Health and Medicine

1. www.elsevier.com/locate/jado
Journal of
Adolescence
Journal of Adolescence 26 (2003) 717–730
Testing direct and indirect effects of sports participation on
perceived health in Spanish adolescents between 15 and 18
years of age$
Yolanda Pastora
, Isabel Balaguerb
, Diana Ponsc,
*, Marisa Garc!ıa-Meritac
a
University of Miguel Hern!andez (Campus Elche) Edificio Torre Blanca, Avda. Ferrocarril, s/n.,
03202 Elche (Alicante), Spain
b
Faculty of Psychology, Area of Social Psychology, University of Valencia, Avda. Blasco Iban˜ ez, 21,
Valencia 46010, Spain
c
Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Valencia,
Avda. Blasco Iban˜ ez, 21, Valencia 46010, Spain
Received 31 July 2002; received in revised form 25 June 2003; accepted 23 July 2003
Abstract
This paper examines the direct and indirect effects of sports participation on perceived health. It is based
on a representative sample of middle adolescents aged 15–18 (N=1038, M age=16.31, s.d.=0.92; 510
boys and 528 girls) from the Valencian Community (Spain). This study used two different models; Model A
is an adaptation of Thorlindsson, Vilhjalmsson and Valgeirsson’s (Social Science and Medicine 31 (1990)
551) model which introduces smoking, alcohol use, feelings of anxiety, feelings of depression and
psychophysiological symptoms as mediator variables; Model B is an extension of Model A with perceived
physical fitness as an added mediator variable. Both models show a good fit to the data. Results showed
that, in both models, sports participation affected perceived health directly and indirectly by decreasing
smoking and alcohol consumption, feelings of depression and psychophysiological symptoms. In Model B,
sport also affected perceived health via increased perceived physical fitness explaining almost 10% more of
the variance.
r 2003 The Association for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights
reserved.
Keywords: Sports participation; Perceived health; Adolescents; Health behaviours; LISREL VIII
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$
This study was supported by a grant of the Conseller!ıa de Educaci!on y Ciencia de la Generalitat Valenciana
(GV-2424/94), Spain.
*Corresponding author.
0140-1971/$30.00 r 2003 The Association for Professionals in Services for Adolescents. Published by Elsevier Ltd. All
rights reserved.
doi:10.1016/j.adolescence.2003.07.001

2. 1. Introduction
Several decades of research have supported the positive effects of physical activity and sport on
physical health (Sallis & Owen, 1999) and psychological well-being (Biddle, Fox, & Boutcher,
2000; Biddle & Mutrie, 2001; Morgan, 1997; US Department of Health and Human Service,
1996). Most research on this topic has been carried out on adults. The literature on health effects
of physical activity among young people is scarce and the reported associations are weak to
moderate (Sallis & Owen, 1999).
Nevertheless, there is suggestive evidence that physical activity during adolescence has benefits
for current and future physical health (Riddoch, 1998; Sallis, 1994; Sallis & Owen, 1999). Not only
does physical activity improve adolescents’ health, but it maintains a positive relationship with
perceived health and fitness as well. That is, active adolescents perceive themselves as healthier
and fitter than sedentary ones (Balaguer et al., 1997a; Castillo & Balaguer, 1998; Vilhjalmsson,
1994; Vilhjalmsson & Thorlindsson, 1998; Wold, 1989).
The psychological well-being of adolescents also benefits from physical activity. Several
reviewers have concluded that exercise is negatively associated with stress, anxiety and depression,
and positively associated with self-esteem, self-concept and self-efficacy in adolescents (Mutrie &
Parfitt, 1998; Sallis & Owen, 1999).
Physical activity also promotes healthy lifestyles. Studies of adolescents show in general
that sports participation is negatively related to smoking and the use of alcohol
(Balaguer, Castillo, Pastor, Atienza, & Llor!ens, 1997b; Balaguer et al., 1994; Balaguer, et al.,
1998; Castillo & Balaguer, 2002; Elliot, 1993; Pate, Heath, Dowda, & Trost, 1996; Thorlindsson,
1989; Vilhjalmsson & Thorlindsson, 1992; Wold, 1989); i.e. active adolescents smoke and
drink alcohol less frequently than sedentary ones. This relationship appears in different
countries (European, American, Australian), in both genders and throughout the adolescent
period, but it is stronger in middle adolescence (Elliot, 1993; Heaven, 1996; King, Wold, Tudor-
Smith, & Harel, 1996).
