Urban context, socioeconomic status, and adolescent physical activity: qualitative findings from Madrid and Bilbao
e202604020
Keywords:
Social inequalities, Socioeconomic factors, Physical activity, Urban context, Qualitative research, AdolescenceAbstract
BACKGROUND // Urban and social environments strongly shape adolescents’ opportunities to engage in physical activity, with inequalities in socioeconomic status, infrastructure and neighbourhood conditions creating uneven access. This study explored the determinants underlying unequal participation in physical activity among adolescents in Madrid and Bilbao.
METHODS // A constructivist qualitative case study informed by grounded theory was conducted in secondary schools in Madrid and Bilbao between February 2022 and April 2024. Schools were selected from neighbourhoods with differing socioeconomic profiles. Fieldwork included thirty six semi structured interviews and twenty-four focus groups, analysed through open, axial and selective coding supported by Atlas.ti.
RESULTS // Four major thematic categories were identified: 1) Household socioeconomic conditions as a determinant of physical activity; 2) The role of the educational community in shaping physical activity engagement; 3) Perceived insecurity, the appropriation of public space and gender; 4) Urban realities and their influence on physical activity practices. Distinct patterns emerged between Madrid and Bilbao, linked to urban structure, the use of sports facilities, and accessibility.
CONCLUSIONS // Economic, spatial and social inequalities limit equitable access to physical activity. The findings underscore the need for context sensitive policies that integrate socioeconomic and urban factors and strengthen the role of schools in reducing adolescent health inequalities.
Downloads
References
1. Franco Gallegos LI, Aguirre Chávez JF, Ponce de León AC, Robles Hernández GSI, Montes Mata KJ. Intersecciones entre la salud mental y la actividad física: revisión de beneficios y mecanismos neurofisiológicos. Rev Cient Salud Desarro Hum. 2024;5(2):304-325. doi: https://doi.org/10.61368/r.s.d.h.v5i2.137
2. Cusme Torres AC. Efectos de la actividad física sobre la depresión en estudiantes universitarios: revisión sistemática. GADE Rev Cient. 2023;3(2):35-50. doi: https://doi.org/10.63549/rg.v3i2.212
3. Urco CLQ, Carrión NJC, Ponce AM, Díaz RTV, Coello MEA, Molina PFC. Efectos de los programas de actividad física en la mejora de la salud mental en adolescentes. South Flor J Dev. 2025;6(4):e5148. doi: https://doi.org/10.46932/sfjdv6n4-027
4. Oliveira LM, da Silva AO, Farah BQ, Leão ICS, Souza FTC, Santiago FL et al. El deporte colectivo como factor protector ante problemas de salud mental e ideación suicida en adolescentes. Salud Ment. 2023;46(4):177-184.
5. Cain KL, Salmon J, Conway TL, Cerin E, Hinckson E, Mitáš J et al. International physical activity and built environment study of adolescents: IPEN Adolescent design, protocol and measures. BMJ Open. 2021;11(1):e046636.
6. Cerin E, Mitáš J, Cain KL, Conway TL, Adams MA, Schofield G et al. Do associations between objectively-assessed physical activity and neighbourhood environment attributes vary by time of the day and day of the week? Int J Behav Nutr Phys Act. 2017;14(1).
7. Kerr J, Emond JA, Badland H, Reis R, Sarmiento O, Carlson J et al. Perceived neighborhood environmental attributes associated with walking and cycling for transport among adult residents of 17 cities in 12 countries: The IPEN study. Environ Health Perspect. 2016;124(3):290-298.
8. Adler NE, Stewart J. Health disparities across the lifespan: Meaning, methods, and mechanisms. Ann N Y Acad Sci. 2010;1186(1):5–23.
9. Braveman P, Gottlieb L. The social determinants of health: It’s time to consider the causes of the causes. Public Health Rep. 2014;129(Suppl 2):19-31.
10. Hartley JEK, Levin K, Currie C. A new version of the HBSC Family Affluence Scale - FAS III: Scottish Qualitative Findings from the International FAS Development Study. Child Ind Res. 2016;9:233-245.
11. Prince SA, Lancione S, Lang JJ, Amankwah N, De Groh M, Jaramillo Garcia A et al. Examining the state, quality and strength of the evidence in the research on built environments and physical activity among adults: an overview of reviews from high income countries. Health Place. 2022;77:102874. doi: https://doi.org/10.1016/j.healthplace.2022.102874
12. Sallis JF, Cerin E, Conway TL, Adams MA, Frank LD, Pratt M et al. Physical activity in relation to urban environments in 14 cities worldwide: A cross-sectional study. Lancet. 2016;387(10034):2207-2217.
13. Neil-Sztramko SE, Caldwell H, Dobbins M. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev. 2021;9(9):CD007651. doi: https://doi.org/10.1002/14651858.CD007651.pub3
14. Lopes de Souza M. From the ‘right to the city’ to the right to the planet: Reinterpreting our contemporary challenges for socio-spatial development. City. 2015;19(4):408-443.
