Background

Evidence suggests neighborhood contexts play a vital role in shaping the availability and diversity of youth sport and participation rates, especially for African American or Black girls. Currently, no index captures interscholastic sport opportunities (eg, sport diversity) within and across school districts and specifically applied to African American or Black girls.

Objective

To visualize the inequalities present in interscholastic sport opportunities for girls across school districts using a novel index in a selected study area of St Louis City and County, Missouri, and discuss the implications for African American or Black girls.

Design

Cross-sectional study.

Setting

Database secondary analysis.

Patients or Other Participants

Data for 47 public high schools in the 23 St Louis City and County school districts.

Main Outcome Measure(s)

We gathered data from the 2014–2018 American Community Survey and Missouri State High School Activities Association. We assessed sport diversity for girls by constructing a sport diversity index (SDI) that uses an entropy index as its foundation. Census-tract data were used to examine the association with neighborhood demographics and contributors to school district income and sport diversity. Descriptive spatial statistics were calculated to evaluate distributions in St Louis City and County, with the bivariate local indicator of spatial autocorrelation used to determine any correlations between variables of interest.

Results

The St Louis City school district, which has areas with high rates of renter-occupied housing and poverty and high percentages of non-Hispanic African American or Black students, had the lowest SDI for girls, contrasted with the school districts in St Louis County, which showed an inverse pattern on average. The SDI for girls was correlated with the percentages of renter-occupied housing and poverty. The SDI for girls was also correlated with race: an increasing presence of the non-Hispanic African American or Black population was associated with decreased sport diversity for girls.

Conclusions

The SDI for girls demonstrated a spatial association with neighborhood-level determinants of sport-opportunity availability for non-Hispanic African American or Black girls in St Louis. The role of social and political determinants of health in shaping community context and resultant health in athletic training research, policy, and practice should be considered.

Key Points
  • Sport diversity of school districts in the St Louis region varied for girls.

  • Neighborhood characteristics were associated with the offering of sports in school districts.

  • The connection between education funding policy and access to resources is crucial for athletic trainers to understand and critique.

The importance of physical activity (PA) for physical and mental health is well established in the literature.1–4  However, only 1 in 5 US youth are meeting the recommended PA guidelines published in 2018; girls overall tended to have lower PA levels than boys, with African American or Black girls having the lowest reported PA levels.5,6  Sport, particularly at the youth level, has been used as a physical and behavioral health intervention and is often seen as a key mechanism for achieving suggested PA levels in adolescents.7  In the United States, school-based opportunities for achieving PA, such as interscholastic sports, are 1 of the most common options for youth activity.8  Interscholastic sports offer multiple benefits for youth, including enhancing social support, fostering positive health behaviors, and providing skills needed to moderate and adapt to stress throughout life, in addition to supplying an easy avenue for achieving recommended PA levels. Sport can also present opportunities to advance educational attainment. However, researchers have shown that youth from lower–socioeconomic status (SES) backgrounds have lower participation rates in sport.9–14  Furthermore, African American or Black and Hispanic youth from lower-SES backgrounds have lower participation rates in intramural and interscholastic sports compared with their White peers from lower-SES backgrounds.11,15,16  In addition, limitations in the types of interscholastic sport opportunities available in school districts with larger shares of racial and ethnic minority youth may restrict these youth to specific sports, and decreased options for participation may, therefore, contribute to lower PA rates in these youth.6,13 

Sports can be vital for all youth and for girls in particular.17  Yet young girls and women are acutely aware of sexism and gender stereotypes and their effects, which can also influence their participation in sports. In a survey of girls’ attitudes, 41% of respondents aged 11 to 16 years reported that their confidence in their body and the fear that people would criticize them stopped them from participating in sports and exercise.18  African American or Black girls have been found to enter sport at an older age compared with girls of other races and ethnicities due to inequities arising from variations in funding or spending on education across school districts, limitations in community sport offerings, and restrictions due to historic gatekeeping along racial and economic lines that still exist in US sport culture today.19–23  In addition, African American or Black girls were more likely to attend schools that lacked physical and human resources to offer opportunities for them, such as interscholastic and intramural sports,24,25  although Title IX of the Education Amendments of 1972 increased women’s and girls’ access to sports in educational institutions.26  Unfortunately, African American or Black girls, and all girls from rural communities, are still underrepresented in sports such as lacrosse, golf, swimming, and soccer, whereas girls from other racial and ethnic groups have reported increased participation in these sports.6  These inequities may affect social and educational advancement through sport for marginalized youth, especially African American or Black girls.

