Nature’s Medicine? The Associations of Organized Youth Sport, Unstructured Physical Activity, and Land-Use Recreation with Children’s Mental Health, Emotional Control, and Social Well-Being

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for the opportunity of reviewing the manuscript that addresses an important and timely topic. I have identified some areas that require further development to strengthen the clarity and depth, and overall contribution of your work to the existing literature.

Specific comments:

• Using the Qualtrics panel may lead to sampling bias, as only individuals who have internet access and are members of this panel participated in the study.
• 
  The information provided regarding the validity and reliability of the instruments is limited.

Author Response

We thank the editor and the three reviewers for their generally positive assessments of our manuscript. The comments have greatly strengthened this iteration of the manuscript. In the following point-by-point response document, we share how and where each comment is addressed in the revised manuscript. In the rare case where we disagree with or need to provide clarification about a comment, we do so in the space below.
Reviewer 1
1. Using the Qualtrics panel may lead to sampling bias, as only individuals who have internet access and are members of this panel participated in the study.
According to the Pew Research Center, more than 96% of the US population has internet access. As such, we don’t think our sampling technique biased the achieved sample or our results in any significant way.

2. The information provided regarding the validity and reliability of the instruments is limited.
Information regarding the validity of utilizing Qualtrics panels was added to section 2.1 (see page 6, lines 274-275). However, validity and reliability statistics are not available for the primary response instruments. Measurement of physical activity contexts and psychosocial outcomes utilized single-item, study-designed measures. We acknowledge this on page 7, lines 302-303. We also discussed this as a potential limitation on page 15, lines 663-666.

Reviewer 2 Report

Comments and Suggestions for Authors

REVIEW REPORT (ijerph-3645746)

Nature’s medicine? The association of organized youth sport, unstructured physical activity, and land-use recreation with children’s mental health, emotional control, and social well-being

ABSTRACT

- Include information that the study is cross-sectional and add quantitative results such as effect values ​​or p-values.

INTRODUCTION

- The introduction provides a good literature review but contains conceptual and argumentative flaws. In my opinion, poorly developed theoretical constructs such as “Ageism” and “aging anxiety” need to be explained under the theoretical framework of the Age Stereotype Theory.

- The authors should present the operational hypothesis of the study related to PA with the related variables.

METHODS

- The authors should explicitly state that this is a cross-sectional study.

- The only thing that is clear in the inclusion and exclusion criteria is that the participants were between 55 and 64 years old; but what about the health, location, language or other criteria?

- Do the instruments used contain information about their validation in the Korean and Chinese samples?

- Include information about the assumption tests (normality, homoscedasticity, multicollinearity) of the linear regression.

RESULTS

- How do you justify the presentation of descriptive statistics in aggregate form, without a detailed analysis by subgroup including gender, type of community for all dependent variables?

- Is it possible to include the percentage distributions of responses on Likert scales (1 to 5)?

- Authors should check the Tables to include explanatory notes on the variables and tests applied. *. a

- In the results of the Dunn tests, which group was compared with the others?

- Please include information on how well the model explains the data (such as adjusted R²). Also, were the models tested considering factors such as gender and location?

- Is it difficult to know how much the type of PA really impacts mental health and emotional control, since there is no information on the size of the effect (such as η² or ε²), which could be calculated in the Kruskal-Wallis test? If it is not possible to include it in the tables, at least present it in text.

DISCUSSION

- The main results should be highlighted in the first paragraph. Please make this small adjustment.

- I expected to at least understand from the discussion how physical activity could reduce ageism or anxiety about aging. The authors need to expand the theoretical discussion to include the explanatory mechanisms or their hypotheses.

- Limitations include social desirability bias, cross-cultural validity of the instruments, and the limitations of the cross-sectional design.

CONCLUSIONS

- The authors should only help the text to include information on the implications of the findings, on how they can inform public policies or PA programs.

REFERENCES

- Some referenes appear with full names of the journals, others with abreviations. Please review this.

- There are many old references, since at least 18 (by my count) were published before 2015. Please update the literature to ensure that the topic is current and relevant and based on the most recent advances.