Although more research is needed, it is accepted that physical activity has benefits on mental
and physical health for adolescents. Less consensus exists among researchers about the
mechanism by which physical activity improves health. A model involving some of the variables
introduced above was proposed by Thorlindsson, Vilhjalmsson, and Valgeirsson (1990). This
model seeks to explain how sports participation enhances perceived health in adolescents.
Perceived health represents ‘a summary statement about the way in which numerous aspects of
health, both subjective and objective, are combined within the perceptual framework of the
individual respondents’ (Tissue, 1972). In the model of Thorlindsson and colleagues, sports
participation is an exogenous factor which directly affects perceived health and which also
indirectly affects perceived health via other health related behaviours (smoking and alcohol
consumption), as well as psychological distress symptoms (feelings of anxiety, feelings of
depression and psychophysiological symptoms). Residuals (error terms) are associated with all
endogenous factors and covariances are specified between the residuals of smoking, alcohol
consumption and the distress measures. This model was postulated and tested in relation to the
adolescent population.
In a sample of Icelandic 15- and 16-year-old adolescents, Thorlindsson and colleagues’ (1990)
results reported that sports participation had a direct effect on perceived health. Furthermore,
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3. sports participation affected perceived health indirectly through smoking, anxiety and
psychophysiological symptoms (the greatest single indirect effect), but did not seem to operate
through alcohol consumption and depression. However, the direct effect of sports participation
was stronger than the indirect effect. The authors suggested that this significant direct effect could
mean that some other critical mediator variables had not been considered.
A study made with Spanish 11–15-year-old adolescents reached similar conclusions.
In that case, the indirect effect was estimated via smoking, alcohol consumption, feelings
of anxiety, feelings of depression and psychophysiological symptoms. The direct effect of
sports participation on perceived health status was also higher than the indirect effect among
the Spanish adolescents. Smoking, feelings of depression and psychophysiological
symptoms emerged as significant mediators in this relationship (Castillo, Tomas, Garc!ıa-Merita,
& Balaguer, 2003).
Although this model may be promising in attempts to define the relationship between
sports participation and perceived health in adolescence, it has scarcely been studied and
the results are weak. One of the weaknesses of the model is the estimated covariation among
the different mediator variables. There is solid empirical evidence to support the positive
relation between smoking and alcohol consumption in adolescence (Aaro, Laberg, & Wold,
1995; Balaguer, Castillo, Tom!as, & Duda, 1997c; Elliot, 1993). In fact, several
theoretical approaches were introduced to explain this high correlation; for example,
Problem Behavior Theory (Jessor & Jessor, 1977; Jessor, 1993) and Kandel’s stages of
drug use (Kandel, 1975; Kandel & Yamaguchi, 1993). There is also strong empirical
support for the relationship between the different symptoms of psychological discomfort included
in the model as anxiety, depression and psychosomatic complaints both in the clinical population
and the subclinical. Clinical depression is frequently accompanied by feelings of irritability and
nervousness and by diffuse pains such as back pains and headache (V!azquez & Sanz, 1995).
Psychophysiological symptoms are also usually present in some anxiety disorders (Chorot &
Mart!ınez-Narvaez, 1995), and negative emotions are associated with self-reported physical pains
(Fern!andez & Fern!andez, 1998). In subclinical populations, it is often difficult to distinguish
between negative feelings and psychophysiological pains (Sanz, 1993). However, there is less
support in the literature for the existence of a relationship between health behaviours (smoking
and alcohol use) and distress symptoms (feelings of depression and anxiety, or psychophysio-
logical symptoms) in adolescence. The fact that the relationship is weak is shown by the results
(1990) of the study by Thorlindsson and colleagues and also by a WHO Cross-National Study
made with adolescents from 11 to 15 years of age (King et al., 1996). Moreover, adolescents stated
that smoking helped them feel part of the group and to control nervousness, and they also stated
that drinking alcohol increased their level of happiness, enjoyment, sociability and relaxation
(Heaven, 1996). Therefore, it is not very probable that these health behaviours were related to
feelings of depression and anxiety and physical pain in adolescence. Therefore, the model might be
improved by eliminating the covariation between health behaviour and symptoms of
psychological discomfort.