Sport diversity in schools and school districts (ie, having multiple options of sports in which to engage) represents a factor that may seem innocuous but may represent another barrier and mechanism to marginalize racial and ethnic minority youth and particularly girls. Current US school district funding mechanisms hurt students in the poorest school districts the most.27,28  They are highly inequitable and woefully inadequate as they rely predominantly on property taxes, outside of state and federal funds. School districts in the highest poverty quintiles often spend less than what is necessary to adequately meet the educational, and arguably the developmental, needs of their students. The reliance on school-based opportunities for PA, such as interscholastic and intramural sports for youth, disadvantages youth, particularly those from rural, low-SES, and racial and ethnic minority communities, and is a mechanism by which systemic inequities in neighborhood context and education funding affect the lives of youth by directly influencing their health and opportunities.8,16,29 

Although access to sport participation might seem to be external to health care and the athletic training profession, it is not. Access to sports medicine, and by extension health care, is obviously not immune to inequities. The reduced capacity to offer interscholastic sport manifests not only in a lack of coaches but also in a lack of access to appropriate health care providers. We know that only one-third of public schools had access to a full-time athletic trainer (AT); however, schools in economically disadvantaged neighborhoods had a lower likelihood of access to any AT services.30–34  Whereas the immediate solution is to increase availability and access to ATs in these school districts, it is potentially unsustainable without understanding and addressing the economic drivers and root cause of this disparity in access at the secondary school level (ie, school district funding).27,35,36  Neighborhoods and school district funding are intertwined, and neighborhoods are not relics or an abstract representation of systematic exclusion; exclusionary laws and policies still shape neighborhoods today.27 

St Louis, Missouri, has a long-standing history of segregation, which continues to shape the health outcomes and access to resources, including education, of its residents depending on their zip code. The historic racial segregation of St Louis has influenced residential and economic segregation and consequently influences the wealth of school districts within the region.37–40  The Show-Me Institute found a moderate to strong positive correlation between Missouri school districts with high property values and the amount spent per student.39,40  This translates to diminished resources for students, including safe sports, equipment, and other activities, in school districts that have less income.34,41 

Examining the relationship between sport offerings and contributors to district resources (ie, community context) adds another layer to the literature surrounding the consequences of status quo school district funding and the persistent disparities in youth PA levels and youth sport opportunities.40  It helps to bridge the understanding of the importance of non–health-related policies and sectors to determinants of health and health behaviors of patients that started in childhood. Thus, the purpose of our report was to visualize the inequalities present in interscholastic sport opportunities for girls across school districts using a novel index in a selected study area of St Louis City and County and to discuss implications for African American or Black girls.

Study Area

The immediate St Louis region consists of 2 entities: St Louis City and County, with an estimated population of 1.3 million people in 2019. The median household income in 2019 was $43 896 in St Louis City and $67 420 in St Louis County. Approximately 20.4% of St Louis City’s population lived in poverty, whereas the rate was dramatically lower in St Louis County at only 9.3%. Most residents in St Louis County were non-Hispanic White (65.3%), followed by non-Hispanic African American or Black (25%); St Louis City’s residents were more equally distributed racially and ethnically (44.7% non-Hispanic White and 45.3% non-Hispanic African American or Black).

We obtained these data from the US Census website (https://www.census.gov/quickfacts/fact/table/stlouiscitymissouri,stlouiscountymissouri/INC110222). However, our numbers reflect 2019 and 2020 figures, as opposed to the 2022 figures currently shown on the website.

Instrument

To measure access to sports, we created a sport diversity index (SDI) with the diversity index as its foundation. The diversity index is an entropy equation used to measure residential segregation at the census-tract level. By joining census tracts with school districts to determine which census tracts were contributing to specific school districts, we used a similar rationale to create the SDI. The SDI represented the diversity of sport that was available to schools in each school district in St Louis City and County. Perfect diversity, a score of 1, indicates schools in that respective district offer a maximum of 27 sanctioned sports, whereas scores closer to 0 indicate that schools in the district offer fewer options for sport participation. This index was then generated for sports by sex, with our emphasis on the SDI for girls’ sports. Girls in Missouri had a total of 14 sport opportunities, and these were included as the denominator in the calculation of the SDI for girls in the following equation (Table 1):
formula
where SDIgirlsj is the SDI for girls in schools in district j, Sik is the proportion of a sport at a school in a given school district, and TSOgirls is the total sport opportunities available for girls in schools under the state governing body for high school activities. The diversity index ranges from 0 (no diversity) to 1 (very diverse, ie, maximum number of sports offered for girls available under a governing body is offered at school).
Table 1.

