that partly unstructured leisure-time activi-ties are well placed to be or to become a health-promoting setting if they take place in a structured environment.
recommendations
• Integrate family, school and community: good contact and interaction with the families seem to have positive outcomes, especially for youth in multicultural and socially deprived neighbour-hoods and families with different cultures. Partnership and collaboration are fundamental for health-promoting settings and are essential for their sustainability [18].
• Integrate NgOs in health promotion: involve civil society and NgOs in health-promoting work. NgOs have added values that will enrich the work and make it more sustainable and cost-effective [16,18].
• Practice-based research: practice-based research gives leaders and young people an opportunity to be heard and to contribute with their perspec-tives, which can further improve the activities and the knowledge base more generally. knowledge is brought back at the group level, which can con-tribute to the promotion of young people’s health and development and development of the activi-ties in the youth centres [18,22].
Acknowledgements
The study could not have been conducted without the help of the engaged and interested staff and young people at the two youth centres Verdandi in Rinkeby-Tensta, Stockholm, and Föreningen Trädet in Örebro.
Declaration of conflicting interests
The authors declare that there is no conflict of interest.
Funding
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
references
[1] Due P, krølner R, Rasmussen M, et al. Pathways and mech-anisms in adolescence contribute to adult health inequali-ties. Scand J Public Health 2011;39:62–78.
[2] Wiium N and Wold B. An ecological system approach to adolescent smoking behavior. J Youth Adolesc 2009;38:1351– 1363.
[3] United Nations. Convention on the Rights of the Child. General Assembly resolution 44/25, 20 November 1989. U.N. Doc. A/ RES/44/25. 1989.
[4] leversen I, Danielsen Ag, Wold B, et al. What they want and what they get: self-reported motives, perceived competence, and relatedness in adolescent leisure activities. Child Dev Res 2012;2012:11.
[5] Sletten MA. Social costs of poverty; leisure time socializ-ing and the subjective experience of social isolation among 13–16-year-old Norwegians. J Youth Studies 2010;13:291– 315.
[6] Swedish National Institute of Public Health. Social health inequalities in Swedish children and adolescents – a systematic review. 2nd ed. Stockholm, Sweden: Swedish National Insti-tute of Public Health, 2011.
[7] Newman l, Baum F, Javanparast S, et al. Addressing social determinants of health inequities through settings: a rapid review. Health Promot Int 2015;30:ii126–ii43.
[8] Blomfield CJ and Barber Bl. Developmental experiences during extracurricular activities and Australian adolescents’ self-concept: particularly important for youth from disad-vantaged schools. J Youth Adolesc 2011;40:582–594. [9] Eccles JS, Barber Bl, Stone M, et al. Extracurricular
activi-ties and adolescent development. J Soc Issues 2003;59:865– 889.
[10] kokko S, green lW and kannas l. A review of settings-based health promotion with applications to sports clubs. Health Promot Int 2014;29:494.
[11] lindström l and Öqvist A. Assessing the meeting places of youth for citizenship and socialization. Int J Soc Sci Educ 2013;3:446–462.
[12] Persson A, kerr M and Stattin H. Staying in or moving away from structured activities: explanations involving parents and peers. Dev Psychol 2007;43:197–207.
[13] Francis N and kentel JA. The fun factor: adolescents’ self-regulated leisure activity and the implications for practitio-ners and researchers. Leisure/Loisir 2008;32:65–90. [14] World Health Organization. Ottawa Charter for Health
Pro-motion. geneva, Switzerland: World Health Organization, 1986.
[15] St leger lH. The opportunities and effectiveness of the health promoting primary school in improving child health – a review of the claims and evidence. Health Educ Res 1999;14:51–69.
[16] geidne S. The non-governmental organization as a health pro-moting setting: examples from alcohol prevention projects con-ducted in the context of national support to NGOs. Doctoral Dissertation, School of Health and Medical Sciences, Öre-bro University, Sweden, 2012.
[17] Fredriksson I, geidne S and Eriksson C. Important strat-egies for youth centers to be health-promoting settings. Health Sci J 2016;10:1.
[18] Fredriksson I. Leisure-time youth-center as health-promotion settings. licentiate Thesis, School of Health Sciences, Öre-bro University, Sweden, 2016.
8 I. Fredriksson et al.
[19] geidne S, Fredriksson I, Dalal k, et al. Two NgO-run youth-centers in multicultural, socially deprived suburbs in Sweden – who are the participants? Health 2015;7:1158–1174. [20] geidne S, Fredriksson I and Eriksson C. What motives
are important for participation in leisure-time activities at Swedish youth centres? Health Educ J 2016;75:972–985. [21] Eriksson C, geidne S, larsson M, et al. A research
strat-egy case study of alcohol and drug prevention by non- governmental organizations in Sweden 2003–2009. Subst Abuse Treat Prev Policy 2011;6.
[22] Potter MA, Quill BE, Aglipay gS, et al. Demonstrating excellence in practice-based research for public health. Pub-lic Health Rep 2006;121:1–16.
[23] Creswell JW. A concise introduction to mixed methods research. london: Sage, 2015.
[24] Dooris M. Holistic and sustainable health improvement: the contribution of the settings-based approach to health pro-motion. J Roy Soc Promot Health 2009;129:29–36.
[25] Viner RM, Ozer EM, Denny S, et al. Adolescence and the social determinants of health. Lancet 2012;379:1641. [26] Eccles JS and Roeser RW. Schools, academic motivation,
and stage–environment fit. Handbook of Adolescent Psychol-ogy. XXX: John Wiley, 2009, pp.XXX–XXX.[AQ: 4] [AQ: 5]
[27] Scriven A and Hodgins M. Health promotion settings: prin-ciples and practice. london: Sage, 2011.
[28] larson RW and Verma S. How children and adolescents spend time across the world: work, play, and developmental opportunities. Psychol Bull 1999;125:701–736.
[29] Mahoney Jl and Stattin H. leisure activities and adolescent antisocial behavior: the role of structure and social context. J Adolesc 2000;23:113–127.
[30] kokko S, Martin l, Villberg J, et al. Does sport club par-ticipation contribute to physical activity among children and adolescents? A comparison across six European countries. Submitted manuscript.[AQ: 6]