Author Response

We thank the editor and the three reviewers for their generally positive assessments of our manuscript. The comments have greatly strengthened this iteration of the manuscript. In the following point-by-point response document, we share how and where each comment is addressed in the revised manuscript. In the rare case where we disagree with or need to provide clarification about a comment, we do so in the space below.

Reviewer 2
ABSTRACT

1. Include information that the study is cross-sectional and add quantitative results such as effect values or p-values.
The revised abstract acknowledges that this is a cross-sectional study and includes p-values and effect sizes (see page 1, lines 13, 19, 21-23).

INTRODUCTION

1. The introduction provides a good literature review but contains conceptual and argumentative flaws. In my opinion, poorly developed theoretical constructs such as “Ageism” and “aging anxiety” need to be explained under the theoretical framework of the Age Stereotype Theory.
We thank Reviewer 2 for this feedback. In the revised Introduction section, we made adjustments to strengthen our argument, including several sentences that emphasize the study and the lack of prior research comparing psychosocial wellbeing across physical activity types (see page 1, lines 37-40; page 2, lines 50-54, page 5, lines 217-218). We also reviewed the Age Stereotype Theory and found that it is used to explain how negative perceptions of aging are related to actual health declines in older adults. This framework also provides insights into how negative beliefs surrounding specific identities are internalized and can negatively impact outcomes for groups of people. Rather than discuss the Age Stereotype Theory directly, we added a brief description of how female stereotypes impact gender differences in youth sports (see page 3, lines 98-100).

2. The authors should present the operational hypothesis of the study related to PA with the related variables.
We revised the language used in our hypothesis in section (see page 6, lines 254-261).

METHOD

1. The authors should explicitly state that this is a cross-sectional study.
Throughout the revised manuscript, we acknowledge that the study is cross-sectional in its design (see page 1, line 13, page 6, line 264 and page 15, line 646).

2. The only thing that is clear in the inclusion and exclusion criteria is that the participants were between 55 and 64 years old; but what about the health, location, language or other criteria?
As noted in the original manuscript (see page 6, lines 268-269), survey respondents were parents or caretakers of youth aged 6 to 18 in Colorado, New Mexico, Utah, and Wyoming. In the revised manuscript, we now offer clearer information about their language, location, and health (see page 6, lines 269-270).

3. Do the instruments used contain information about their validation in the Korean and Chinese samples?
We did not include Korean or Chinese samples.

 

4. Include information about the assumption tests (normality, homoscedasticity, multicollinearity) of the linear regression.
The authors did not conduct any linear regressions within the manuscript. The current statistical analyses are for non-normal data and are a form of statistical difference (means) testing across groups. However, the authors did run assumption tests. We conducted Levene’s Test (p < 0.001), Bartlett’s Test (p < 0.001), and the Fligner-Killeen Test (p < 0.001), all of which indicated a violation of the homogeneity of variance assumption, suggesting that the assumptions for ANOVA were not fully satisfied. Given the normality violations, the Kruskal-Wallis Test is the most appropriate test.

RESULTS

1. How do you justify the presentation of descriptive statistics in aggregate form, without a detailed analysis by subgroup including gender, type of community for all dependent variables?
Our intention in presenting the descriptive statistics in aggregate form was to provide contextual background on the overall respondent pool. As noted in the Limitations sub-section, our survey was regionally limited to the Intermountain West region of the United States, so we aimed to offer a concise overview of who responded within that context (see page 15, lines 643-645). However, we are happy to clarify or expand this section depending on the specific type of subgroup analysis you are requesting.

2. Is it possible to include the percentage distributions of responses on Likert scales (1 to 5)?

Yes, in the revised manuscript, we now include this information in an appendix section (see page 17, lines 728-730) and acknowledged this information in the results (see page 7, lines 336-337).

3. Authors should check the Tables to include explanatory notes on the variables and tests applied. *. a
We would appreciate clarification regarding the specific additions you are requesting. We want to ensure we address your feedback accurately and thoroughly. The Reviewer may be referring to our use of “*” which we address below in #4.