Sports Sanctioned by the Missouri State High School Activities Association

Sports Sanctioned by the Missouri State High School Activities Association
Sports Sanctioned by the Missouri State High School Activities Association

Sport data for high schools were obtained from the 2019 Missouri State High School Activities Association website. For this study, only schools in St Louis City and County were considered (n = 47).

Independent Variables

The 4 main components of the formula currently used to compute the funding allocation are weighted average daily attendance, state adequacy target, dollar value modifier, and local effort (LE).39  The LE represents the amount of money a school district can generate on its own, primarily through property taxes, and is intrinsically tied to property value and area wealth. Despite hold harmless provisions (ie, provisions meant to minimize or restrict declines in revenue in school district funding), this component of the equation is still inherently inequitable and biases funding toward districts with higher property values.38–40,42  The first independent variable for our study was the percentage of the population that lived in renter-occupied housing units (a proxy for the LE component of the Missouri state funding equation). Second was the poverty rate for the population aged <18 years. We chose renter-occupied housing as a proxy, though some researchers have shown that affordable low-income housing can have positive effects on property values; the complex interactions of location, racial and ethnic makeup, poverty, management, etc, can influence the direction and effect of affordable rental housing on property values.35,43–45  For example, in California, districts with a high concentration of low-income housing still had a substantial gap in funding available per student.35  Therefore, using both renter-occupied housing and poverty rates provides neighborhood-level texture that suitably describes what may be occurring in areas with concentrated low-income housing.

The 2014–2018 American Community Survey provided school district– and census-tract–level social, economic, housing, and demographic data for St Louis City and County. School district shapefiles for 2018 to 2019 were obtained from the US Department of Education’s National Center for Education Statistics through its Education Demographic and Geographic Estimates program’s Composite School District Boundaries. We also examined distributions of race and ethnicity (non-Hispanic White and non-Hispanic African American or Black) at the census-tract level to determine the distribution of the population along racial and ethnic lines in St Louis City and County.

Data Analysis

Descriptive data are presented to display the distribution of the SDI for girls. Choropleth maps were generated to visualize distributions of the variables of interest across the study area. We computed spatial descriptive statistics (mean center, directional distributions) for the study variables. Spatial measures of association (bivariate local indicator of spatial autocorrelation) were collected to ascertain the correlations of any patterns observed between key variables. For spatial analysis, we used ArcGIS Pro (version 2.6; Esri), ArcMap (version 10.8.1; Esri), and Geoda (version 1.14.0; The University of Chicago). We used Stata (version 16.1; StataCorp LLC) for other statistical analyses. The α level was set at .05.

The available sports by sex in Missouri under the Missouri State High School Activities Association are listed in Table 1. St Louis City and County comprise 23 school districts. St Louis City is 1 school district with 13 high schools under its purview, the most of any school district in the study area.

In evaluating the demographics by school district, we observed that St Louis City had the highest percentage of families with a child or children aged <18 years (38.2%). This district also predominantly consisted of racial and ethnic minority youth: 70.5% were non-Hispanic African American or Black with a median household income of $26 192 (Table 2). In St Louis County, most of the school districts were predominantly non-Hispanic White, with Ladue School District having the highest median income for non-Hispanic White families at $181 250. Overall, school districts with a larger population of racial and ethnic minority youth than non-Hispanic White youth had lower median household incomes than school districts with a larger population of non-Hispanic White youth. These school districts also had higher rates of renter-occupied housing (Table 2).

Table 2.

