Content Servger

SYSTEMATIC REVIEW
Influence of Friends on Childrens Physical Activity:

A Review
We examined evidence
for friendship influences on
childrens physical activity
(PA) through systematic
searches of online databases
in May 2012. We identified
106 studies (25 qualitative)
published in English since
2000 that analyzed indicators of friendship influences
(e.g., communication about
PA, friends PA, and PA with
friends) among persons
younger than 19 years.
Childrens PA was positively associated with encouragement from friends
(43 of 55 studies indicating a positive relationship),
friends own PA (30/35), and
engagement with friends in
PA (9/10). These findings
are consistent with friends
influencing PA, but most
studies did not isolate influence from other factors that
could explain similarity.
Understanding friendship
influences in childhood can
facilitate the promotion of
lifelong healthy habits. PA
with friends should be considered in health promotion
programs. (Am J Public
Health. Published online
ahead of print May 16,
2013: e1e16. doi:10.2105/
AJPH.2013.301366)
Claire C. Maturo, MPH, and Solveig A. Cunningham, PhD
EXTENSIVE RESEARCH HAS

linked physical activity to health
and inactivity to poor health, especially to obesity and other cardiometabolic problems such as
diabetes and cardiovascular disease.1---3 Increases in overweight,
obesity, diabetes, and metabolic
syndrome among children and
adolescents over the past few decades4---7 have stimulated a surge
of research into possible contributing factors, including insufcient
physical activity.8---10
In spite of its health benets,
physical activity is declining
around the world.11 In the United
States, levels of physical activity in
children and adolescents are not
sufcient to promote optimal
health.12 The Centers for Disease
Control and Prevention recommends that children and adolescents be active for at least 60
minutes per day, but in 2009, only
18.4% of adolescents reported
this much physical activity and
23.1% of adolescents reported not
participating in 60 minutes of
physical activity on any day.13,14
A factor that may affect health
behaviors that has received increasing attention in recent years
is social inuence. Research has
suggested that family, friends, and
peers can guide behaviors such as
smoking, sexual initiation, and
eating behaviors.15---19 Inuences
from these close contacts can occur through social pressure, social
modeling and imitation, social
comparison, and behavior approximation.20 However, not all
social relations are equally important: the closer and stronger the
connection, the broader and
Published online ahead of print May 16, 2013 | American Journal of Public Health
stronger the possibilities for inuence.21,22 Information transmitted

from friends is generally more
clearly understood and more
likely to be internalized than is
information from others, meaning
that friends may be more inuential than other social contacts,23---26
such as cliques and peer
groups.24,27,28
Although social inuences on
physical activity can occur
throughout life, they are particularly important to study in children and adolescents, for several
reasons. First, childhood and adolescence are a formative period
when friends are a primary point
of reference29,30 in deciding
which behaviors, values, and attitudes are desirable and which
activities warrant effort.31---34
Friends have been shown to affect
timing of rst sexual intercourse,
drug use, delinquency, and educational attainment among adolescents.31,32,35---42 Second, physical activity tracks across life:
activity levels during adolescence
predict adult levels, and active
children and adolescents are more
likely to become active adults.43
Third, physical activity often decreases during adolescence, so
children and adolescents may be
the most important age groups to
target for interventions to establish
lifelong activity levels.44 Finally, the
development of successful interventions to increase physical activity in children and adolescents requires an understanding of the
unique determinants of physical
activity at these ages.
Quantifying the extent to which
friends can promote or discourage
physical activity is critical for understanding why physical activity

levels are decreasing and for developing strategies to promote active lifestyles. We reviewed the
literature to determine the role of
friends in shaping physical activity
among children and adolescents.
METHODS
We conducted a systematic
search of peer-reviewed journals
in May 2012 in the PubMed,
Sociological Abstracts, EconLit,
and Web of Science databases.
Because patterns of physical activity have changed over time, we
focused on studies published since
2000 to identify the most relevant
information for todays youths.
Searches used combinations of
keywords that included a friendship term (friend* or peer*)
and a physical activity term
(sport* or physical activity or
exercise). We included the word
peer in searches because it is
sometimes used to mean friend,
but only retained the articles
where peer referred explicitly to
friends rather than to general peer
groups or schoolmates. We did not
include schoolmates and peer
groups not specically identied
as friends because our goal was to
quantify the importance of friends,
who are more inuential than
other social contacts, according to
the literature.23---26
Study Selection
We included articles if they (1)
were published in English, (2)
were published in or after 2000,
(3) presented results from analyses
Maturo and Cunningham | Peer Reviewed | Systematic Review | e1
SYSTEMATIC REVIEW
2424 in PubMed, 79 in Sociological Abstracts, and 58 in EconLit.

A review of titles and abstracts
narrowed the results to 271 articles, which each author then
reviewed independently. The
process is illustrated in Figure 1.
We identied an additional 5 articles through hand searches of the
references of retrieved articles.
After all reviews, our analytic
sample comprised 106 studies, of
which 25 were qualitative studies
discussing friends inuence on
physical activity; we reviewed
these separately.
Data Collection and Analysis
Identification
We used a data extraction

spreadsheet to collect information
about each study, determine
whether it met inclusion criteria,
and compare across studies. We

extracted the following information for each study: authors and
year of publication, study design,
sample size and participant age
range, physical activity outcome
variables, friendship exposure
variables, control variables, and
reported estimated effect sizes and
signicance levels.
We grouped studies by outcome and exposure measures and
analyzed for patterns. We
assessed studies design, population, and method of data analysis.
We considered the control variables used, the size and generalizability of the sample, whether the
study used a longitudinal or
cross-sectional design, whether
physical activity indicators were
self-reported or directly measured,
Records identified through

database searching
(n = 5357)
and whether information on

friends was collected from the index respondent or directly from
the friend. These characteristics
of the studies meeting inclusion
criteria are summarized in
Table 1.
RESULTS
Eighty-one quantitative articles
met inclusion criteria. Of these
studies, 40 reported signicant
positive associations between a
measure of friendship inuences
and respondents physical activity
in all populations and models,45---84
30 reported signicant positive
associations in some but not all
populations or models,26,85---113
and 11 reported no signicant
positive associations.114---124
Additional records identified

through other sources
(n = 5)
Screening
Records after duplicates removed

(n = 3939)
Eligibility
Abstracts screened
(n = 3939)
Full-text articles assessed

for eligibility
(n = 271)
Studies included in
qualitative synthesis
(n = 25)
Included
of primary or secondary data, (4)

used a child or adolescent sample
(aged < 19 years or attending
secondary school or lower), (5)
included a measure of physical
activity as the outcome variable,
and (6) included as a predictor
variable an explicit physical activity measure (communication with
friends about physical activity,
such as social support, encouragement, or advice; behavior modeling by friends, such as a friends
own physical activity; or participation with friends in physical
activity, such as being teammates
in a sport or exercising together).
We required that friend variables
be analyzed separately from other
social contacts, such as family or
classmates.
We dened friends as individuals identied as friends by the
participant, regardless of whether
the friendship was conrmed or
reciprocated. We excluded studies
that measured only the quality or
number of friendships an individual had or the amount of time
spent with friends but lacked
friendship indicators specic to
physical activity. We included
studies that collected information
from respondents about their
friends (e.g., respondent-reported
activity levels of friends or attitudes of friends toward physical
activity) and that collected data
from friends directly as predictor
variables. For measures of physical activity, we accepted both
self-reported and objective measures (e.g., accelerometer data).
Physical activity measures had to
pertain to behaviors, such as intensity of activity or activity done in
a specic context, not to intentions,
such as motivation to engage in
physical activity or preoccupation
with physical activity. We placed
no restrictions on study design.
Searches identied 5357 articles: 2796 in Web of Science,
Studies included in
quantitative synthesis
(n = 81)
Records excluded
(n = 3668)
Full-text articles excluded

(n = 165):
Participants were adults (n = 41)
Physical activity behavior not an outcome
variable (n = 40)
Published before 2000 (n = 3)
Friend influence assessed uniquely is
not a predictor variable (n = 40)
Peers not explicitly defined as
friends (n = 26)
Relationship of interest is in the wrong
direction (n = 5)
Review article (n = 6)
Missing key data (n = 4)
FIGURE 1Literature search for research on influence of friends on childrens physical activity, 2000
2012.
e2 | Systematic Review | Peer Reviewed | Maturo and Cunningham
American Journal of Public Health | Published online ahead of print May 16, 2013
47
Ievers-Landis et al.53
Leslie et al.94
Ommundsen et al.55
Ommundsen et al.55
Ommundsen et al.55
Jago et al.91
Jago et al.91
Friends support for PAa

Friends support for PA
Zhang et al.78
Duncan et al.87
Wenthe et al.107
Wu et al.72
Taymoori et al.122

Raudsepp and Viira62

Roesch et al.63
MVPA on weekend, follow-up
MVPA after school, follow-up
at school
Participates in active games
Active commute to school
Active travel to/from school

WBPA
Overall PA
Overall PA
Overall PA
Overall PA
Overall PA
Overall PA
Overall PA
De Bourdeaudhuij et al.48 Overall PA
Overall PA
Kirby et al.109
Overall PA
Overall PA
Overall PA
Overall PA
MVPA
MVPA
MVPA
MVPA
MVPA
MVPA
MVPA
MVPA
MPA
MVPA
VPA
VPA
VPA
VPA
PA Indicator (Outcome)
Loucaides58
Lubans and Morgan120
Duncan et al.49
Davison and Schmalz
Wenthe et al.
Patnode et al.106
107

Kelly et al.92
Kitzman-Ulrich et al.119
Hamilton and White117
Huang et al.52
Hsu et al.118
Heitzler et al.51
Anderson et al.
Bergh et al.46
115

