Socioeconomic inequalities in adolescent mental wellbeing in China—a longitudinal path analysis of sport opportunities, exercise self-efficacy, and physical activity

Abstract

Mental wellbeing among adolescents in China is of increasing concern. However, previous studies have shown that adolescents from lower socioeconomic backgrounds have fewer opportunities to participate in sport, develop exercise self-efficacy, be physically active, and maintain good mental wellbeing. The temporal trajectories of these variables have not been tested in previous studies. This study aimed to determine whether school- and community-based sport opportunities, exercise self-efficacy, and physical activity mediate the relationship between socioeconomic status and adolescents’ mental wellbeing in China. Data from three waves of adolescents were used to perform an observed-variable path analysis in R with the lavaan package. At Time 1, 328 adolescents were observed. At Time 2, 294 adolescents were followed to assess variables related to school- and community-based sport opportunities, exercise self-efficacy, and physical activity. At Time 3, 240 adolescents were assessed for their mental wellbeing. Analyses used full-information maximum likelihood methods to handle missing data and 1,000 bootstrap draws to assess the indirect effects of the variables of interest. Because the Time 2 variables were measured concurrently, their hypothesised ordering is theoretical rather than observed, and only the Time 1 to Time 2 to Time 3 structure is longitudinally ordered. Adolescents of higher socioeconomic status had greater opportunities to participate in sport within their schools (0.443, p < 0.001) and within their communities (0.457, p < 0.001). Greater opportunities to participate in school and community sports were associated with higher levels of exercise self-efficacy (0.327, p < 0.001, 0.339, p < 0.001). Higher levels of exercise self-efficacy were associated with greater physical activity (0.354, p < 0.001). Higher levels of physical activity were associated with higher mental wellbeing later in adolescence (0.536, p < 0.001). Furthermore, the indirect effects of socioeconomic status on mental wellbeing were significant via both the school-based sport pathway (0.029, 95% CI [0.014, 0.050]) and the community-based sport pathway (0.031, 95% CI [0.016, 0.053]), yielding a total indirect effect of 0.061 (95% CI [0.033, 0.096]). Finally, these variables accounted for 76.9% of the variance in mental wellbeing among adolescents at Time 3. These findings are consistent with the proposition that higher socioeconomic status is associated with greater opportunities to participate in school and community sports, higher levels of exercise self-efficacy, higher rates of physical activity, and better later mental wellbeing. Because the design was observational and the Time 2 mediators were measured concurrently, these findings identify potentially modifiable correlates and plausible intervention targets rather than demonstrated causal mechanisms. With this caveat, policies that aim to increase sport opportunities in schools and communities, improve the accessibility of community sport, and strengthen adolescents’ confidence in engaging in physical activity—particularly for adolescents of lower socioeconomic status or those living in rural communities—may merit consideration.