Demographic Information for School Districts Across St Louis City and St Louis Countya

Demographic Information for School Districts Across St Louis City and St Louis Countya
Demographic Information for School Districts Across St Louis City and St Louis Countya

The mean centers for the non-Hispanic African American or Black population, renter-occupied housing, and families with children aged <18 living below the poverty rate were predominantly in the St Louis City school district. Similarly, the directional distribution for these 3 variables encompassed most of the St Louis City school district, with some inclusion of school districts immediately west of the city (Figures 1 through 3). The choropleth maps of the SDI for girls showed that the distribution of diversity of sports for girls across school districts in St Louis increased (closer to 1) the farther west they were (purple color). School districts with large populations of non-Hispanic African American or Black students had lower SDIs (ie, less diversity of sports offered) than schools with a predominantly non-Hispanic White population (Figure 1), indicating that fewer opportunities for sport participation were available for girls in these school districts. The bivariate local indicator of spatial autocorrelation cluster maps depicting the spatial cluster association between variables and the SDI for girls demonstrated that the SDI for girls was moderately negatively correlated with renter-occupied housing, poverty rate, and the non-Hispanic African American or Black population (Table 3; Figure 4). Regarding race and ethnicity, the non-Hispanic White population was moderately positively correlated with the SDI for girls. The opposite was true for the non-Hispanic African American or Black population; that is, it was negatively correlated with the SDI for girls, indicating a relationship between race and ethnicity and access to sport opportunity spatially that did not favor non-Hispanic African American or Black girls (Table 3). All results were significantly different.

Figure 1

The sport diversity index for girls with spatial distribution of the non-Hispanic African American or Black population in the St Louis City and County school districts (SDs).

Figure 1

The sport diversity index for girls with spatial distribution of the non-Hispanic African American or Black population in the St Louis City and County school districts (SDs).

Close modal
Figure 2

The sport diversity index for girls with spatial distribution of youth under 18 living in poverty in the St Louis City and County school districts (SDs).

Figure 2

The sport diversity index for girls with spatial distribution of youth under 18 living in poverty in the St Louis City and County school districts (SDs).

Close modal
Figure 3

The sport diversity index for girls with spatial distribution of renter-occupied housing in the St Louis City and County school districts (SDs).

Figure 3

The sport diversity index for girls with spatial distribution of renter-occupied housing in the St Louis City and County school districts (SDs).

Close modal
Figure 4

Bivariate local indicator of spatial autocorrelation maps showing the spatial correlation between the sport diversity index for girls and A, renter-occupied housing; B, the non-Hispanic African American or Black population; C, the non-Hispanic White population; and D, the poverty rate.

Figure 4

Bivariate local indicator of spatial autocorrelation maps showing the spatial correlation between the sport diversity index for girls and A, renter-occupied housing; B, the non-Hispanic African American or Black population; C, the non-Hispanic White population; and D, the poverty rate.

Close modal
Table 3.

Bivariate Local Moran I (Bivariate Local Indicator of Spatial Autocorrelation) Spatial Correlation Valuesa

Bivariate Local Moran I (Bivariate Local Indicator of Spatial Autocorrelation) Spatial Correlation Valuesa
Bivariate Local Moran I (Bivariate Local Indicator of Spatial Autocorrelation) Spatial Correlation Valuesa

Schools in districts with low SDIs also had higher percentages of renter-occupied housing (ie, potentially less LE generated) and, as mentioned, served predominantly non-Hispanic African American or Black youth, including girls. These initial results showed that spatial inequality existed in interscholastic sports in the St Louis region that was consistent with the persistence of segregation.

These preliminary results lend more evidence to current criticisms of education funding mechanisms that rely heavily on property tax revenues but also add nuanced context to the effect on the other components of educational development of children. The Whole School, Whole Community, Whole Child model emphasizes the important role of schools in providing opportunities to meet the recommended 60 minutes of PA daily.46  The SDI for girls highlighted that not only did disparities exist in interscholastic sports for girls, but these disparities had a geographic relationship with various neighborhood contexts. The spatial correlation between renter-occupied housing, poverty, and the SDI for girls added evidence to expand the lens with which we examine not only youth sports but also access to resources and services, such as to ATs and other health care services.

The relationship between a lack of resources and the ability to create an environment for safe sport must be explored in tandem; increasing opportunities to play sports without ensuring access to appropriate care or resources has the potential to negatively affect youth health and developmental outcomes. Youth athletes from economically disadvantaged communities or lower-income areas were less likely to have access to appropriate sports medicine care.33  This finding emphasized how systemic inequities in the education system and neighborhood development, which are grounded in policy, are critical to the athletic training profession’s understanding of such disparities. Given that the Content Outline for Practice Analysis, 8th edition, indicated that many ATs “fill the role of a community advocate involved with promoting public health initiatives,” knowledge and awareness about the drivers of community health and well-being must permeate the research and pedagogy.47  Secondary schools along with colleges and universities employ most of the ATs in the profession.48  Athletic directors have noted that financial constraints and budgetary power at the district level often affect their ability to hire ATs.41  Thus, factors affecting the ability of secondary schools and school districts to provide equitable and adequate resources, including athletic training services, should interest the profession. Therefore, without a contextual understanding of the cross-branching historical and modern-day consequences of non–health-related law and policy in shaping the communities that we serve, micro- and macro-level movements toward sustainable health equity will not take root.