Another weakness of the model is the strong direct connection between sport and perceived
health, which is greater than the indirect effects. This may suggest that not all the variables in this
relationship have yet been determined. For example, the presence or absence of illness may
directly affect the level of of sports participation. Adolescents who suffer from physical disease
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4. might be less likely to participate in sports and might also view their health less favourably. In
order to evaluate this suggestion Thorlindsson et al. (1990) re-estimated their model with a
dummy exogenous variable, indicating whether or not the adolescent had a disease of any kind at
the time of the survey. Thorlindsson et al. (1990) reported that controlling for all potential disease
effects only slightly altered the direct and indirect effects of sports participation on perceived
health.
Boutchard and Shepard (1993) proposed a model in which they introduced physical fitness as a
mediator variable between sport and health. We consider that perceived physical fitness could
mediate in the relation between sports participation and perceived health. Thus, those adolescents
who take part in sports activities think they are improving their physical fitness and perceive
themselves as fitter than those who do not. This, in turn, leads to a perception that they are in
better health. We consider perceived physical fitness to be a summary statement about the ability
to carry out daily tasks with vigour and without fatigue within the perceptual framework of the
individual respondents.
The aim of our study was to examine the direct and indirect effects of sports participation
on perceived health in Spanish adolescents using two different models (see Models A and B in
Fig. 1). The first one is an adaptation of the model proposed by Thorlindsson et al. (1990) with
the same variables as mediators (tobacco consumption, alcohol consumption, subjective
feelings of anxiety, subjective feelings of depression, and psychophysiological symptoms).
Whereas the original model estimates error covariances between health behaviours and
distress symptoms, the above information suggests the advisability of estimating the
error covariances between health behaviours themselves and among distress symptoms, but
not of estimating error covariances between health behaviours and distress symptoms (Model A).
Based on the contribution of Boutchard and Shepard (1993) mentioned above, the second model
(Model B) includes the same variables as Model A, plus perceived physical fitness, as mediator
variables.
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Frequency of sport
participation
Perceived health
status
Tobacco
Consumption
Alcohol
Consumption
Feelings of
anxiety
Feelings of
depression
Psychophysiological
symptoms
Perceived physical
fitness
1
Broken lines represent the added variable and paths in Model B
Fig. 1. Structural models tested (Models A and B1
).
Y. Pastor et al. / Journal of Adolescence 26 (2003) 717–730720

5. 2. Method
2.1. Sample and procedure
A representative sample of 1.038 adolescents (510 boys [M age=16.36, s.d.=0.93] and 528 girls
[M age=16.25, s.d.=0.92]) between 15 and 18 years of age all high school, from the Valencian
Community (Spain) was assigned to this study. We carried out a proportional stratified random
sampling. The stratification variables used were: the relative size of each province (Alicante,
Valencia and Castell!on) and the type of educational establishment (public, private or
semiprivate). Eighty high-school centres were randomly selected. Schools were proportionally
distributed by province (47.8% from Valencia, 35.2% were from Alicante and 17% from
Castell!on) and by type of educational establishment (70.5% were public, 22.7% semiprivate and
6.8% private). The maximum statistical error for the total sample was 72.9%, with a confidence
level of 95.5%.
Schools were approached and asked to take part in research on adolescents’ health-related
lifestyles. When a school did not agree to collaborate, it was replaced by another school from the
same sample stratum. In each school centre, students were randomly selected. Adolescents were
informed that participation in the study was voluntary and asked to complete the questionnaire
anonymously. At least one researcher was present at each school during the administration of the
questionnaire and the data collection size group never was composed for more than 5 student
from each school.