Sallis et al.
103
Sallis et al.
103
Kelly et al.92
Anderson et al.114
Study
Friends communication about PA
Friend Influence Indicator
X
X
X
X
Friend
Indicator
PA Objectively Objectively Longitudinal
Measured
Measured
Design
TABLE 1Summary of Studies of Friends Influences on Childrens Physical Activity, 20002012
657
657
760
760
2961
760
354
285
371
205
832
558
193
878
6078
641
652
119
371
202
205
294
1180
669
423
303
666
63
408
1129
200
781
1180
408
Sample
Size
1011 y
1011 y
915 y
915 y
1014 y
915 y
811 y
1215 y
1217 y
1214 y
1215 y
1217 y
Grade 6
1115 y
1119 y
1115 y
Grades 79
1415 y
1217 y
Grades 68
1214 y
1017 y
Grade 6
Grade 6
1216 y
914 y
Middle school
1017 y
1315 y
11 y
Grades 112
Grades 112
Grade 6
1315 y
US
US
US
China
US
US
Belgium
Scotland
Cyprus
Australia
US
US
US
US
US
US
US
Taiwan
Both
Both
Both
Both
Both
Both
UK
UK
Norway
Norway
Australia
Norway
Female US
Both
Both
Both
Both
Female Iran
Female Estonia
Both
US
Both
Both
Both
Both
Both
Both
Both
Both
Location
US
Norway
US
US
Female US
Both
Both
Both
Both
Both
Both
Both
Both
Both
Female US
Both
Age Group,
Range or Mean Gender
X
X
X
X
Continued
Xd
Xg,d
X
Xd
X
Xf
Xe
Xd
Xd
Xb
Xc
Xc
Xb
Findings
Consistent
Covariates With Influence
SYSTEMATIC REVIEW
Overall PA
After school PA
Lunchtime PA
Sports team participation
Change in PA
Dunton et al.124
Prochaska et al.102
Prochaska et al.102
Ha et al.79
Wu and Pender82
Hohepa et al.110
Hohepa et al.110
Hohepa et al.110
Johnson et al.54
Raudsepp and Viira62

Change in friends support
Overall PA
VPA
MVPA
Sport team participation
Sabiston and Crocker64
Seabra et al.68
Best friends support for PA
Friend influences sport

High-intensity PA
Moderate-intensity PA
Overall PA
Overall PA
MVPA
MVPA
VPA
VPA
Overall PA
Overall PA
Seabra et al.76
Seabra et al.76
Wilson and Dollman108
Sharma et al.69
Sharma et al.70
Friend influences PA
Friend influences PA
Best friend encourages PA
Friend encourages PA
participation
Change in MVPA on weekend
Jago et al.91
Change in MVPA after school
Overall PA
Change in MVPA
Total MVPA out of school, min

Change in VPA
Weekend MVPA, min

for PA
for PA
Jago et al.91
Overall PA
Lytle et al.111
Dunton et al.124

for PA
Overall PA
Lytle et al.111
MVPA after school, mean min
Lytle et al.111
MVPA before school, mean min
Bouts of MVPA
Participates in sports team
Lytle et al.111
Wenthe et al.107
Anderson et al.115
TABLE 1Continued
718
718
113
180
113
180
113
3352
180
3352
3352
857
857
857
657
657
193
145
3471
3471
3471
832
1538
138
138
63
3378
63
3378
3378
3378
205
1139
Grade 6
Grade 6
Grades 89
Grades 69
Grades 89
Grades 69
Grades 89
1018 y
Grades 69
1018 y
1018 y
1518 y
1518 y
1518 y
1011 y
1011 y
Grade 6
Grades 912
1218 y
1218 y
1218 y
1215 y
1116 y
Grades 68
Grades 68
Grades 1011
Grade 11
Grades 1011
Grade 10
Grade 9
Grade 8
1214 y
815 y
US
US
US
New Zealand
New Zealand
New Zealand
Taiwan
Australia
Hong Kong,
US
US
Australia
Australia
Australia
Australia
Australia
Portugal
Australia
Portugal
Portugal
Canada
Canada
Canada
UK
UK
Female US
Female US
Male
Male
Male
Male
Male
Both
Male
Both
Both
Both
Both
Both
Both
Both
Female Estonia
Both
Both
Both
Both
Both
Both
Both
Both
Female US
Female US
Female US
Female US
Female US
Female US
Both
Both
X
X
X
X
X
X
X
Continued
Xh
Xh
X
X
SYSTEMATIC REVIEW
MVPA
MVPA
VPA
60 min MVPA 7 d/wk
Overall PA
Overall PA
Frequency of changing exercise
Springer et al.71
Anderson et al.115
Springer et al.71
Lemstra et al.113
Prochaska et al.102
Prochaska et al.102
Stanford and McCabe104
Martn-Matillas et al.96
Friend encourages PA/sports
Friends feedback on health
60 min MVPA 7 d/wk
Lemstra et al.113
Friends do not tease for not
Overall PA
Bike to school
Walk to school
WBPA
Overall PA
Overall PA
MVPA
Coppinger et al.86
Panter et al.100
Panter et al.100
Price et al.101
Prochaska et al.102
Prochaska et al.102
Viira and Raudsepp84
Friends not supportive of
Friends encourage walking or
Friends encourage walking or

biking to school
Friends criticize PA
Friends praise PA/sports
Overall PA
MVPA
Overall PA
Macdonald-Wallis et al.60
Mean MVPA of friends

Friends ever do PA
Friends do PA now
Overall PA
Macdonald-Wallis et al.60
Mean overall PA of friends
Friends modeling of PA
biking to school
PA (perceived)
Change in MVPA
de la Haye et al.88
Pressure from friends
(boys) is important to friends
Friends praise sports abilities

Being thin (girls) or muscular
60 min MVPA 7 d/wk

Change in MVPA
Overall PA
Finnerty et al.50
Discuss PA with friends
Lemstra et al.113
Kahn et al.97
Overall PA
Coppinger et al.86
Friends remind to be active
being good at sports
2260
559
2260
559
197
138
138
1000
2012
2012
106
378
4197
12 812
4197
315
106
106
669
3007
3007
MVPA
Overall PA
MVPA
3007
362
138
138
718
4197
3007
Overall PA
Kitzman-Ulrich et al.119
Friend discourages PA
718
1139
VPA
Friends talk about PA positively Coppinger et al.86

718
718
MPA
to decrease weight
Jumping activities, d/wk
Sharma et al.70
behavior
Sharma et al.69
TABLE 1Continued
1318.5 y
1011 y
1318.5 y
1011 y
Grades 78
Grades 68
Grades 68
912 y
910 y
910 y
911 y
1215 y
915 y
1018 y
915 y
1013 y
911 y
911 y
Grade 6
12.517.5 y
12.517.5 y
12.517.5 y
12.517.5 y
1214 y
Grades 68
Grades 68
1014 y
915 y
815 y
1014 y
Grade 6
Grade 6
US
UK
UK
UK
Australia
Canada
US
Canada
UK
UK
UK
US
Europe
Europe
Europe
Europe
Australia
US
US
Both
Both
Both
Both
Both
Both
Both
Spain
UK
Spain
UK
Estonia
US
US
Female US
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Male
Both
Both
Female US
Both
Canada
Both
Female US
Female US
Female US
X
X
X
X
X
X
X
X
Continued
Xh
Xj
X
X
Xi
X
X
SYSTEMATIC REVIEW
Loucaides et al.112
Best friends PA
Best friends PA
Participation in organized PA
Participation in non-organized PA
de la Haye et al.75
de la Haye et al.75
Friends PA
Friends PA
Duncan et al.87
Friends PA
VPA
MPA
MVPA
MVPA
WBPA
King et al.56
King et al.56
Springer et al.71
Springer et al.71
Price et al.101
Sharma et al.70
Gilmer et al.116
Friends PA
Friends PA
Friends PA
Friends PA
Friends PA
Friends PA
one third of best friends
or hard PA
Jago et al.
Duncan et al.87
Leatherdale et al.
Leatherdale et al.57
Schofield et al.26
Friends overall PA
3 friends are active

90
Change in friends PA
Friends MVPA
57
VPA
McDermott et al.61
Friends PA
Jago et al.90
Overall PA (energy expenditure)
Plotnikoff et al.77
Friends PA
Overall PA
Moderately active
Highly active
Change in PA
Overall PA in CPM
MVPA min/d
Overall PA
Overall PA
Bramoulle et al.83
Friends PA
engage in school sports
Overall PA
Luszczynska et al.81
Overall PA
Overall PA
Overall PA
Overall PA
Friends PA
Sharma et al.
Voorhees et al.105
Friends PA
70
Schofield et al.
Friends PA
Friends PA
Duncan et al.87
Gesell et al.74
Friends PA
Friends PA
26
Change in PA
Change in percentage of after
de la Haye et al.75
Friends PA
school play that is MVPA
Change in MVPA
de la Haye et al.
Friends PA
Change in MVPA
past 7 d
Plays active sports
Ali et al.45
Friends PA
75
Xk
Xk
X
X
318
2379
2379
371
472
472
113
1000
718
718
718
535
535
1407
2688
Both
Canada
US
US
US
Australia
Australia
Australia
Australia
US
Europe
US
Cyprus
Europe
Europe
Europe
Female US
Female Australia
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
1320 y
1518 y
Grades 58
Grades 58
1217 y
1011 y
1011 y
1114 y
912 y
Grade 6
1014 y
1014 y
Grades 912
Grades 912
913 y
Grades 912
US
US
US
Canada
Turkey, US
US
Hungary, Poland,
Canada
Canada
US
UK
UK
US
Female Australia
Both
Both
Both
Both
Both
Both
Female US
Female US
Female US
Female US
Both
Both
Both
Both
Both
Both
Grades 6 and 8 Female US
Grade 6
1518 y
1217 y
1217 y
512 y
1215 y
1215 y
Grades 89
Grades 89
1218 y
12.517.5 y
1218 y
Grade 6
12.517.5 y
12.517.5 y
12.517.5 y
15.62 y
not listed Grades 612
2387
488
718
318
371
371
81
378
378
385
385
3898
Overall PA
Exercised 3 times in
Ali et al.45
256
3007
3898
MVPA
3007
3007
MVPA
3007
MPA
VPA
2688
MVPA
Best friends PA
Friends PA
Best friends PA
Best friends PA
Loucaides et al.59
Close friends doing PA, No.
TABLE 1Continued
X
X
X
X
X
X
X
X
X
Continued
X
X
Xh
Xd,k
X
X
Xk
Xh
Xd
X
X
X
SYSTEMATIC REVIEW
Leisure-time sports
VPA
Does muscle-strengthening
Page et al.98
Keresztes et al.93
Page et al.99
Page et al.99
Page et al.99
active
All friends are physically
3 friends do sports
All/most friends are active
Participates in team sports
Is active outside school
Overall PA
MVPA
Overall PA
Page et al.98
Page et al.98
Page et al.98
Page et al.98
Ries et al.121
All friends are active
Friends use of facilities for PA
Best friend does PA
exercise
VPA
VPA
Page et al.98
VPA
MVPA
MVPA
active play
Best friend engages in
active play
active play
active play
active play

Overall PA
Overall PA
Page et al.99
active play
VPA
Page et al.
Page et al.99
Is active outside of school