15. Frank LD, Iroz-Elardo N, MacLeod KE, Hong A. Pathways from built environment to health: A conceptual framework linking behavior and exposure-based impacts. J Transp Health. 2019;12:319-335.
16. Wu XY, Han LH, Zhang JH, Luo S, Hu JW, Sun K. The influence of physical activity and sedentary behavior on health-related quality of life among the general population of children and adolescents: a systematic review. PLoS One. 2017;12(11):e0187668. doi: https://doi.org/10.1371/journal.pone.0187668
17. Stake RE. Multiple case study analysis. New York (NY): Guilford Press; 2006.
18. Charmaz K. Constructing grounded theory: A practical guide through qualitative analysis. London: Sage; 2006.
19. Vollstedt M, Rezat S. An introduction to grounded theory with a special focus on axial coding and the coding paradigm. En: Kaiser G, Presmeg N, editores. Compendium for early career researchers in mathematics education. Cham: Springer; 2019. doi: https://doi.org/10.1007/978-3-030-15636-7_4
20. Bernal Agudo JL, Vera Báez CR. La elección de centro como mecanismo de segregación social. Rev Fuentes. 2019;21(2):189-200. doi: https://doi.org/10.12795/revistafuentes.2019.v21.i2.04
21. Fuenmayor A, Granell R, Villarreal E. Determinantes de la elección de centro educativo por parte de los padres. Estud Econ Apl. 2003;21(2):377-389.
22. Rivera Navarro J, Franco Tejero M, Conde Espejo P, Sandín Vázquez M, Gutiérrez Sastre M, Cebrecos A, Sainz Muñoz A, Gittelsohn J. Understanding Urban Health Inequalities: Methods and Design of the Heart Health Hoods Qualitative Project. Gac Sanit. 2019 Nov-Dec;33(6):517-522. doi: https://doi.org/10.1016/j.gaceta.2018.07.010. Epub 2018 Oct 25. PMID: 30929680.
23. Ayuntamiento de Madrid. Municipio en Cifras [Internet]. 2023 [consultado 19 Mar 2025]. Disponible en: https://portalestadistico.com/municipioencifras/?pn=madrid&pc=ZTV21
24. Bilbao Open Data. Catálogo de Datos [Internet]. 2023 [consultado 19 Mar 2025]. Disponible en: https://www.bilbao.eus/opendata/es/catalogo
25. Ahmad M, Wilkins S. Purposive sampling in qualitative research: a framework for the entire journey. Qual Quant. 2025;59:1461-1479. doi: https://doi.org/10.1007/s11135-024-02022-5
26. Whitehorne-Smith P, Lalwani K, Martin R, Mitchell G, Milbourn B, Abel W, Burns S. A grounded theory exploration of the enablers and barriers of public healthcare access for people with comorbid serious mental and chronic physical illnesses in Jamaica. PLoS One. 2024 Aug 30;19(8):e0309678. doi: https://doi.org/10.1371/journal.pone.0309678. PMID: 39213323; PMCID: PMC11364246.
27. Castro Vasquez MC, Arellano Gálvez MC. La teoría fundamentada en la investigación social: experiencia en un estudio sociocultural en salud. NOESIS 2024 33(66):4-20. https://erevistas.uacj.mx/ojs/index.php/noesis/article/view/6204
28. Moura CO, Silva ÍR, Silva TP, Santos KA, Crespo MD, Silva MM. Percurso metodológico para alcance do grau de saturação na pesquisa qualitativa: teoria fundamentada. Revista Brasileira de Enfermagem. 2022;75:e20201379.
29. Currie C, Alemán Díaz AY, Bosáková L, De Looze M. The International Family Affluence Scale (FAS): charting 25 years of indicator development, evidence produced, and policy impact on adolescent health inequalities. SSM Popul Health. 2023;25:101599. doi: https://doi.org/10.1016/j.ssmph.2023.101599
30. Zhang X, Warner ME. Linking Urban Planning, Community Environment, and Physical Activity: A Socio-Ecological Approach. Int J Environ Res Public Health. 2023 Feb 8;20(4):2944. doi: https://doi.org/10.3390/ijerph20042944. PMID: 36833640; PMCID: PMC9956976.
31. Nordbø ECA, Nordh H, Raanaas RK, Aamodt G. Promoting activity participation and well-being among children and adolescents: a systematic review of neighborhood built-environment determinants. JBI Evid Synth. 2020 Mar;18(3):370-458. doi: https://doi.org/10.11124/JBISRIR-D-19-00051. PMID: 32197008.