2.2. Measures
The items used in this paper came from a WHO cross-national survey of Health Behavior in
School-children (HBSC; World, 1995). Sports participation was measured by asking the subjects
how often they participated in sports (excluding athletics at school), scores ranged from 6=‘6–7
times a week’ to 1=‘never’. Tobacco and alcohol consumption were measured by several items of
this questionnaire, which were used to create the following indices:
Tobacco Consumption Index:
1=they have never tried tobacco
2=they have tried, but don’t smoke now
3=they smoke but not every week
4=they smoke every week
5=they smoke every day but smoke 40 cigarettes or less a week
6=they smoke every day and smoke more than 40 cigarettes a week
Alcohol Consumption Index:
1=they never drink alcohol beverages (beer, wine, liquor or spirits)
2=they drink at least one of these beverages less than once a month
3=they drink at least one of these beverages every month
4=they drink at least one of these beverages every week, but they have never been drunk or
only once
5=they drink at least one of these beverages every week, and they have been drunk two or three
times
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Y. Pastor et al. / Journal of Adolescence 26 (2003) 717–730 721

6. 6=they drink at least one of these beverages every week, and they have been drunk four times
or more
The three dimensions of psychological distress employed in our work were: subjective feelings
of anxiety and subjective feelings of depression and psychophysiological symptoms. Feelings of
anxiety were assessed by asking the subjects how often they felt nervous (range: 1=‘almost never’
to 5=‘almost every day’). Feelings of depression were measured by asking the subjects how often
they felt depressed (range: 1=‘almost never’ to 5=‘almost every day’). These two variables were
used only to measure subjective feelings of anxiety or nervousness and bad moods. Under no
circumstances was it our intention to measure anxiety disorders or clinical depression. The
psychophysiological symptoms variable is a mean score from four items measuring how often
subjects suffered from headache, stomach pains, back pains or felt dizzy. Subjects rated each item
on a five-point scale (range: 1=‘almost never’ to 5=‘almost every day’).
Perceived physical fitness was measured by using the single item ‘How would you rate your physical
fitness?’. This was assessed on a four point scale that ranges from 1 (not good at all) to 4 (very good).
The endogenous variable of the model, perceived health status, was measured by asking
adolescents to assess their health on a four point scale, ranging from 1 (not healthy at all) to 4
(very healthy). Several studies by other researchers using large samples have demonstrated the
ability of a single item subjective health rating to detect variance in perceived health status
(Mossey & Shapiro, 1982; Ware, Davies-Avary, & Donald, 1978). After reviewing almost 40
studies of general health perceptions, Ware et al. (1978) concluded that such ratings appeared to
be both reliable and reproducible.
2.3. Statistical analysis
The hypothesized models (Models A and B in Fig. 1) were tested using LISREL VIII (J.oreskog &
S.orbom, 1993). Maximum likelihood method was employed, because this procedure has been
shown to be robust to departures from normality (Huba & Harlow, 1987). There is a broad
consensus that no single measure of a model’s overall fit should be relied on exclusively; therefore,
researchers are advised to use a variety of indices from different families of measures (Tanaka,
1993). From among the absolute fit indices , we report (a) the w2
statistic in comparison to its
degrees of freedom; (b) Hoelter’s (1983) CN which is independent of sample size and its value should
exceed 200; (c) the root mean square residual (RMSR), which should be close to zero; and (d) the
goodness of fit index (GFI) which should have values approaching unity (above 0.90). From among
the incremental fit indices, we used (1) the Comparative Fit Index (CFI) and (2) the Incremental Fit
Index (IFI); both should have values approaching unity (above 0.90) (Mueller, 1996).
Pathways within the models were tested for significance (po0:01 or po0:05) and provided with
standardized parameter estimates. Additionally, it is possible to examine the significance of the
direct and indirect effects of sport practice on perceived health status.
3. Results
Table 1 presents range, means and standard deviations for each of the variables of this study.
Table 2 contains Pearson correlation matrix of variables. This second table shows that sports
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Y. Pastor et al. / Journal of Adolescence 26 (2003) 717–730722

7. participation was negatively and significantly related to tobacco and alcohol consumption,
feelings of anxiety and depression and psychophysiological symptoms. It also shows that
perceived health was negatively and significantly related to all these variables, as well as positively
and significantly related to sports participation. Perceived fitness presented a positive relationship
with both sports participation and perceived health.
Table 3 presents fit indices for the two models tested. Although w2
was significant for both
models (probably due to the large sample size, N=1038), the other fit indices indicated a good
model fit to the data. Model A displayed a CFI of 0.95, a GFI of 0.98, a IFI of 0.95, a CN of
255.54 and an RMSR of 0.06. Model B displayed similar fit indices to Model A (RMSR=0.07;
GFI=0.98; CFI=0.95; IFI=0.95; CN=245.34).
Standardized parameter estimates of Model A are presented in Table 4 and Fig. 2. Almost all
the hypothesized paths were significant (except the path from feelings of anxiety to perceived
health). As shown in Fig. 2, sports participation had significant negative effects on tobacco and
alcohol consumption, feelings of anxiety and depression, and psychophysiological symptoms, as
well as a significant positive effect on perceived health. Furthermore, the negative effects of
tobacco and alcohol consumption, feelings of depression and psychophysiological symptoms on
perceived health were all significant. The model explained 27% of variance in perceived health.