Overall PA
exercise
Overall PA

active
active
99
Is active outside of school
Page et al.98
exercise
Page et al.98
active
Page et al.98
TABLE 1Continued
857
327
1886
1886
1886
1886
1886
113
180
113
180
113
180
2519
2519
2519
2519
2519
2519
548
1886
1886
1886
1886
1518 y
Grades 912
16.5 y
16.5 y
16.5 y
16.5 y
16.5 y
Grades 89
Grades 69
Grades 89
Grades 69
Grades 89
Grades 69
Grades 712
Grades 712
Grades 712
Grades 712
Grades 712
Grades 712
1015 y
16.8 y
16.7 y
16.6 y
16.5 y
Both
Both
Both
Both
Both
Both
Both
Male
Male
Male
Male
Male
Male
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
X
Canada
X
Czech Republic
US
X
Hungary, Romania,
Czech Republic
Hungary, Romania,
Czech Republic
Hungary, Romania,
Xd
X
Czech Republic
X
Czech Republic
Hungary, Romania,
X
X
Hungary, Romania,
Australia
Australia
Australia
Australia
Australia
Australia
Thailand
Thailand
Thailand
Thailand
Thailand
Thailand
Hungary
Czech Republic
Czech Republic
Hungary, Romania,
Hungary, Romania,
Czech Republic
Hungary, Romania,
Czech Republic
Hungary, Romania,
Continued
Xj
Xj
Xj
Xj,d
Xg
Xg
Xg,d
Xg
SYSTEMATIC REVIEW
MVPA
VPA
Overall PA
Overall PA
Overall PA
MVPA
Moderately active
Active
Overall sport participation
Saxena et al.67
Voorhees et al.105
Voorhees et al.105
Voorhees et al.105
Ries et al.121
Leggett et al.73
Leggett et al.73
Denault and Poulin80
Best friend does PA
All/most friends exercise
In sports team or class
Invited friend to do PA
Friends invite to be active
Friends use of facilities for PA
Number of active friends
Number of active friends
Friends overall sport
MVPA ( 60 min 1 d/wk)

Overall PA
Overall PA
MVPA
Fermino et al.89
PA with friends
PA with best friend
PA with best friend
PA with best friend
1518
Overall PA
Distance biked
Overall PA
Salvy et al.66
Coppinger et al.86
Friend present during PA
Friends change schedule
Overall PA
Overall PA
MVPA min/d
Overall PA in CPM
Finnerty et al.50
Coppinger et al.86
Jago et al.90
Jago et al.90
Exercise with friends
Friends plan PA together
Weekly PA with friend
Weekly PA with friend
Jago et al.90
class with friend

On sports team/in PA
class with friend
Jago et al.
On sports team/in PA
Overall PA in CPM
MVPA min/d
MVPA ( 60 min 5 d/wk)
Fermino et al.89
PA with friends
90
Overall PA
Overall PA
Prochaska et al.102
Prochaska et al.102
PA/sports with friend

PA/sports with friend
to exercise/do PA together
PA intensity
Salvy et al.65
Friend present during PA
60 min MVPA 7 d/wk
Lemstra et al.113
Friends invite to be
472
472
472
472
106
315
1518
138
138
106
88
20
4197
VPA
VPA

PA with best friend

PA with best friend
active together
180
113
MVPA
PA with best friend
113
180
113
180
488
60 min MVPA 7 d/wk

4197
272
31 202
31 202
327
488
488
Voorhees et al.105
305
488
PA with friends
857
857
Lemstra et al.113
Participation in PA with friends

PA with friends
participation
together
with friend
VPA
Best friend does PA
TABLE 1Continued
1518 y
Both
Canada
Canada
Female US
Both
Both
Both
Both
Both
Both
US
Canada
Canada
Canada
Canada
1011 y
1011 y
1011 y
1011 y
911 y
1013 y
1418 y
Grades 68
Grades 68
911 y
1214 y
1214 y
915 y
Grades 69
Grades 89
Grades 89
Grades 69
Grades 89
Grades 69
1418 y
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Both
Male
Male
Male
Male
Male
Male
Both
UK
UK
UK
UK
UK
UK
Brazil
US
US
UK
US
US
Canada
Australia
Australia
Australia
Australia
Australia
Australia
Brazil
915 y
Grade 6
912 Grades
Grades 912
Grades 912

1221 y
1518 y
X
X
X
X
X
Continued
Xh,m
Xh,l
SYSTEMATIC REVIEW
SYSTEMATIC REVIEW
The types of physical activity

considered in this literature can be
grouped as overall physical activity, dened as a measure of the
respondents total activity of
all types over a given period
(n = 41)26,45,47---50,57,58,60,62--64,69,70,72,73,77-79,81---83,85--87,89,90,95,96,98,99,102,105,107---
1011 y
1011 y
1011 y
131
131
131
Overall PA
do PA to be with friends
Jago et al.85
Neighborhood affiliation,
do PA to be with friends
with friends
Jago et al.85
MVPA
Light PA
do PA to be
Jago et al.85
to be with friends
Note. CPM = counts per minute; MPA = moderate-intensity PA; MVPA = moderate-to-vigorous PA; PA = physical activity; VPA = vigorous-intensity PA; WBPA = weight-bearing PA.
a
Sallis et al. Social support scale.125
b
For Blacks and Whites but not Hispanics.
c
Only in some grades for girls and for boys.
d
Boys only.
e
Only medium level of support, compared with low support.
f
Intervention study.
g
Compared with no physically active friends.
h
Girls only.
i
For the purpose of increasing muscle but not for losing weight.
j
Compared with no or some physically active friends.
k
Distance <1 km.
l
Best friend only.
m
For 5 times/week.
1011 y
131
Jago et al.85
Social affiliation, do PA
Overall PA
X
MVPA
to be with friends
Jago et al.85
1011 y
131
Both
Both
Finland
Finland
Finland
Both
Finland
1011 y
131
X
Light PA
to be with friends
Jago et al.85
TABLE 1Continued
Both
Both
Both
Finland
Finland
109,111,116,120,122,123
; engagement in
specic activities, such as weightbearing physical activity and
sports team participation (n =
11)53,54,68---70,80,98,99,101,114,123;
physical activity in specic contexts, such as leisure time or commuting to and from school (n =
10)93,94,97---100,68,110,111,123; physical
activity performed at a specic intensity, such as vigorous or moderate (n = 35)46,51,52,55,56,59--61,64,65,67,71,74,76,84,85,90--92,96,98,99,103,106---108,112---114,116--118,120,122,124
; and change in
any of these over time (n =
7).62,74,75,87,91,97,124 Vigorousintensity physical activities are
those that have an assigned metabolic expenditure value greater
than 6 (requires a large amount
of effort and causes rapid breathing or a substantial increase in
heart rate); moderate-intensity
physical activities have an
assigned metabolic expenditure of
3 to 6 (requires a noticeable
amount of effort and raises the
heart rate).126
We identied a priori and conrmed empirically from the literature 3 broad mechanisms
through which friends could inuence physical activity: friends
communication through social
norms and conversations about
physical activity (n = 55), including positive messaging, such as
encouragement and social support
(n = 54)46---55,58,62---64,68---72,75,76,
78,79,82,84,86,87,90---92,94,96,97,100,102-
111,114,115,117---120,122,123,113
and negative messaging, such as criticism

and teasing (n = 4)86,91,101,119;
SYSTEMATIC REVIEW
friends modeling of physical activity through their own physical

activity, that is, friends own behavior that might provide guidance, enticement, or pressure for
the respondent (n = 35)26,45,56,57,
59---61,64,67,69---71,73---75,77,80,81,83,85,
87,88,90,93,95,96,98,99,101,105,108,112,116,121,123
; and participation in physical

activity with friends, including organized sports and recreational
play in the company of friends (n =
10).50,65,66,89,90,102,105,108,113,123
We organized our ndings according to these proposed pathways of inuence.
Communication About
Physical Activity
Communication about physical
activity most frequently consisted
of social support or friends encouragement for physical activity.
The items used to measure social
support generally described 1 or
more of the following behaviors:
friends reminding the respondent
to exercise, encouraging the respondent to engage in physical
activity, praising the respondent
for engaging in physical activity, or
discussing physical activity with
the respondent. Other indicators
of communication used in studies
(but not referred to as social support) included the respondents
perceptions of friends attitudes
and beliefs about physical activity
(such as the importance of physical
activity to the friend), respondentperceived inuence from friends
over their participation in physical
activity, and invitations to or from
a friend to engage in physical
activity together. Twenty-nine
studies used the Sallis et al. social
support scale125 to measure
friends inuence.46,47,49,51---53,55,
58,62,63,72,78,87,91,92,94,102,103,106,
107,109,114,117---120,122,124
This scale
incorporates measures of peer
encouragement and support for
physical activity, as well as 2
measures of participation in physical activity together: friends exercising with the respondent and
friends changing their schedule to
be active with the respondent.125
We categorized separate measures
of friends exercising with the respondent and of friends changing
their schedule to exercise with the
respondent as a combined measure of participation in physical
activity with a friend.
Of the 55 studies that investigated communication about or
social support for physical activity,
25 showed signicant positive
relationships in all models46---55,58,
62---64,69---72,75,76,78,79,82,84,96,
;
18 showed signicant associations in some models or some
groups within the population55,86,87,91,92,94,97,100,102---104,106,
107,109---111,113,124
; and 12 did not
show any signicant associations90,101,105,108,114,115,117---120,122,123
(including 1 focused on negative
messages101). One of the studies
with mixed results yielded an unexpected relationship: lower friend
social support at the beginning of
an intervention was associated with
a greater subsequent increase in
physical activity.124
The most common measures of
physical activity in these studies
were overall physical activity (n =
27)47---50,58,62---64,69,70,72,78,79,82,86,
87,90,96,102,105,107---109,111,120,122,123
and moderate-to-vigorous physical

activity (n = 19).46,51,52,64,76,84,91,92,
97,103,106,107,113-115,117-119,124
Overall
physical activity was more often
associated with friends communication than was activity intensity
(21/27 vs 14/23). Eleven of the 55
studies measured physical activity
directly (with an accelerometer, a
pedometer, or observation).46,48,50,
51,90---92,106,111,118,119
Thirty-six studies used self- or parent reports,52--55,58,62---64,68---72,75,76,78,79,82,
84,94,97,100,101,103---105,108---110,113,
114,117,118,122,123,124
and 6 studies
combined indirect and direct

measures.49,86,87,96,102,103 Studies that used direct measures, or
a combination of direct and indirect measures, found signicant
associations (at least some support in 10/1846,48,50,51,68,86,91,92,
106,111
) less frequently than did
studies that used self- or parent
reports of physical activity (at
least some support in 28/3647,52--55,58,62---64,68,69---72,75,76,78,79,82,84,
94,97,100,103,104,109,110,113
).
Four studies investigated negative messaging from friends about
physical activity, specically criticism for being active or exercising,
making fun of the respondent for
being active, declining an invitation from the respondent to be
active together, and the respondents belief that friends would
not be supportive of being active.86,91,101,119 None of these forms
of negative messaging were signicantly associated with respondents physical activity, which was
measured most often in these
studies with objective measures
(e.g., pedometer, accelerometer).86,91,119
Modeling of Physical Activity