32. Nakanishi M, Stanyon D, Richards M, Yamasaki S, Ando S, Endo K, Hosozawa M, Miyashita M, Hiraiwa-Hasegawa M, Kasai K, Nishida A. Informal Caregiving in Adolescents from 10 to 16 Years Old: A Longitudinal Study Using Data from the Tokyo Teen Cohort. Int J Environ Res Public Health. 2023 Jul 31;20(15):6482. doi: https://doi.org/10.3390/ijerph20156482. PMID: 37569023; PMCID: PMC10419092.
33. Montalt García S, Garcia-Massó X, Monfort Torres G. Relación entre actividad física, autopercepción física, hábitos de vida saludable y nivel socio-económico en el alumnado adolescente (Relationship between physical activity, physical self-perception, healthy lifestyle habits and socioeconomic level in adolescent students). Retos 2023; 49:1027-1023. Disponible en: https://www.revistaretos.org/index.php/retos/article/view/97045
34. Druzhinin AG. Spatial possibilities and barriers of the postindustrial development of a regional metropolis (the case study of Rostov-on-Don). Reg Res Russ. 2013;3(4):386-391.
35. Ewing R, Hamidi S, Grace JB, Wei YD. Does urban sprawl hold down upward mobility? Landsc Urban Plan. 2016;148:80-88.
36. Benassi F, Naccarato A, Iglesias-Pascual R, Salvati L, Strozza S. Measuring residential segregation in multi-ethnic and unequal European cities. Int Migr. 2023;61(2):341–361.
37. Franc R, Sucic I. Fear of Crime. En: Encyclopedia of Quality of Life and Well-Being Research. Springer; 2021:1-7.
38. Hybel J, Mulalic I. Transportation and quality of life: evidence from Denmark. Transp Res A Policy Pract. 2022;157:107-125.
39. Ceccato V, Loukaitou-Sideris A. Fear of sexual harassment and its impact on safety perceptions in transit environments: a global perspective. Violence Against Women. 2021;28(1):26-48. doi: https://doi.org/10.1177/1077801221992874
40. Garreton M, Basauri A, Valenzuela L. Exploring the correlation between city size and residential segregation: Comparing Chilean cities with spatially unbiased indexes. Environ Urban. 2020;32(2):569-588.
41. Ewing R, Hamidi S, Grace JB, Wei YD. Does urban sprawl hold down upward mobility? Landsc Urban Plan. 2016;148:80-88.
42. Haandrikman K, Costa R, Malmberg B, Rogne AF, Sleutjes B. Socio-economic segregation in European cities: a comparative study of Brussels, Copenhagen, Amsterdam, Oslo and Stockholm. Urban Geogr. 2023;44(1):1-36. doi: https://doi.org/10.1080/02723638.2021.1959778
43. Giles-Corti B, Vernez-Moudon A, Reis R, Turrell G, Dannenberg AL, Badland H et al. City planning and population health: A global challenge. Lancet. 2016;388(10062):2912-2924.
44. Gilliland J, Olson S. Residential segregation in the industrializing city: A closer look. Urban Geogr. 2010;31(1):29-58.
Downloads
Additional Files
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2026 Áxel De León Marcos, Jesús Rivera Navarro, Ainara San-Juan-Escudero, Leyre Gravina Alfonso
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Usted es libre de:
Compartir — copiar y redistribuir el material en cualquier medio o formato.
La licenciante no puede revocar estas libertades en tanto usted siga los términos de la licencia.
Bajo los siguientes términos:
Atribución — Usted debe dar crédito de manera adecuada , brindar un enlace a la licencia, e indicar si se han realizado cambios. Puede hacerlo en cualquier forma razonable, pero no de forma tal que sugiera que usted o su uso tienen el apoyo de la licenciante.
NoComercial — Usted no puede hacer uso del material con propósitos comerciales.
SinDerivadas — Si remezcla, transforma o crea a partir del material, no podrá distribuir el material modificado.
No hay restricciones adicionales — No puede aplicar términos legales ni medidas tecnológicas que restrinjan legalmente a otras a hacer cualquier uso permitido por la licencia.
Avisos:
No tiene que cumplir con la licencia para elementos del material en el dominio público o cuando su uso esté permitido por una excepción o limitación aplicable.
No se dan garantías. La licencia podría no darle todos los permisos que necesita para el uso que tenga previsto. Por ejemplo, otros derechos como publicidad, privacidad, o derechos morales pueden limitar la forma en que utilice el material.
![¿Cómo evaluar para la RESP? [PARA REVISORES]](https://ojs.sanidad.gob.es/public/site/images/rmartinb/pastilla-revisores-0eaa113abcbc4fc554c7c6c7840ca4c6.jpg)
![¿Cómo recibir avisos sobre nuevos artículos de la RESP? [PARA LECTORES]](https://ojs.sanidad.gob.es/public/site/images/rmartinb/pastilla-lectores-aa689338e95aab07df45b4b0d583188f.jpg)
