• Alcohol;
  • drugs;
  • gambling;
  • participation;
  • sport;
  • tobacco

Terry-McElrath & O'Malley [1] have conducted an interesting analysis that adds to a pool of studies that seek to elucidate the relationship between participation in sport, exercise and physical activity and substance use. The rationale for researchers examining these relationships arises from an assumption that participation in sport protects against early substance use initiation (mediates gateway effects) and misuse in adulthood [2], and that sport participation and physical activity may be an effective intervention for substance misuse and other problems. Although the relationship is complex, the majority of research in young people shows that participation in sport, if not exercise, is associated with lower use of cigarettes, marijuana and other illicit substances (but not steroids), but greater (mis)use of alcohol, particularly in some team sports [3,4].

The strength of Terry-McElrath & O'Malley's [1] study is its longitudinal design and analysis. However, as the authors themselves acknowledge, the measure used to assess participation in sport and physical activity, ‘How often do you actively participate in sports, athletics or exercising’, obscures understanding of important theoretical and conceptual distinctions; is it sport, athletics and/or exercise that is central to understanding substance use? While all involve degrees of physical activity, sports (e.g. football, tennis) bring a host of contextual and socio-cultural factors [5,6] that plausibly effect substance use beyond ‘walking’, the most commonly reported regular ‘sport, physical activity, exercise’ in surveys (≈40%). The significant effect for the control variable ‘team sports participation’ in Terry-McElrath & O'Malley's [1] analysis illustrates the importance of sport specifically, at least for alcohol consumption. It is possible that the lower rates of illicit substance use often reported in those who participate in sport, physical activity and exercise is attributable to sport participation only, as drug testing is common in competitive sport. We do not know, but better questions would allow us to.

The problem with assessment of sport participation is not only Terry-McElrath & O'Malley's. Most population-level surveys, to their detriment, do not distinguish between sport and other exercise [7]. Indeed, substance and addiction researchers have paid little attention to the relationship between involvement in sport, either as a participant or consumer, and relevant problem behaviours (e.g. alcohol, gambling, smoking, illicit drug use), despite sports centrality to the cultural milieu of most nations; but why is it important that researchers start examining sport in more detail?

Sport is, arguably, the primary vehicle for the marketing of alcohol, tobacco, junk foods and gambling/betting [8]. For example, the majority of alcohol industry advertising and sponsorship is in sport [9]. Because sport is typically charged with strong emotional valence and social identification that is not present in other activities, products presented within sporting contexts are more likely to be liked and chosen [10,11], yet few studies examining the influence of exposure to alcohol advertising and sponsorship have asked participants about their participation in and/or viewing of sport [12]. Notably, only two studies have examined exposure to direct alcohol industry sponsorship and drinking in sports participants, with both showing more hazardous drinking in those receiving alcohol sponsorship [13,14]. A recent call for more research on alcohol marketing mentioned sport only peripherally [15]. Given that marketing reports from companies such as the Neilson Company suggest that the bulk of alcohol marketing expenditure is in sport [16], sport should be the major focus of this research.

Studying the relationship between sport and problem behaviours is more than an academic exercise; it is critical to current policy debates in several countries. For example, in Australia, New Zealand and the United Kingdom, where one could be forgiven for thinking major sports are a subsidiary of the alcohol, gambling and junk food industries, health advocates calling for bans on alcohol and gambling advertising and sponsorship in sport need empirical evidence that tests and challenges arguments used by vested interests (alcohol, gambling, junk food, advertising industries and sport administrators) to forestall good health policy.

There is even greater importance for research in developing nations. Although the marketing of tobacco via sport has dissipated in most first-world nations, research from developing nations show that tobacco is still being promoted via sport [17,18]. Given that China, Indonesia, Africa and India make up half the world's population, and sport is a primary vehicle for the marketing of alcohol and tobacco (e.g. the Indian Premier League cricket tournament), a greater focus on the use of, and participation in, sport is warranted in those nations.

What can we do to understand the influence of sport more clearly? First, population-level surveys on substance use and health could ask participants to state, perhaps in order of importance/involvement, the sport(s) in which they participate, and at what level of sport participation (e.g. social/organized, community/university, competitive, elite/professional). Questions of this nature would allow researchers to establish sport type (e.g. football versus tennis), whether it is a team or individual sport, in/out of season status, context and level of investment, which are all variables found to be related to alcohol and other substance use. Secondly, general health surveys already ask questions about sedentary behaviours such as TV viewing. Items assessing frequency/proportion of viewing sport on TV, and perceived frequency of exposure to alcohol (and/or gambling, tobacco, junk food) advertising during TV sport, may be a good first step. Finally, longitudinal and experimental studies on the effect of exposure to alcohol, tobacco and gambling marketing would benefit from a greater examination of sport backgrounds and contexts.

In conclusion, sport is an important factor in the use of alcohol, tobacco, illicit substances and in other addictions. A more focused examination of the use of sport for marketing harmful products is overdue, and research capacity building in this area for developing countries should be a priority.


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  2. Declaration of interest
  3. References