Thirty-ve studies focused on
friends demonstrated or perceived physical activity, which we
called friends modeling of physical activity. Only 9 of these
obtained physical activity data
directly from respondents
friends.26,45,60,74,75,80,83,88,90
Nineteen of the 35 studies showed
signicant positive associations
between friends physical activity
and respondents physical activity
across specications,45,56,57,59--61,64,67,69---71,73---75,77,80,81,83,101
and
11 reported positive associations
only in some specications.26,85,87,88,90,93,95,96,98,99,112
Five studies did not nd signicant
relationships between measures
of friends physical activity and
respondents physical activity.105,108,116,121,123

The most commonly used
measures of physical activity explored in the context of friendship
modeling were overall physical
activity (at least some support in
16/21)26,45,57,64,69,70,74,77,80,81,
83,87,95,96,98,99
and physical activity at a specic intensity (at least
some support in 12/16).56,59,61,64,
67,71,73,85,90,96,98,112
Studies that
used objective measures of physical activity yielded signicant results less often than studies that
used self-reported measures.
Joint Participation in Physical

Activity
Ten studies investigated the
importance of being physical active with friends or in the presence
of friends for respondents physical activity levels.50,65,66,89,90,102,
105,108,113,123
Nine of these reported
signicant associations in at least
1 model50,65,66,89,90,102,105,108,113
(4 in all models50,65,66,113). Indicators of joint activity were frequency of physical activity with
friends,50,89,90,102,105,108,123 friends
presence during physical activity,65,66 and whether respondents
were on a sports team or in an
exercise class with a friend.90,105
Only 1 study used direct measures
(distance biked on a stationary bicycle in a laboratory)66; the others
relied on self-reports of participation in physical activity with
friends. The most commonly used
physical activity measure was
overall physical activity level, with
6 of 7 studies reporting signicant
relationships in at least some specications.50,89,90,102,105,108
Qualitative Studies
Qualitative studies can enhance
our understanding of the mechanisms through which friends could
inuence physical activity or
at least illustrate why children
SYSTEMATIC REVIEW
believe their friends matter for

their own behavior. We separately
analyzed the 25 qualitative studies that met inclusion criteria,
because the data could not be
compared and assessed in the
same way as the quantitative
studies.127---151
These studies found that friends
were important for childrens and
adolescents physical activity
levels. Nine studies found that
children and adolescents perceived fun as an important motivator for engaging in physical activity and that the presence of
friends during physical activity
was associated with having
fun.128,130,134,141,142,145,146,149,150
Sixteen identied friends as
motivating factors for participating in physical activity.127,128,131--142,145,146
In addition, children and
adolescents reported that they
engaged in physical activity to
spend time with their friends
(n = 11127,131---136,138,139,145,146) and
that their friends physical activity
guided their own decisions about
physical activity (n = 10127,129,133,
139,141,145---149
). That is, having active friends encouraged physical
activity, and having inactive
friends discouraged it.129,147
DISCUSSION
Physical inactivity is a strong
predictor of overweight, obesity,
and other chronic diseases.152
Numerous studies have investigated the determinants of physical
activity in children and adolescents, and social inuences have
been proposed as potentially important forces in determining
physical activity levels. Diverse
analytic approaches have been
taken to dene, measure, and understand social inuences. We
synthesized current ndings on
the ways friends may inuence
physical activity in childhood and
adolescence. Results show a positive association between physical

activity and indicators of inuences from friends: positive communication about physical activity
from friends, friends own physical
activity levels, and the presence
of friends during physical activity.
Our review found substantial
evidence for a relationship between positive communication
with friends about physical activity and a childs own physical
activity (43/55 studies reported
signicant associations). The importance of communication is
consistent with ndings on other
health behaviors, such as sexual
initiation and eating behaviors.153,154 We also found substantial evidence that childrens
physical activity is associated
with the physical activity of their
friends (30/35 studies), suggesting
that individuals may be guided
by their friends behavior. Friends
behaviors have also been shown
to predict dieting, body dissatisfaction, and extreme weight control.155---159 Finally, we found
strong evidence that participation
with friends and the presence of
friends during physical activity is
associated with physical activity
(9/10 studies), consistent with
previous studies reporting that an
individuals eating behavior is affected by the presence of a friend
while eating160---163 and that
friends match their food intake
more closely than do unfamiliar
peers eating together.162
There is some indication that
children anchor their physical activity on friends actions and messages more in some settings than
in others. For example, friends
may be more important for unstructured physical activity or active play but less so for organized
sports involvement.90 Also, being
active with friends at home or
in the neighborhood was more
strongly associated with higher

levels of physical activity than
was being active with friends at
school.90 Friends support for active commuting predicted biking
to school for children who lived
within a kilometer of school, but
not for children who lived farther
away,100 likely because of the importance of other factors, such as
age, distance, topography, safety,
and parenting styles, in selecting
modes of commuting.164,165 Another study showed that childrens
best friends were important for
their activity during winter but not
summer, perhaps indicating that
when the weather and daylight
hours are less conducive to physical activity, children are only active if their friends entice them.112
To effectively engage friends in
health intervention, it will be necessary to map out more clearly
under which circumstances they
can alter physical activity behaviors.
An important consideration is
whether friendship inuences are
important only among children
who already have a high propensity for active living. Findings suggest that this is not the case. Indeed, 3 studies found that the
relationship between friends support for physical activity or presence during physical activity and
respondents physical activity was
stronger in children at high risk for
physical inactivity, such as overweight children,47,48,65 children
who thought they were not good
at sports, and girls.47 Thus, the
children in most need of physical
activity may benet the most from
the involvement of friends.
Also important were friends
characteristics and the strength of
the relationship. One study highlighted that not all friendships
were equally inuential, with only
the physical activity of the best
friend signicantly predicting respondents physical activity.26 In
addition, a study distinguishing

reciprocal and nonreciprocal
friendships found stronger associations in the former, that is, in
relationships where a respondents
nominated friend also nominated
the respondent as a friend.26
Age may be another important
factor in the relevance of friends
for childrens physical activity.
The focus of research on friendship inuences has been on older
children, with only 1 (qualitative)
study examining the role of friends
in physical activity among
preschool-aged children. 151 Three
of the 4 studies that focused
on children aged 5 to 8 years
reported results consistent with
friendship inuences, as did 39 of
44 studies (89%) among children
aged 9 to 11 years, 45 of 53
studies (85%) among participants
aged 12 to 13 years, 44 of 54
studies (83%) of adolescents aged
14 to 15 years, and 25 of 29
studies (86%) of young adults
aged 18 to 19 years. Younger
children tend to be more heavily
inuenced in all aspects of wellbeing by family factors,166 although social inuences may
commence during the rst few
years of life.167,168 A priority for
future research is to begin to understand at what ages friends involvement and support become
important determinants of physical activity and how the process of
inuence begins.
Limitations
Because of the variation in indicators and study populations,
a meta-analysis of this body of
literature was not possible; the
large variability would have limited meta-analysis procedures to
small subsets of the studies. Our
review was limited to friendships
rather than broader social networks. This is because we expect,
in light of previous studies,24,28
SYSTEMATIC REVIEW
that the closer and stronger the

relationship between 2 individuals, the more possibilities for inuence. However, because schools
provide a captive audience for
interventions and a forum that can
be targeted by policy changes,
schools may present the most
practical avenue for interventions
that use social networks to improve health behavior. In addition,
previous physical activity interventions delivered in school settings have been shown to be successful and to change long-term
physical activity trajectories.169
Therefore, for future research and
applications, we can take friends
as an upper bound of possible
levels of social inuence, but it will
be important to consider how
other peers, especially within the
school context, can encourage
healthy behaviors such as promoting physical activity. Intervention experiments are already being
carried out to train school-based
peer advocates to disseminate information about and promote
healthy choices.170,171
Some weaknesses of this literature remain to be addressed by
future studies. Most studies relied
on cross-sectional data (n = 68
studies) and on respondents reports about their friends (n = 72),
approaches that are not suited to
studying inuence. Another notable weakness was the use of insufcient control variables and
statistical methods to understand
the nature of the associations: 20
studies only explored correlations
and bivariate associations,50,52,56,
58,61,63,64,70,72,77,79,81,82,85,86,93,
115,116,119,122
11 used only a limited

set of control variables,26,47,49,
62,65,66,95,96,107,120,123
and only 2
were intervention studies.88,111
Cross-sectional analyses accounting for no or only limited
confounding variables do not permit researchers to assert causality.
Such study designs also do not

make it possible to distinguish inuence from homophily; that is,
children may behave similarly
because they select friends who
are similar to them, in their interest in physical activity among
other traits, or they may behave
similarly to their friends because
they live in the same or a similar
environment (e.g., neighborhood
sidewalks or playgrounds may
entail similar physical activity patterns within communities). Thus,
signicant associations between
friends behaviors do not necessarily indicate inuence, but many
studies have not clearly addressed
or acknowledged this concern20
and have tended to overestimate
inuence.172---174 A large literature
addresses the difculty of distinguishing between inuence and
selection, and although there is
disagreement about the best
approach for disentangling
them,19,45,174---176 only 4 of the
studies we reviewed attempted to
use such methods to account for
homophily or to distinguish inuence from homophily.45,74,75,83
To advance our understanding of
the determinants of physical activity, future studies should strive
to disentangle the roles of selection, environmental factors, and
social inuences.
Our ndings provide evidence
consistent with the existence of
friendship inuences on childrens physical activity. Specically, the studies that attempted
to distinguish between homophily and inuence found that
indicators of inuence were more
strongly associated with physical
activity over time than were the
indicators of selection.74,75 Furthermore, the 13 longitudinal
studies reported signicant associations between indicators of
friendship inuences and physical activity, consistent with
friendship inuence.45,62,74,
75,80,83,84,86,87,91,97,109,124
Another concern is that reliance

