• Elena Mylona, Maartje Kletter, Helen M Jones, Marie Murphy, Richard Lampard, and Oyinlola Oyebode.
• Warwick Medical School, University of Warwick, Coventry, UK. Electronic address: e.mylona@warwick.ac.uk.
• Lancet. 2022 Nov 1; 400 Suppl 1: S66S66.

BackgroundAdolescent physical activity is influenced by biological, psychological, sociocultural, and environmental factors; however, no systematic review to date has explicitly explored the effect of family structure. This systematic review aims to identify and synthesise evidence for the effect of family structure on adolescent physical activity levels.MethodsWe searched six databases: MEDLINE, Embase, Web of Science, PsycINFO, CINAHL, and Sociological Abstracts. Search terms used included "adolescence", "family structure", and "physical activity". The search was limited to peer-reviewed studies with a quantitative component published from Jan 1, 2010, to Feb 8, 2022, with no restrictions imposed on the language, country, and year the data were collected. Studies looking at adolescents aged 10-19 years and any association between family structure and physical activity levels were included. Screening of studies occurred in duplicate. Data were extracted and study quality was assessed (in duplicate) before narrative synthesis, which followed the SWiM guidelines. This systematic review was registered with PROSPERO, number CRD42020221090.FindingsIn total, 30 studies met the inclusion criteria: 17 (57%) looked at global physical activity and 13 (43%) at leisure physical activity and sport participation. 29 (97%) of 30 studies used a cross-sectional study design and 27 (90%) assessed the outcome through a survey, with 16 (53%) reporting a significant association between family structure and adolescent physical activity. Ten (33%) of 30 studies used multivariable regression; in these studies, nuclear family structure was shown to be associated with higher physical activity levels in eight (27%) studies, of which seven were good quality studies, looking at middle adolescent in high-income countries. Two (7%) of 30 studies reported the opposite effect, with one looking at a disadvantaged sample and the other at physical exercise class attendance and active transport.InterpretationImproving our understanding of social determinants of adolescent physical activity levels could help inform strategies to promote healthier behaviour. Current evidence suggests that adolescents in nuclear families engage in more physical activity, however robust high-quality longitudinal studies are required to further investigate the long-term effect.FundingNone.Copyright © 2022 Elsevier Ltd. All rights reserved.

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