4. In the results of the Dunn tests, which group was compared with the others?
We used the * to indicate that the two groups listed were being compared to each other. We have changed the * to an X to make this comparison clearer (see table 2 on page 8, table 4 on page 9, and table 6 on page 10).

5. Please include information on how well the model explains the data (such as adjusted R²). Also, were the models tested considering factors such as gender and location?
We utilized Kruskal-Wallis analyses (with follow up Dunn’s Test) because we were most interested in understanding differences across groups and not predictive relations across variables. We did not utilize ANOVA because assumptions of linearity/normality were not met. The current analyses are a form of statistical difference testing. Model fit is not applicable or useful since observed versus predicted models are not being tested. We have included measures of (z score, effect size, etc.), but are not running any tests that establish observed and predicted datasets (for model fit).

6. Is it difficult to know how much the type of PA really impacts mental health and emotional control, since there is no information on the size of the effect (such as η² or ε²), which could be calculated in the Kruskal-Wallis test? If it is not possible to include it in the tables, at least present it in text.
In the revised manuscript, we now include eta-squared statistics for the Kruskal-Wallis Test in the text (see page 8, lines 342-343, 348, and 354) and r for the Dunn Test (see table 2 on page 8).

DISCUSSION

1. The main results should be highlighted in the first paragraph. Please make this small adjustment.
In the revised manuscript, we now highlight our main results in the first paragraph (see page 10, lines 394-401). In addition, we thoroughly revised the whole of the Discussion section to reduce redundancy and to add additional interpretations of our results (see pages 10-16).

2. I expected to at least understand from the discussion how physical activity could reduce ageism or anxiety about aging. The authors need to expand the theoretical discussion to include the explanatory mechanisms or their hypotheses.

Consistent with our response in the Introduction, we did not directly address age stereotype theory; however, we discussed how female stereotypes may have influenced the results of our study (see page 13, lines 551–554).

3. Limitations include social desirability bias, cross-cultural validity of the instruments, and the limitations of the cross-sectional design.
In line with comments from all three reviewers, we have expanded our Limitations sub-section to include more discussion on these factors (see page 16, lines 666-670).

CONCLUSIONS
1. The authors should only help the text to include information on the implications of the findings, on how they can inform public policies or PA programs.
We agree with the comment made by Reviewer 2! We have revised the Conclusion subsection to be more streamlined and to clearly state the implications of our study and its findings (see page 16, lines 682-696).

REFERENCES
1. Some references appear with full names of the journals, others with abreviations. Please review this.
We have addressed this concern and all journals titles are now abbreviated in the revised Reference section (see pages 17-20).

2. There are many old references, since at least 18 (by my count) were published before 2015. Please update the literature to ensure that the topic is current and relevant and based on the most recent advances.
We acknowledge this as a potential concern; however, the literature in this area is relatively sparse. We have reviewed all citations older than 2015 (an arbitrary cutoff) and have updated the revised manuscript with newer citations that were available (see citations 13, 29, and 35).

Reviewer 3 Report

Comments and Suggestions for Authors

The present study was set out to investigate the ways children’s physical activity engagement is associated with their psychosocial health. This is an interesting study that merits publication. However, several parts, such as the discussion section, need thorough improvement. Below there are comments that the authors may wish to consider in order to improve the quality of the manuscript. In the introduction, it would be helpful for the reader to describe what type of physical activity exerted impact on the measured physical activity outcomes. This would clarify the effects of different types on physical activity on these outcomes and would help define the research problem of the study and accordingly the discussion. Having said that, the rationale for the study has not been sufficiently elaborated and there is no clear justification of the potential of different types of physical activity to differentially influence these physical activity outcomes. The study does not explicitly indicate the timeframe in which physical activity (and its effects) were measured. In this respect, if this period covered the COVID-19 then the literature review should more explicitly discuss the effect of COVID-19 on physical activity. Otherwise this should be reflected in the limitations of the study. In the results section it is difficult to follow the percentages of children classified in each physical activity type. This raises a concern about the criteria used for the children classification. For instance, how were classified children participating in unstructured play and land-use recreation? It is highly likely that a child can do both. Similarly, a child participating in organized sport will definitely participate in unstructured or land-use recreational physical activity. Having said that, it is difficult to understand the actual influence of each physical activity type on the measured variables. In the discussion section, the first paragraph reiterates the hypotheses which is redundant. In this paragraph briefly present the main findings of the study. In the discussion of the results, this section re-iterates the results which is redundant. The authors should focus on interpretating their findings in this section rather than describing them again.