on respondents reports about
their friends attitudes, beliefs, and
behaviors introduces the possibility of projection bias, or reecting
ones own attitudes and beliefs
onto friends, which would inate
observed associations between
respondents and friends. Previous
research has found that adolescents tend to misperceive their
friends behaviors in ways that are
partially mediated by their own
behaviors.177 However, all 11 articles that collected data directly
from respondents friends showed
signicant associations in some
models or population groups,26,45,
60,65,66,74,75,80,83,88,90
6 of them
in all models.45,60,65,66,74,75 A related weakness is that 55 studies
used subjective measures of respondents own physical activity.
These studies more often reported
evidence of a relationship between
respondents physical activity and
indicators about friends than did
studies that used objective measures. In fact, researchers who
used both subjective and objective
measures found the relationship
between indicators of friend inuences and objective physical
activity variables to be weaker
than the relationship with selfreported physical activity measures.96,102,103 For example,
Martn-Matillas et al. found that
friends physical activity was associated with all of the subjective
measures of physical activity but
with none of the objective measures.96 These patterns may occur
if children exaggerate similarity
with their friends to highlight that
they are socially connected or
engaged with their peers. It may
also be that direct measures, such
as accelerometers and pedometers, pick up all physical activity
and not just voluntary, conscious
activity, and respondents may

simply not be aware of the differences or may only anchor their
voluntary physical activity on their
friends.
It may be that some friends, for
example, those who are more
popular or older, can be more
important than other friends in
guiding behaviors. The studies in
our review did not explore this
possibility, but understanding
which friends are most likely to be
inuential will be an important
step for the development of
interventions.
Conclusions
The value of the ndings from
the studies in our review comes
in part from understanding the
social processes that guide health
behavior and in part from exploring the possible use of social networks to promote healthy behaviors. We found extensive research
about and fairly strong evidence
of associations between physical
activity and friends behaviors.
The use of friendships to promote
physical activity in experiments or
interventions remains largely unexplored: only 1 study attempted
to manipulate the inuence of
friends in a controlled experiment;
it found that children biked longer
and more intensely in the presence of a friend than in the presence of an unknown peer.66 Only
1 study explored the impact of
friends social support for physical
activity in an intervention; it concluded that support from friends
predicted change in physical activity over time.124 It may be that
some interventions have been
unsuccessful in manipulating
physical activity through friendships and that those results have
not been published. However,
ndings from observational studies suggest that friends have potential to affect physical activity
SYSTEMATIC REVIEW
and that friendships may offer

opportunities to promote the early
development of healthy physical
activity habits and preferences
that can translate into lifelong
habits.43 These opportunities are
worth exploring, because a recent
review of physical activity interventions found that most interventions until now have had only
small effects, amounting to an increase in activity of approximately
4 minutes per day.178
The challenge to incorporating
friendship inuences into health
interventions is that friendships
are complex. Can an intervention
create friendships? Can a health
professional identify who in a
friendship dyad is inuential and
who is inuenced or how mutual
inuence occurs? Can recommendations alter the type of information transmitted by friends in ways
that can overcome habits, tastes,
and social norms? If inuence
operates primarily through individuals perceptions of their
friends behaviors, can childrens
perceptions of their friends behaviors be altered or overcome?
To address these complexities,
several observational, experimental, and implementation steps, developed through multidisciplinary
collaborations, are needed. These
should include (1) data collection
efforts including both survey instruments and direct measurements of attitudes, beliefs, and
behaviors among sets of friends to
understand how, when, and to
what extent inuence occurs; (2)
longitudinal studies with data and
methods that permit at least some
causal inferences; and (3) experimental studies that test multiple
possible mechanisms of friendship
inuence over the short term (day,
week) and over the longer term
(months, years).
Our systematic review of the literature revealed strong evidence
that physical activity behaviors

are positively associated with encouragement and support for
physical activity from friends, with
friends physical activity patterns,
and with engagement with friends
in physical activity. We found
some indication that these associations may result from friends
inuencing each others behaviors,
although further research is needed
to understand the magnitude of
inuences and to explore the potential for using friendship to promote a lifetime of healthy physical
activity habits. j
About the Authors

Claire C. Maturo is with the Department of
Behavioral Science and Health Education
and Solveig A. Cunningham is with the
Hubert Department of Global Health and
Department of Sociology, Emory
University, Atlanta, GA.
Correspondence should be sent to Solveig
A. Cunningham, 1518 Clifton Rd, NE, Room
7045, Atlanta, GA 30322 (e-mail:
sargese@emory.edu). Reprints can be ordered
at http://www.ajph.org by clicking the
Reprints link.
This article was accepted March 25,
2013.
Contributors
C. C. Maturo conducted and documented
the literature searches. Both authors
evaluated studies and wrote the article.
Acknowledgments
This study was supported by the National
Institute of Diabetes and Digestive and
Kidney Diseases (grant R21DK081878).
We thank Elizabeth Vaquera and K.
M. Venkat Narayan for guidance and
comments and Melissa Matz for assistance
with searches.
Note. The content is solely the responsibility of the authors and does not
necessarily represent the ofcial views of
the National Institute of Diabetes and
Digestive and Kidney Diseases or the
National Institutes of Health.
Human Participant Protection

No protocol approved was required because the study had no human participants.
References
1. Luke A, Dugas LR, Durazo-Arvizu RA,
Cao G, Cooper RS. Assessing physical activity and its relationship to cardiovascular
risk factors: NHANES 2003---2006. BMC

Public Health. 2011;11(1):387.
2. Mekary RA, Feskanich D, Malspeis S,
Hu FB, Willett WC, Field AE. Physical
activity patterns and prevention of weight
gain in premenopausal women. Int J Obes
(Lond). 2009;33(9):1039---1047.
3. Kelishadi R, Razaghi E, Gouya M,
et al. Association of physical activity and
the metabolic syndrome in children and
adolescents: CASPIAN Study. Horm Res.
2007;67(1):46---52.
4. Ogden CL, Carroll MD, Curtin LR,
Lamb MM, Flegal KM. Prevalence of high
body mass index in US children and
adolescents, 2007---2008. JAMA. 2010;
303(3):242---249.
5. Pinhas-Hamiel O, Dolan LM, Daniels
SR, Standiford D, Khoury PR, Zeitler P.
Increased incidence of non-insulindependent diabetes mellitus among adolescents. J Pediatr. 1996;128(5 pt 1):
608---615.
6. Centers for Disease Control and
Prevention. National diabetes fact sheet:
national estimates and general information on diabetes and prediabetes in the
United States, 2011. Available at: http://
www.cdc.gov/diabetes/pubs/pdf/ndfs_
2011.pdf. Accessed 2011.
7. Duncan GE, Li SM, Zhou XH. Prevalence and trends of a metabolic syndrome phenotype among U.S. adolescents, 1999---2000. Diabetes Care. 2004;
27(10):2438---2443.
8. Eisenmann JC, Bartee RT, Wang
MQ. Physical activity, TV viewing, and
weight in U.S. youth: 1999 Youth Risk
Behavior Survey. Obes Res. 2002;10(5):
379---385.
9. Rowlands AV, Eston RG, Ingledew
DK. Relationship between activity levels,
aerobic tness, and body fat in 8- to 10yr-old children. J Appl Physiol. 1999;86
(4):1428---1435.
10. Adkins S, Sherwood NE, Story M,
Davis M. Physical activity among
African-American girls: the role of parents
and the home environment. Obes Res.
2004;12(suppl):38S---45S.
physical activity, national YRBS: 1991--2009. Available at: http://www.cdc.gov/

healthyyouth/yrbs/pdf/us_physical_
trend_yrbs.pdf. Accessed July 28, 2011.
15. Simons-Morton B, Chen RS. Over
time relationships between early adolescent and peer substance use. Addict
Behav. 2006;31(7):1211---1223.
16. Simons-Morton BG, Farhat T. Recent ndings on peer group inuences on
adolescent smoking. J Prim Prev. 2010;31
(4):191---208.
17. Romer D, Black M, Ricardo I, et al.
Social inuences on the sexual behavior
of youth at risk for HIV exposure. Am J
Public Health. 1994;84(6):977---985.
18. Eisenberg ME, Wall M, Shim JJ,
Bruening M, Loth K, Neumark-Sztainer D.
Associations between friends disordered
eating and muscle-enhancing behaviors.
Soc Sci Med. 2012;75(12):2242---2249.
19. Valente TW. Social Networks and
Health: Models, Methods, and Applications.
New York, NY: Oxford University Press;
2010.
20. Brechwald WA, Prinstein MJ. Beyond homophily: a decade of advances in
understanding peer inuence processes.
J Res Adolesc. 2011;21(1):166---179.
21. Duncan SC, Duncan TE, Strycker
LA. Risk and protective factors inuencing adolescent problem behavior: a multivariate latent growth curve analysis. Ann
Behav Med. 2000;22(2):103---109.
22. Lin N. Social Capital: A Theory of
Social Structure and Action. Cambridge,
UK: Cambridge University Press; 2001.
23. Berten H, Van Rossem R. Mechanisms of peer inuence among adolescents:
cohesion versus structural equivalence.
Sociol Perspect. 2011;54(2):183---204.
24. Urberg KA. Locus of peer inuence:
social crowd and best friend. J Youth
Adolesc. 1992;21(4):439---450.
25. Crosnoe R, Muller C. Body mass
index, academic achievement, and school
context: examining the educational experiences of adolescents at risk of obesity. J
Health Soc Behav. 2004;45(4):393---407.
11. Guthold R, Ono T, Strong K, Chatterji

S, Morabia A. Worldwide variability in
physical inactivity: a 51-country survey.
Am J Prev Med. 2008;34(6):486---494.
26. Schoeld L, Mummery WK,

Schoeld G, Hopkins W. The association
of objectively determined physical activity
behavior among adolescent female friends.
Res Q Exerc Sport. 2007;78(2):9---15.
12. Salmon J, Timperio A. Prevalence,

trends and environmental inuences on
child and youth physical activity. Med
Sport Sci. 2007;50:183---199.
27. Hallinan MT, Williams RA. Students

characteristics and the peer-inuence
process. Sociol Educ. 1990;63(2):122--132.

Prevention. Physical activity for everyone.
Available at: http://www.cdc.gov/
physicalactivity/everyone/guidelines/
children.html. Accessed July 28, 2011.
28. Wilkinson RB. Best friend attachment versus peer attachment in the prediction of adolescent psychological
adjustment. J Adolesc. 2010;33(5):709--717.