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Table 1
Descriptive statistics for study variables
Variables Range Mean s.d.
1. Sport participation 1–6 2.97 1.53
2. Tobacco 1–6 2.87 1.80
3. Alcohol 1–6 3.32 1.66
4. Anxiety 1–5 3.00 1.39
5. Depression 1–5 1.94 1.20
6. Psych. Symptoms 1–5 1.81 0.76
7. Perceived fitness 1–4 2.31 0.83
8. Perceived health 1–4 2.82 0.62
Table 2
Pearson correlations among study variables
1 2 3 4 5 6 7
1. Sport participation 1.00
2. Tobacco À0.16ÃÃ 1.00
3. Alcohol À0.07Ã 0.46ÃÃ 1.00
4. Anxiety À0.07Ã 0.11ÃÃ 0.09Ã 1.00
5. Depression À0.14ÃÃ 0.13ÃÃ 0.06Ã 0.34ÃÃ 1.00
6. Psych. symptoms À0.15ÃÃ 0.22ÃÃ 0.09Ã 0.37ÃÃ 0.35ÃÃ 1.00
7. Perceived fitness 0.46ÃÃ À0.13ÃÃ À0.05 À0.11ÃÃ À0.15ÃÃ À0.21ÃÃ 1.00
8. Perceived health 0.29ÃÃ À0.33ÃÃ À0.24ÃÃ À0.10ÃÃ À0.22ÃÃ À0.22ÃÃ 0.40ÃÃ
à po0:05:
ÃÃ po0:001:
Y. Pastor et al. / Journal of Adolescence 26 (2003) 717–730 723

8. To sum up, in Model A, sports participation had a significant direct effect as well as a
significant indirect effect on perceived health mediated by tobacco, alcohol, feelings of depression
and psychophysiological symptoms. However, it is important to note that the direct effect of
sports participation on perceived health was greater (regression coefficient=0.27; po:01) than the
indirect effect (sum of effects mediated by health behaviour and distress symptoms=0.09; po:01).
Standardized parameter estimates of Model B are presented in Table 5 and Fig. 3. As in the
previous model, all hypothesized paths in Model B were significant (excluding the one from
feelings of anxiety to perceived health status). Therefore, the new paths were introduced in Model
B. Sports participation had a positive effect on perceived physical fitness, which also exerted a
positive effect on perceived health. The other hypothesized relationships were in the same
direction as in Model A. However, the new variable included in Model B, perceived physical
fitness, produced some changes in the results. One change was the decrease in the direct effect of
sports participation on perceived health. Another change was the increase in accounted variance
for perceived health to 36%.
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Table 3
Model fit indices
Indices Model A Model B
w2
68.22 104.53
Gl 6 11
P o0.01 o0.01
w2
/gl 11.37 9.5
RMSR 0.06 0.07
GFI 0.98 0.98
CFI 0.95 0.95
IFI 0.95 0.95
CN 255.54 245.34
Table 4
Parameter estimates of Model A
1 2 3 4 5 6 7
1. Sport participation [0.04Ã] À0.16Ã À0.08Ã À0.08Ã À0.17Ã À0.15Ã 0.27Ã
2. Tobacco (0.97Ã) 0:50Ã À0.26Ã
3. Alcohol (0.99Ã) À0.09Ã
4. Anxiety (0.99Ã) 0:39Ã 0.40Ã 0.04
5. Depression (0.97Ã) 0:35Ã À0.16Ã
6. Psych. Symptoms (0.98Ã) À0.10Ã
7. Perceived health (0.70Ã)
[ ]=variance of the exogenous variable.
( )=error variance of endogenous variables.
00=error covariances.
à po0:01:
Y. Pastor et al. / Journal of Adolescence 26 (2003) 717–730724

9. In Model B, sports participation had a significant direct effect as well as a significant
indirect effect on perceived health mediated by tobacco, alcohol, feelings of de-
pression, psychophysiological symptoms and perceived physical fitness. In contrast with
the previous model, Model B indicated that the indirect effect of sports participation
on perceived health was greater (sum of effects mediated by health behaviours, distress
symptoms and perceived fitness=0.26; po:001) than the direct effect (regression coeffi-
cient=0.10; po:01).