Author Response

We thank the editor and the three reviewers for their generally positive assessments of our manuscript. The comments have greatly strengthened this iteration of the manuscript. In the following point-by-point response document, we share how and where each comment is addressed in the revised manuscript. In the rare case where we disagree with or need to provide clarification about a comment, we do so in the space below.

Reviewer 3

1. In the introduction, it would be helpful for the reader to describe what type of physical activity exerted impacts the measured physical activity outcomes. This would clarify the effects of different types of physical activity on these outcomes and would help define the research problem of the study and accordingly the discussion.
We added additional information to the revised Introduction section, including specific types of physical activities and their specific psychosocial benefits (see page 4, lines 166-168, page 5, lines 199).

2. Having said that, the rationale for the study has not been sufficiently elaborated and there is no clear justification on the potential of different types of physical activity to differentially influence these physical activity outcomes.

In the revised manuscript, we have attempted to strengthen the Introduction section by including several sentences to acknowledge the lack of prior research comparing psychosocial wellbeing across the physical activity settings (see page 1, lines 37-40; page 2, lines 50-54, page 5, lines 217-218)

3. The study does not explicitly indicate the timeframe in which physical activity (and its effects) were measured. In this respect, if this period covered the COVID-19 then the literature review should more explicitly discuss the effect of COVID-19 on physical activity. Otherwise, this should be reflected in the limitations of the study.
We acknowledge in the revised Introduction Section (see page 2, lines 63-64, page 6, lines 241-245) and Limitations sub-section (see page 15, lines 646-647) that our data collection occurred in 2022. Although it is raised as a potential limitation by Reviewer 3, there remained very few restrictions on organized sport, unstructured free play, and/or land-use recreation during this time across the United States and especially in this region of the country. The literature is subsequently sparse and emerging on the effects of COVID-19 on organized sport, unstructured physical activity, or land-use recreation within the U.S. youth sport landscape, and we have attempted to bolster our discussion by including recent studies in this space (see page 11, lines 445-460).

4. In the results section it is difficult to follow the percentages of children classified in each physical activity type. This raises a concern about the criteria used for the children classification. For instance, how were classified children participating in unstructured play and land-use recreation? It is highly likely that a child can do both. Similarly, a child participating in organized sport will definitely participate in unstructured or land-use recreational physical activity. Having said that, it is difficult to understand the actual influence of each physical activity type on the measured variables.

We thank Reviewer 3 for this comment. In section 2.2 of the revised manuscript, we include a sentence explaining that survey respondents were asked to complete a series of questions about one child who “participated most regularly or was most committed to participating” in that physical activity type (see page 7, lines 295-298). In the revised Limitations sub-section, we also expanded on the second paragraph that addresses the concern that there are blurred lines across the different types of physical activity (see page 16, lines 656-660).

5. In the discussion section, the first paragraph reiterates the hypotheses which is redundant. In this paragraph briefly presents the main findings of the study. In the discussion of the results, this section re-iterates the results which is redundant. The authors should focus on interpretating their findings in this section rather than describing them again.
Given this comment and others from Reviewers 1 and 2, we thoroughly revised the Discussion section to reduce redundancy within the manuscript. This afforded more opportunity/space to add additional interpretations of our results (see pages 10-16).

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for your detailed and thoughtful revisions. I appreciate the improvements made in response to the previous comments. All of my concerns have been sufficiently addressed, and I believe the current version is suitable for publication. I commend the authors for their effort and clarity in the point-by-point responses.

Reviewer 2 Report

Comments and Suggestions for Authors

None.

Reviewer 3 Report

Comments and Suggestions for Authors

The authors have satisfactorily addressed the commetns and the manuscript has been significantly improved.