Prevention. Trends in the prevalence of
29. Adler PA, Adler P. Peer Power:

Preadolescent Culture and Identity. New
SYSTEMATIC REVIEW
Brunswick, NJ: Rutgers University Press;

1998.
30. Erwin P. Friendship in Childhood and
Adolescence. New York, NY: Routledge;
1998.
31. Berndt TJ. Friends inuence on
students adjustment to school. Educ Psychol. 1999;34(1):15---28.
32. Crosnoe R, Cavanagh S, Elder GH Jr.
Adolescent friendships as academic resources: the intersection of friendship,
race, and school disadvantage. Sociol
Perspect. 2003;46(3):331---352.
33. Carbonaro WJ. A little help from my
friends parents: intergenerational closure
and educational outcomes. Sociol Educ.
1998;71(4):295---313.
34. Crosnoe R. Friendships in childhood
and adolescence: the life course and new
directions. Soc Psychol Q. 2000;63
(4):377---391.
35. Berndt TJ. Friendship quality and
social development. Curr Dir Psychol Sci.
2002;11(1):7---10.
36. Billy JOG, Udry JR. Patterns of
adolescent friendship and effects on sexual behavior. Soc Psychol Q. 1985;48:
27---41.
37. Giordano PC, Cernkovich SA, Pugh
MD. Friendships and delinquency. Am J
Sociol. 1986;91:1170---1202.
38. Kandel DB. Homophily, selection,
and socialization in adolescent friendships. Am J Sociol. 1978;84:427---436.
39. Antonio AL. The inuence of
friendship groups on intellectual selfcondence and educational aspirations in
college. J Higher Educ. 2004;75(4):446--471.
40. Crosnoe R. High school curriculum
track and adolescent association with delinquent friends. J Adolesc Res. 2002;17
(2):143---167.
41. Vaquera E, Kao G. Do you like me
as much as I like you? Friendship reciprocity and its effects on school outcomes
among adolescents. Soc Sci Res. 2008;37
(1):55---72.
42. Kao G, Vaquera E. The salience of
racial and ethnic identication in friendship choices among Hispanic adolescents.
Hisp J Behav Sci. 2006;28(1):23---47.
43. Barnekow-Bergkvist M, Hedberg G,
Janlert U, Jansson E. Physical activity
pattern in men and women at the ages of
16 and 34 and development of physical
activity from adolescence to adulthood.
Scand J Med Sci Sports. 1996;6(6):359--370.
44. Troiano RP, Berrigan D, Dodd KW,
Masse LC, Tilert T, Mcdowell M. Physical
activity in the United States measured
by accelerometer. Med Sci Sports Exerc.
2008;40(1):181---188.
45. Ali MM, Amialchuk A, Heiland FW.

Weight-related behavior among adolescents: the role of peer effects. PLoS One.
2011;6(6):e21179.
46. Bergh IH, Grydeland M, Bjelland M,
et al. Personal and social-environmental
correlates of objectively measured physical activity in Norwegian pre-adolescent
children. Scand J Med Sci Sports. 2011;21
(6):e315---e324.
47. Davison KK, Schmalz DL. Youth at
risk of physical inactivity may benet
more from activity-related support than
youth not at risk. Int J Behav Nutr Phys Act.
2006;3:5.
48. De Bourdeaudhuij I, Lefevre J,
Deforche B, Wijndaele K, Matton L,
Philippaerts R. Physical activity and psychosocial correlates in normal weight and
overweight 11 to 19 year olds. Obes Res.
2005;13(6):1097---1105.
LA. Sources and types of social support in
youth physical activity. Health Psychol.
2005;24(1):3---10.
50. Finnerty T, Reeves S, Dabinett J,
Jeanes YM, Vgele C. Effects of peer
inuence on dietary intake and physical
activity in schoolchildren. Public Health
Nutr. 2010;13(3):376---383.
examination of school programs, policies

and resources associated with physical
activity among elementary school youth
in the PLAY-ON study. Int J Behav Nutr
Phys Act. 2010;7(1):6.
58. Loucaides CA. School location and
gender differences in personal, social,
and environmental correlates of physical
activity in Cypriot middle school children. J Phys Act Health. 2009;6(6):722--730.
59. Loucaides CA, Plotnikoff RC,
Bercovitz K. Differences in the correlates
of physical activity between urban and
rural Canadian youth. J Sch Health. 2007;
77(4):164---170.
60. Macdonald-Wallis K, Jago R, Page A,
Brockman R, Thompson JL. School-based
friendship networks and childrens physical activity: a spatial-analytical approach.
Soc Sci Med. 2011;73(1):6---12.
61. McDermott RJ, Nickelson J, Baldwin
JA, et al. A community-school districtuniversity partnership for assessing physical activity of tweens. Prev Chronic Dis.
2009;6(1):A15.
62. Raudsepp L, Viira R. Changes in
physical activity in adolescent girls: a latent growth modelling approach. Acta
Paediatr. 2008;97(5):647---652.
51. Heitzler CD, Lytle LA, Erickson DJ,

Barr-Anderson D, Sirard JR, Story M.
Evaluating a model of youth physical
activity. Am J Health Behav. 2010;34(5):
593---606.
63. Roesch SC, Norman GJ, Adams MA,

et al. Latent growth curve modeling of
adolescent physical activity: testing parallel process and mediation models. J
Health Psychol. 2009;14(2):313---325.
52. Huang YJ, Wong SH, Salmon J, Hui

SS. Reliability and validity of psychosocial
and environmental correlates measures of
physical activity and screen-based behaviors among Chinese children in Hong Kong.
Int J Behav Nutr Phys Act. 2011;8:16.
64. Sabiston CM, Crocker PR. Exploring

self-perceptions and social inuences
as correlates of adolescent leisure-time
physical activity. J Sport Exerc Psychol.
2008;30(1):3---22.
53. Ievers-Landis CE, Burant C, Drotar

D, Morgan L, Trapl ES, Kwoh CK. Social
support, knowledge, and self-efcacy as
correlates of osteoporosis preventive behaviors among preadolescent females.
J Pediatr Psychol. 2003;28(5):335---345.
54. Johnson KE, Kubik MY, McMorris
BJ. Prevalence and social-environmental
correlates of sports team participation
among alternative high school students.
J Phys Act Health. 2011;8(5):606---612.
55. Ommundsen Y, Klasson-Heggeb L,
Anderssen SA. Psycho-social and environmental correlates of location-specic
physical activity among 9- and 15-yearold Norwegian boys and girls: the European Youth Heart Study. Int J Behav Nutr
Phys Act. 2006;3:32.
56. King KA, Tergerson JL, Wilson BR.
Effect of social support on adolescents
perceptions of and engagement in physical activity. J Phys Act Health. 2008;5(3):
374---384.
57. Leatherdale ST, Manske S, Faulkner
G, Arbour K, Bredin C. A multi-level
65. Salvy SJ, Bowker JW, Roemmich JN,

et al. Peer inuence on childrens physical
activity: an experience sampling study.
J Pediatr Psychol. 2008;33(1):39---49.
66. Salvy SJ, Roemmich JN, Bowker JC,
Romero ND, Stadler PJ, Epstein LH. Effect
of peers and friends on youth physical
activity and motivation to be physically
active. J Pediatr Psychol. 2009;34(2):
217---225.
67. Saxena R, Borzekowski DL, Rickert
VI. Physical activity levels among urban
adolescent females. J Pediatr Adolesc
Gynecol. 2002;15(5):279---284.
68. Seabra AF, Mendonca DM, Thomis
MA, Peters TJ, Maia JA. Associations
between sport participation, demographic
and socio-cultural factors in Portuguese
children and adolescents. Eur J Public
Health. 2008;18(1):25---30.
69. Sharma SV, Hoelscher DM, Kelder
SH, Day RS, Hergenroeder A. Psychosocial, environmental and behavioral factors
associated with bone health in middleschool girls. Health Educ Res. 2009;24
(2):173---184.
70. Sharma SV, Hoelscher DM, Kelder

SH, Diamond PM, Day RS, Hergenroeder
AC. A path analysis to identify the psychosocial factors inuencing physical activity and bone health in middle-school
girls. J Phys Act Health. 2009;6(5):606--616.
71. Springer AE, Kelder SH, Hoelscher
DM. Social support, physical activity and
sedentary behavior among 6th-grade
girls: a cross-sectional study. Int J Behav
Nutr Phys Act. 2006;3:8.
72. Wu SY, Pender N, Noureddine S.
Gender differences in the psychosocial
and cognitive correlates of physical activity among Taiwanese adolescents: a
structural equation modeling approach.
Int J Behav Med. 2003;10(2):93---105.
73. Leggett C, Irwin M, Grifth J, Xue L,
Fradette K. Factors associated with physical activity among Canadian high school
students. Int J Public Health. 2012;57(2):
315---324.
74. Gesell SB, Tesdahl E, Ruchman E.
The distribution of physical activity in an
after-school friendship network. Pediatrics. 2012;129(6):1064---1071.
75. de la Haye K, Robins G, Mohr P,
Wilson C. How physical activity shapes,
and is shaped by, adolescent friendships.
Soc Sci Med. 2011;73(5):719---728.
76. Seabra AF, Mendonca DM, Thomis
MA, Malina RM, Maia JA. Correlates of
physical activity in Portuguese adolescents from 10 to 18 years. Scand J Med
Sci Sports. 2011;21(2):318---323.
77. Plotnikoff RC, Bercovitz K, Rhodes
RE, Loucaides CA, Karunamuni N. Testing a conceptual model related to weight
perceptions, physical activity and smoking
in adolescents. Health Educ Res. 2007;22
(2):192---202.
78. Zhang T, Solmon MA, Gao Z, Kosma
M. Promoting school students physical
activity: a social ecological perspective. J
Appl Sport Psychol. 2012;24(1):92---105.
79. Ha A, Abbott R, Macdonald D, Pang
B. Comparison of perceived support for
physical activity and physical activity related practices of children and young
adolescents in Hong Kong and Australia.
Eur Phys Educ Rev. 2009;15(2):155---173.
80. Denault A-S, Poulin F. Predictors of
adolescent participation in organized activities: a ve-year longitudinal study. J
Res Adolesc. 2009;19(2):287---311.
81. Luszczynska A, Gibbons FX, Piko
BF, Tekozel M. Self-regulatory cognitions,
social comparison, and perceived peers
behaviors as predictors of nutrition and
physical activity: a comparison among
adolescents in Hungary, Poland, Turkey,
and USA. Psychol Health. 2004;19
(5):577---593.
82. Wu TY, Pender N. Determinants
of physical activity among Taiwanese
SYSTEMATIC REVIEW
adolescents: an application of the health

promotion model. Res Nurs Health.
2002;25(1):25---36.
their relatives physical activitythe

AVENA study. J Sports Sci. 2011;29(4):
329---336.
83. Bramoull Y, Djebbari H, Fortin B.