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Frequency of sport
participation
Alcohol
consumption
Feelings of
anxiety
Feelings of
depression
Psychophysiological
symptoms
Perceived health
status
Tobacco
consumption
.27*
-.17*
-.08*
-.08*
-.17*
-.15*
-.26*
-.09*
.04
-.16*
-.10*
(27.8)
(2.7)
(0.7)
(0.7)
(3.0)
(2.4)
* p ≤ .01
Fig. 2. Model A’s standardized solution. Values on paths represents standardized regression coefficients. Values within
parentheses represents variance percentages.
Table 5
Parameter estimates of Model B
1 2 3 4 5 6 7 8
1. Sport participation [1.00ÃÃ] À0.16ÃÃ À0.08ÃÃ À0.08ÃÃ À0.17ÃÃ À0.15ÃÃ 0.51ÃÃ 0.10ÃÃ
2. Tobacco (0.97ÃÃ) 0:50ÃÃ À0.24ÃÃ
3. Alcohol (0.99ÃÃ) À0.11ÃÃ
4. Anxiety (0.99ÃÃ) 0:39ÃÃ 0:40ÃÃ 0.05
5. Depression (0.97ÃÃ) 0:35ÃÃ À0.15ÃÃ
6. Psych. symptoms (0.98ÃÃ) À0.06Ã
7. Perceived fitness (0.74ÃÃ) 0.36ÃÃ
8. Perceived health (0.61ÃÃ)
[ ]=variance of the exogenous variable.
( )=error variance of endogenous variables.
00=error covariances.
à po0:05:
ÃÃ po0:01:
Y. Pastor et al. / Journal of Adolescence 26 (2003) 717–730 725

10. 4. Discussion
This paper examines the direct and indirect effects of sports participation on perceived health in
Spanish middle adolescents through two different models. The first model (Model A) is an
adaptation of the one proposed by Thorlindsson et al. (1990) with the same mediator variables
(smoking, alcohol use, subjective feelings of depression, subjective feelings of anxiety and
psychophysiological symptoms). The second model (Model B) constitutes an extension of Model
A with an added mediator variable, perceived physical fitness.
Results provided validity evidence of both models for describing the effects of sports
participation on perceived health. Our findings showed that sports participation was both directly
and indirectly related to perceived health. Both models exhibited indirect effects through alcohol
and tobacco consumption, feelings of depression and psychophysiological symptoms. Feelings
of anxiety did not work as a mediator. Perceived physical fitness acts as a mediator variable in
Model B.
Some of these results contrast with Thorlindsson and colleagues’ study in which alcohol did not
mediate the relationship between sports participation and perceived health. Age differences
between our sample (15–18 years old) and the original study (15–16 years old) might explain this.
It may be possible that alcohol acts as a mediator in 17 and 18 years old but not in 15 and 16 years
old since consumption is greater in later stages of adolescence. In fact, in a study that we made
with even younger adolescents (11–15 years old) alcohol consumption did not mediate
significantly (Castillo et al., 2003).
Another difference in our findings, when compared with the results of Thorlindsson et al.
(1990), is that in the latest anxiety was a significant mediator and depression was not. We have
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Frequency of sport
participation
Alcohol
consumption
Feelings of
anxiety
Feelings of
depression
Psychophysiological
symptoms
Perceived health
status
Tobacco
consumption
.10**
-.16**
-.08**
-.17**
-.15**
-.24**
-.11**
.05
-.15**
-.06*
(36.2)
(2.7)
(0.7)
(0.7)
(3.0)
(2.4)
Perceived physical
fitness
-.36**-.51**
(26.2)
**p ≤ .01; *p ≤.05
-.08**
Fig. 3. Model B’s standardized solution. Values on paths represents standardized regression coefficients. Values within
parentheses represents variance percentages.
Y. Pastor et al. / Journal of Adolescence 26 (2003) 717–730726

11. two different explanations for this. One possible explanation is the cultural differences in
education related to how emotions are expressed in the two countries. The same function of
feelings of depression as a mediator was found with younger Spanish teenagers (Castillo et al.,
2003). Another possible justification is the use of different measures. Measurement of depression
in Thorlindsson and colleagues’ study depicted three aspects: feeling sad, feeling tired and having
sleeping problems. In our study, we only included feeling sad. Measurement of anxiety in
Thorlindsson and colleagues’ study was a mixture of feeling anxious, tense or restless and having
problems concentrating, whereas in our study we only included feeling anxious or tense.