The lack of opportunities for girls in school districts that were underfunded facilitated girls’ steep dropout rate from sports by the age of 14 years.14,25  Girls’ sports are undervalued, are underresourced, and often do not provide the opportunity for girls to see themselves in their coaches, with only 23% of youth sport coaches being women, a number that was declining.20,21,23  The intersection of race and ethnicity, sex, and sports is particularly salient for African American or Black girls, who faced not only racial stereotyping in sport participation but also policing of the validity of their athletic abilities along acceptable dimensions of femininity.20,23  The lack of sport diversity in racial and ethnic minority school districts may be contributing to a perpetuation of sports participation by African American or Black female athletes that is concentrated predominantly in basketball and track and field, a phenomenon that has persisted since the 1990s.14 

Racial and ethnic minority youth wanted to participate in sports that were often unavailable to them.20  The ever-increasing cost of youth sport, coupled with youth from lower-income households participating at lower rates, demands that we explore ways to increase not only access to but also the quality of interscholastic sports.12,13,20 

Our work had limitations. Renter-occupied housing does not provide an exact measure of LE or property tax contribution to school district funding. However, combined with measures of poverty distribution, it offers a contextual idea of housing disparities that are driven by socioeconomic factors and influence not only health outcomes but also opportunities for social mobility.49–51  Access to stable, affordable, and good-quality housing in safe neighborhoods is an important determinant of health and can influence a plethora of outcomes for youth.52  School district revenue data and cost-adjusted revenues per student can be used for a more accurate estimation of school district LE. Nonetheless, that was beyond the scope of this report, as it involves a deeper dive into educational economics and law analysis. We simultaneously encourage transdisciplinary collaboration to further this analysis along those lines. This work included only high school youth, and the patterns may be different for younger youth, indicating that the resource allocation for sports within districts may also need to consider age level. The latter is also important to consider given that the average age at which girls tend to drop out of sports is around 14 years.14,25 

The measurement of sport in the creation of the SDI is binary—that is, it is either offered or not; yet this value does not always take into consideration the level of play and whether a team is active that semester or for the entirety of the term, both of which are important to consider when discussing diversity and equity in development. Economic resources may affect not only the presence of a sport but also the caliber of the team and skill-building resources for coaches and athletes, thereby presenting another mechanism through which economic disparities at the policy and system level may affect youth opportunities.

The shapefiles had certain limitations. Some census tracts that make up St Louis County were outside the Rockwood R-VI School District boundary. This was attributed to errors in the drawing of the Topologically Integrated Geographic Encoding and Referencing/Line Shapefile for the National Center for Education Statistics school district boundary, as the boundary line extended into counties other than St Louis County and prematurely cut off some areas of St Louis County. This error did not affect the analysis because the school district boundary files contained no demographic data, and the census tracts that fell outside the Rockwood R-VI School District were still considered to contribute to that school district, based on their centroid location as well as regional knowledge.

Sport diversity is important, as it represents, at a deeper level, inequities in school district funding and opportunities for educational and social advancement. It is also an avenue for girls to play, be physically active, and be competitive, and it can present a path toward education as well as facilitate higher levels of body acceptance and self-confidence.17  The cultural idea of which sports certain racial and ethnic groups participate in must be dismantled through grassroots efforts to increase access and provide socioecological support to encourage the involvement of racial and ethnic minority girls in sports.14,21,23  Not offering racial and ethnic minority girls diverse opportunities to engage in sport denies them the plethora of benefits that come with sport participation and hinders any long-term progress in the reduction of health disparities that persist and harm racial and ethnic minority women and girls. The examination of system-level influencers on sport and athletic training needs to be expanded so that the profession can continue to demonstrate its stance as an advocate for athletes and contribute to dismantling the covert ways systemic inequalities continue to successfully marginalize the vulnerable among us.

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