Identication of peer effects through social networks. J Econom. 2009;150(1):
41---55.
96. Martn-Matillas M, Ortega FB, Ruiz

JR, et al. Adolescents physical activity
levels and relatives physical activity engagement and encouragement: the HELENA study. Eur J Public Health. 2011;21
(6):705---712.
84. Viira R, Raudsepp L. Psychosocial

correlates of physical activity among
seven through eight grades. J Hum Mov
Stud. 2003;44(6):501---577.
85. Jago R, Fox KR, Page AS, Brockman
R, Thompson JL. Development of scales
to assess childrens perceptions of friend
and parental inuences on physical activity. Int J Behav Nutr Phys Act. 2009;
6:67.
86. Coppinger T, Jeanes YM, Dabinett J,
Vogele C, Reeves S. Physical activity and
dietary intake of children aged 9---11
years and the inuence of peers on these
behaviours: a 1-year follow-up. Eur J Clin
Nutr. 2010;64(8):776---781.
LA, Chaumeton NR. A cohort-sequential
latent growth model of physical activity
from ages 12 to 17 years. Ann Behav Med.
2007;33(1):80---89.
Wilson C. Obesity-related behaviors in
adolescent friendship networks. Soc Networks. 2010;32(3):161---167.
89. Fermino RC, Rech CR, Hino AA,
Rodriguez Anez CR, Reis RS. Physical
activity and associated factors in highschool adolescents in Southern Brazil. Rev
Saude Publica. 2010;44(6):986---995.
90. Jago R, Macdonald-Wallis K,
Thompson JL, Page AS, Brockman R, Fox
KR. Better with a buddy: inuence of best
friends on childrens physical activity.
Med Sci Sports Exerc. 2011;43(2):259--265.
91. Jago R, Page AS, Cooper AR. Friends
and physical activity during the transition
from primary to secondary school. Med
Sci Sports Exerc. 2012;44(1):111---117.
92. Kelly EB, Parra-Medina D, Pfeiffer
KA, et al. Correlates of physical activity in
Black, Hispanic, and White middle school
girls. J Phys Act Health. 2010;7(2):184--193.
97. Kahn JA, Huang B, Gillman MW,

et al. Patterns and determinants of physical activity in U.S. adolescents. J Adolesc
Health. 2008;42(4):369---377.
98. Page RM, Ihasz F, Simonek J, Klarova
R, Hantiu I. Friendships and physical
activity: investigating the connection in
Central-Eastern European adolescents.
Int J Adolesc Med Health. 2007;19(2):
187---198.
99. Page RM, Taylor J, Suwanteerangkul
J, Novilla LM. The inuence of friendships
and friendship-making ability in physical
activity participation in Chiang Mai,
Thailand high school students. Int Electron J Health Educ. 2005;8:95---103.
100. Panter JR, Jones AP, van Sluijs EM,
Grifn SJ. Attitudes, social support and
environmental perceptions as predictors
of active commuting behaviour in school
children. J Epidemiol Community Health.
2010;64(1):41---48.
101. Price SM, McDivitt J, Weber D,
Wolff LS, Massett HA, Fulton JE. Correlates of weight-bearing physical activity
among adolescent girls: results from a national survey of girls and their parents. J
Phys Act Health. 2008;5(1):132---145.
102. Prochaska JJ, Rodgers MW, Sallis JF.
Association of parent and peer support
with adolescent physical activity. Res Q
Exerc Sport. 2002;73(2):206---210.
103. Sallis JF, Taylor WC, Dowda M,
Freedson PS, Pate RR. Correlates of vigorous physical activity for children in
grades 1 through 12: comparing parentreported and objectively measured physical activity. Pediatr Exerc Sci. 2002;14
(1):30---44.
104. Stanford JN, McCabe MP. Sociocultural inuences on adolescent boys body
image and body change strategies. Body
Image. 2005;2(2):105---113.
93. Keresztes N, Piko BF, Pluhar ZF,

Page RM. Social inuences in sports activity among adolescents. J R Soc Promot
Health. 2008;128(1):21---25.
105. Voorhees CC, Murray D, Welk G,

et al. The role of peer social network
factors and physical activity in adolescent
girls. Am J Health Behav. 2005;29
(2):183---190.
94. Leslie E, Kremer P, Toumbourou

JW, Williams JW. Gender differences in
personal, social and environmental inuences on active travel to and from school
for Australian adolescents. J Sci Med
Sport. 2010;13(6):597---601.
106. Patnode CD, Lytle LA, Erickson DJ,

Sirard JR, Barr-Anderson D, Story M. The
relative inuence of demographic, individual, social, and environmental factors
on physical activity among boys and girls.
Int J Behav Nutr Phys Act. 2010;7:79.
95. Martn-Matillas M, Ortega FB,

Chillon P, et al. Physical activity among
Spanish adolescents: relationship with
107. Wenthe PJ, Janz KF, Levy SM.

Gender similarities and differences in
factors associated with adolescent
moderate-vigorous physical activity.

Pediatr Exerc Sci. 2009;21(3):291---304.
108. Wilson AN, Dollman J. Social inuences on physical activity in Anglo- and
Vietnamese-Australian adolescent males
in a single sex school. J Sci Med Sport.
2007;10(3):147---155.
109. Kirby J, Levin K, Inchley J. Parental
and peer inuences on physical activity
among Scottish adolescents: a longitudinal study. J Phys Act Health. 2011;8
(6):785---793.
110. Hohepa M, Scragg R, Schoeld G,
Kolt GS, Schaaf D. Social support for
youth physical activity: importance of
siblings, parents, friends and school support across a segmented school day. Int J
Behav Nutr Phys Act. 2007;4:54.
111. Lytle LA, Murray DM, Evenson KR,
et al. Mediators affecting girls levels of
physical activity outside of school: ndings from the trial of activity in adolescent
girls. Ann Behav Med. 2009;38(2):124--136.
112. Loucaides C, Chedzoy S, Bennett N,
Walshe K. Correlates of physical activity
in a Cypriot sample of sixth-grade children. Pediatr Exerc Sci. 2004;16(1):25--36.
113. Lemstra M, Rogers M, Thompson A,
Moraros J. Physical activity in youth:
prevalence, risk indicators, and solutions
[published correction appears in Can Fam
Physician. 2012;58(5):516]. Can Fam
Physician. 2012;58(1):e54---e61.
114. Anderson CB, Masse LC,
Hergenroeder AC. Factorial and construct
validity of the athletic identity questionnaire for adolescents. Med Sci Sports
Exerc. 2007;39(1):59---69.
115. Anderson CB, Masse LC, Zhang H,
Coleman KJ, Chang S. Contribution of
athletic identity to child and adolescent
physical activity. Am J Prev Med. 2009;37
(3):220---226.
116. Gilmer MJ, Harrell JS, Miles MS,
Hepworth JT. Youth characteristics and
contextual variables inuencing physical
activity in young adolescents of parents
with premature coronary heart disease.
J Pediatr Nurs. 2003;18(3):159---168.
117. Hamilton K, White KM. Extending
the theory of planned behavior: the role
of self and social inuences in predicting
adolescent regular moderate-to-vigorous
physical activity. J Sport Exerc Psychol.
2008;30(1):56---74.
body mass index and psychosocial factors

on physical activity in underserved adolescent boys and girls. Health Psychol.
2010;29(5):506---513.
120. Lubans DR, Morgan PJ. Social, psychological and behavioural correlates of
pedometer step counts in a sample of
Australian adolescents. J Sci Med Sport.
2009;12(1):141---147.
121. Ries AV, Yan AF, Voorhees CC. The
neighborhood recreational environment
and physical activity among urban youth:
an examination of public and private
recreational facilities. J Community Health.
2011;36(4):640---649.
122. Taymoori P, Rhodes RE, Berry TR.
Application of a social cognitive model
in explaining physical activity in Iranian
female adolescents. Health Educ Res.
2010;25(2):257---267.
123. Wilson AN, Dollman J. Social inuences on physical activity in AngloAustralian and Vietnamese-Australian
adolescent females in a single sex school.
J Sci Med Sport. 2009;12(1):119---122.
124. Dunton GF, Schneider M, Cooper
DM. Factors predicting behavioral response to a physical activity intervention
among adolescent females. Am J Health
Behav. 2007;31(4):411---422.
125. Sallis JF, Grossman RM, Pinski RB,
Patterson TL, Nader PR. The development of scales to measure social support
for diet and exercise behaviors. Prev Med.
1987;16(6):825---836.
126. World Health Organization. Global
strategy on diet, physical activity and
health. What is moderate-intensity and
vigorous-intensity physical activity?
2013. Available at: http://www.who.int/
dietphysicalactivity/physical_activity_
intensity/en/index.html. Accessed May 1,
2012.
127. Allison KR, Dwyer JJ, Goldenberg E,
Fein A, Yoshida KK, Boutilier M. Male
adolescents reasons for participating in
physical activity, barriers to participation,
and suggestions for increasing participation.
Adolescence. 2005;40(157):155---170.
128. Casey MM, Eime RM, Payne WR,
Harvey JT. Using a socioecological approach to examine participation in sport
and physical activity among rural adolescent girls. Qual Health Res. 2009;19
(7):881---893.
129. Coleman L, Cox L, Roker D. Girls
and young womens participation in
physical activity: psychological and social
inuences. Health Educ Res. 2008;23(4):
633---647.
118. Hsu YW, Chou CP, NguyenRodriguez ST, McClain AD, Belcher BR,
Spruijt-Metz D. Inuences of social support, perceived barriers, and negative
meanings of physical activity on physical
activity in middle school students. J Phys
Act Health. 2011;8(2):210---219.
130. Hohepa M, Schoeld G, Kolt GS.