If we examine the results of our study, both models (Models A and B) show that Spanish
adolescents who engaged more frequently in sports participation drank less alcohol, smoked fewer
cigarettes, tended to experience fewer feelings of anxiety and depression, described fewer
psychophysiological symptoms and indicated higher perceived fitness (the latest in Model B).
These findings are consistent with studies that analysed the benefits of physical and sports activity
on healthy life styles (Balaguer et al., 1994, 1997b, 1998; Pate et al., 1996; Thorlindsson, 1989;
Vilhjalmsson and Thorlindsson, 1992), and on psychological well-being (Mutrie & Parfitt, 1998;
Sallis & Owen, 1999).
In line with previous studies, our research also showed that smoking, alcohol use, feelings of
depression and psychophysiological symptoms could reduce the health status perceptions of
adolescents (Mechanic & Hansell, 1987) and perceived fitness might improve it (Boutchard &
Shephard, 1993).
Spanish adolescents who smoke more frequently tend to drink alcohol more frequently too.
This is in accordance with some theoretical approaches such as Problem Behaviour Theory (Jessor
& Jessor, 1977; Jessor, 1993) and Kandel’s stages of drug use (Kandel, 1975; Kandel &
Yamaguchi, 1993) and with the results of previous studies (Aaro et al., 1995; Balaguer et al.,
1997c; Elliot, 1993).
The variables of psychological distress (i.e. feelings of anxiety, feelings of depression and
psychophysiological symptoms) maintained high positive associations with each other as the
literature suggests (Chorot & Mart!ınez-Narvaez, 1995; Fern!andez & Fern!andez, 1998;
Thorlindsson et al., 1990; V!azquez & Sanz, 1995).
Overall, Model A accounted for 27% of variance for perceived health. The direct effect of sport
on perceived health was greater than the indirect effect. This could be interpreted as a problem of
the model due to the non-inclusion of important mediators in this relationship. This result was in
keeping with the original study (Thorlindsson et al., 1990) and other replications of the model
with younger Spanish adolescents (Castillo et al., 2003).
Adding perceived physical fitness as a mediator in Model B increased the percentage of variance
accounted for perceived health (almost 10% more) and reduced the magnitude of the direct effect
of sport on perceived health. Therefore, in Model B the indirect effect was greater than the direct
effect in contrast to Model A. Model B represented the indirect effect between sport and perceived
health better than Model A.
Considering the magnitude of regression coefficients involved with perceived fitness, it was the
most important mediator evaluated in both models. This means that perceived physical fitness
adequately described the process by which sport enhances perceived health. The higher the level of
sports participation, the higher the perceived physical fitness was; and as a consequence, it
enhanced perceived health. These results could serve as partial support for the suggestions from
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12. Boutchard and Shephard’s (1993) model, which illustrated how sports participation increased
health status via the enhancement of fitness components (morphological, muscular, motor,
cardiorespiratory, metabolic). Our findings suggested that it was also important to note how sport
improved perceived fitness and thereby health status perception.
Other mediators in both models exerted a lower but significant influence. In this sense, sports
participation could reduce smoking and alcohol use in adolescents, which in turn would enhance
health perceptions. Also, sports participation might lessen feelings of depression, feelings of
anxiety and reported psychophysiological symptoms, and thus lead to improvements in health
perceptions.
In spite of the results, the significant direct effect of sports participation on perceived health is
not altogether clear. There is still a significant percentage of variance which requires explanation
and the estimated parameters suggest a weak to moderate relationship. Other variables might be
mediating this relationship. For example, it is suggested that sports participation could improve
self-esteem by increasing self-efficacy in the performance of specific sport activities and the
different components of physical self-concept (Sonstroem, 1997). It might be that the higher self-
esteem is, the more optimistic the health assessment is.
Other explanations of the effect of sport on perceived health could be the improvement of
physiological functions (i.e. oxygenated blood for heart muscle needs, heart rhythm disturbances,
blood pressure, beta-endorphin concentrations, mono-amines synthesis, etc.). Further research is
required to shed light on processes involved in the effect of sports on perceived health.
It is important to consider that this study with Spanish adolescents highlighted direct and
indirect effects of sports participation on perceived health status. However, definite causal
inferences cannot be made based on these data, due to the cross-sectional nature of the study.
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