Physical activity: what do high school
students think? J Adolesc Health. 2006;39
(3):328---336.
119. Kitzman-Ulrich H, Wilson DK, Van

Horn ML, Lawman HG. Relationship of
131. Humbert ML, Chad KE, Bruner

MW, et al. Using a naturalistic ecological
SYSTEMATIC REVIEW
approach to examine the factors inuencing youth physical activity across

grades 7 to 12. Health Educ Behav.
2008;35(2):158---173.
132. Humbert ML, Chad KE, Spink KS,
et al. Factors that inuence physical activity participation among high- and lowSES youth. Qual Health Res. 2006;16(4):
467---483.
133. Jago R, Brockman R, Fox KR,
Cartwright K, Page AS, Thompson JL.
Friendship groups and physical activity:
qualitative ndings on how physical activity is initiated and maintained among
10---11 year old children. Int J Behav Nutr
Phys Act. 2009;6:4.
134. Loman DG. Promoting physical activity in teen girls: insight from focus
groups. MCN Am J Matern Child Nurs.
2008;33(5):294---299, quiz 300---301.
135. Moore JB, Jilcott SB, Shores KA,
Evenson KR, Brownson RC, Novick LF. A
qualitative examination of perceived barriers and facilitators of physical activity
for urban and rural youth. Health Educ
Res. 2010;25(2):355---367.
136. Pescud M, Pettigrew S, McGuigan
MR, Newton RU. Factors inuencing
overweight childrens commencement of
and continuation in a resistance training
program. BMC Public Health. 2010;10:709.
137. Vu MB, Murrie D, Gonzalez V, Jobe
JB. Listening to girls and boys talk about
girls physical activity behaviors. Health
Educ Behav. 2006;33(1):81---96.
138. Wilson DK, Williams J, Evans A,
Mixon G, Rheaume C. Brief report: a
qualitative study of gender preferences
and motivational factors for physical activity in underserved adolescents. J
Pediatr Psychol. 2005;30(3):293---297.
139. Walia S, Leipert B. Perceived facilitators and barriers to physical activity for
rural youth: an exploratory study using
photovoice. Rural Remote Health. 2012;
12:1842.
140. Beets MW, Banda JA, Erwin HE,
Beighle A. A pictorial view of the physical
activity socialization of young adolescents
outside of school. Res Q Exerc Sport.
2011;82(4):769---778.
141. Rhoades DR, Kridli SA, Penprase B.
Understanding overweight adolescents
beliefs using the theory of planned behaviour. Int J Nurs Pract. 2011;17(6):
562---570.
142. Peeters C, Marchand H, Tulloch H,
et al. Perceived facilitators, barriers, and
changes in a randomized exercise trial for
obese youth. J Phys Act Health. 2012;9
(5):650---660.
143. Stanley RM, Boshoff K, Dollman J.
A qualitative exploration of the critical
window: factors affecting Australian
childrens after-school physical activity. J
Phys Act Health. 2013;10(1):33---41.
144. Knowles AM, Niven A, Fawkner S. A

qualitative examination of factors related
to the decrease in physical activity behavior in adolescent girls during the
transition from primary to secondary
school. J Phys Act Health. 2011;8(8):
1084---1091.
145. Brophy S, Crowley A, Mistry R, et al.
Recommendations to improve physical
activity among teenagersa qualitative
study with ethnic minority and European
teenagers. BMC Public Health. 2011;11:
412.
146. Stanley RM, Boshoff K, Dollman J.
Voices in the playground: a qualitative
exploration of the barriers and facilitators
of lunchtime play. J Sci Med Sport. 2012;
15(1):44---51.
147. Dwyer JJ, Allison KR, Goldenberg
ER, Fein AJ, Yoshida KK, Boutilier MA.
Adolescent girls perceived barriers to
participation in physical activity. Adolescence. 2006;41(161):75---89.
148. Eime RM, Payne WR, Casey MM,
Harvey JT. Transition in participation in
sport and unstructured physical activity
for rural living adolescent girls. Health
Educ Res. 2010;25(2):282---293.
their weight? An interview study examining sociocultural pressures to be thin.

J Psychosom Res. 1997;42(4):345---355.
for 6th graders: feasibility and results of

a pilot study. J Phys Act Health. 2012;9
(4):492---499.
158. Clemens H, Thombs D, Olds RS,

Gordon KL. Normative beliefs as risk
factors for involvement in unhealthy
weight control behavior. J Am Coll Health.
2008;56(6):635---641.
171. Cui Z, Shah S, Yan L, et al. Effect of

a school-based peer education intervention on physical activity and sedentary
behaviour in Chinese adolescents: a pilot
study. BMJ Open. 2012;2(3):e000721.
159. Eisenberg ME, Neumark-Sztainer D,

Story M, Perry C. The role of social norms
and friends inuences on unhealthy
weight-control behaviors among adolescent girls. Soc Sci Med. 2005;60(6):
1165---1173.
172. Bauman KE, Ennett ST. On the

importance of peer inuence for adolescent drug use: commonly neglected considerations. Addiction. 1996;91(2):185--198.
160. Ball K, Crawford D. An investigation

of psychological, social and environmental correlates of obesity and weight gain
in young women. Int J Obes (Lond).
2006;30(8):1240---1249.
161. Doyle EI, Feldman RH. Factors
affecting nutrition behavior among
middle-class adolescents in urban area
of Northern region of Brazil. Rev Saude
Publica. 1997;31(4):342---350.
162. Salvy SJ, Howard M, Read M, Mele
E. The presence of friends increases food
intake in youth. Am J Clin Nutr. 2009;90
(2):282---287.
149. Thompson JL, Davis SM, Gittelsohn

J, et al. Patterns of physical activity among
American Indian children: an assessment
of barriers and support. J Community
Health. 2001;26(6):423---445.
163. Wing RR, Jeffery RW. Benets of

recruiting participants with friends and
increasing social support for weight loss
and maintenance. J Consult Clin Psychol.
1999;67(1):132---138.
150. Yungblut HE, Schinke RJ, McGannon

KR. Views of adolescent female youth on
physical activity during early adolescence.
J Sports Sci Med. 2012;2012(11):39---50.
164. Duke NN, Borowsky IW, Pettingell

SL. Parent perceptions of neighborhood:
relationships with US youth physical activity and weight status. Matern Child
Health J. 2012;16(1):149---157.
151. Hinkley T, Salmon J, Okely AD,

Crawford D, Hesketh K. Inuences on
preschool childrens physical activity: exploration through focus groups. Fam
Community Health. 2011;34(1):39---50.
165. Timperio A, Ball K, Salmon J, et al.

Personal, family, social, and environmental
correlates of active commuting to school.
Am J Prev Med. 2006;30(1):45---51.
152. Spear BA, Barlow SE, Ervin C, et al.

Recommendations for treatment of child
and adolescent overweight and obesity.
Pediatrics. 2007;120(suppl 4):S254--S288.
166. Birch LL, Davison KK. Family environmental factors inuencing the developing behavioral controls of food intake
and childhood overweight. Pediatr Clin
North Am. 2001;48(4):893---907.
153. Busse P, Fishbein M, Bleakley A,

Hennessy M. The role of communication
with friends in sexual initiation. Communic
Res. 2010;37(2):239---255.
167. Illingworth RS, Lister J. The critical

or sensitive period, with special reference
to certain feeding problems in infants
and children. J Pediatr. 1964;65(6):839--848.
154. Chiodo J, Latimer PR. Vomiting as a

learned weight-control technique in bulimia. J Behav Ther Exp Psychiatry. 1983;
14(2):131---135.
155. Wardle J, Watters R. Sociocultural
inuences on attitudes to weight and
eating: results of a natural experiment. Int
J Eat Disord. 2004;35(4):589---596.
156. Page RM, Suwanteerangkul J. Dieting among Thai adolescents: having
friends who diet and pressure to diet. Eat
Weight Disord. 2007;12(3):114---124.
157. Wertheim EH, Paxton SJ, Schutz HK,
Muir SL. Why do adolescent girls watch
173. Kobus K. Peers and adolescent

smoking. Addiction. 2003;98(suppl 1):
37---55.
174. Mercken L, Candel M, Willems P,
de Vries H. Disentangling social selection
and social inuence effects on adolescent
smoking: the importance of reciprocity
in friendships. Addiction. 2007;102(9):
1483---1492.
175. Noel H, Nyhan B. The unfriending
problem: the consequences of homophily
in friendship retention for causal estimates of social inuence. Soc Networks.
2011;33(3):211---218.
Wilson C. Homophily and contagion as
explanations for weight similarities among
adolescent friends. J Adolesc Health.
2011;49(4):421---427.
177. Prinstein MJ, Wang SS. False consensus and adolescent peer contagion:
examining discrepancies between perceptions and actual reported levels of
friends deviant and health risk behaviors.
J Abnorm Child Psychol. 2005;33(3):
293---306.
178. Metcalf B, Henley W, Wilkin T.
Effectiveness of intervention on physical
activity of children: systematic review and
meta-analysis of controlled trials with
objectively measured outcomes (EarlyBird 54). BMJ 2012;345:e5888.
168. Lucas A. Programming by early

nutrition: an experimental approach. J
Nutr. 1998;128(2 suppl):401S---406S.
169. Dobbins M, De Corby K, Robeson P,
Husson H, Tirilis D. School-based physical activity programs for promoting
physical activity and tness in children
and adolescents aged 6---18. Cochrane
Database Syst Rev. 2009(1):CD007651.
170. Barr-Anderson DJ, Laska MN,
Veblen-Mortenson S, Farbakhsh K,
Dudovitz B, Story M. A school-based, peer
leadership physical activity intervention
Copyright of American Journal of Public Health is the property of American Public Health Association and its
content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's
express written permission. However, users may print, download, or email articles for individual use.

Content Servger

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Content Servger

Uploaded by

Copyright:

Available Formats

SYSTEMATIC REVIEW

Influence of Friends on Childrens Physical Activity:

Claire C. Maturo, MPH, and Solveig A. Cunningham, PhD

EXTENSIVE RESEARCH HAS

stronger the possibilities for inuence.21,22 Information transmitted

physical activity is critical for understanding why physical activity

Maturo and Cunningham | Peer Reviewed | Systematic Review | e1

2424 in PubMed, 79 in Sociological Abstracts, and 58 in EconLit.

Data Collection and Analysis

We used a data extraction

and compare across studies. We

Records identified through

and whether information on

Additional records identified

Records after duplicates removed

Full-text articles assessed

of primary or secondary data, (4)

Full-text articles excluded

e2 | Systematic Review | Peer Reviewed | Maturo and Cunningham

Friends support for PAa

Friends support for PAa

Friends support for PAa

Friends support for PAa

Friends support for PAa

Friends support for PAa

Friends support for PA

Friends support for PAa

Friends support for PAa

Friends support for PA

Friends support for PAa

Friends support for PA

Raudsepp and Viira62

MVPA on weekend, follow-up

MVPA after school, follow-up

Participates in active games

Active commute to school

Active travel to/from school

De Bourdeaudhuij et al.48 Overall PA

Friends support for PAa

Friends support for PAa

Friends support for PA

Lubans and Morgan120

Friends support for PAa

Davison and Schmalz

Friends support for PAa

Friends support for PA

Friends support for PA

Friends support for PA

Friends support for PAa

Hamilton and White117

Friends support for PAa

Friends support for PA

Friends support for PAa

Friends support for PAa

Friends support for PA

Friends support for PA

Friends support for PA

Friends support for PA

Friends support for PAa

Friends communication about PA

Friend Influence Indicator

TABLE 1Summary of Studies of Friends Influences on Childrens Physical Activity, 20002012

Maturo and Cunningham | Peer Reviewed | Systematic Review | e3

e4 | Systematic Review | Peer Reviewed | Maturo and Cunningham