Background: Gender inequality is widespread throughout Latin America, in large part due to a ‘machista’ culture in which women tend to be regarded as inferior to men. In Colombia, especially in low-income areas, women and girls are consistently excluded and marginalized. As a result of this, adolescent girls are susceptible to gang recruitment, teen pregnancy, and substance abuse. In similar settings globally, sport has been shown to be an effective tool for development and for the socialization and inclusion of youth. Few studies have taken place in Latin America, however, and hardly any of them have focused specifically on marginalized girls. This study aims to address this gap in literature by exploring how sport can break down barriers of exclusion and promote inclusion of marginalized, adolescent girls in Colombia. Methods: This qualitative, multi-methods study involved the analysis of data collected from semi-structured and key informant interviews, as well as participant observation sessions. All data collection was conducted in Cazucá, Colombia with participants from local NGO Tiempo de Juego (TDJ). Semi-structured interviews were conducted with adolescent girls between the ages of 11-18 who were participating in at least 1 sport at TDJ. Key informant interviews were conducted with TDJ staff and a guardian of several girls who participate in TDJ. Interview transcripts and participant observation memos and reflections were reviewed and coded to identify themes through thematic analysis. Results: All participants interviewed indicated that sport had a positive impact on their day to day lives. Three main themes and two sub-themes were identified during data analysis: 1) ‘Machismo’ in Colombia with sub-themes: i) Gender Roles and ii) Gender Norms, 2) Exclusion and marginalization, and 3) Empowerment through sport. Most participants spoke about the prevalence of machismo in Colombian society and how gender roles and norms limit the types of opportunities that are available to them. Participants expressed how, although they are marginalized based on where they live, sport provided them with a healthy activity to engage in as an alternative to the negative behaviours that they are susceptible to in their neighbourhoods. Sport provided them with an outlet to escape from their daily problems, and they felt that through sport, they were able to realize their self-worth and gain confidence in themselves. Conclusion: These findings suggest that sport can become a useful tool for promoting the inclusion of marginalized girls through empowerment. While sport was shown to break down some barriers of exclusion, further work must be done to explore its potential role in breaking down gender stereotypes that remain prevalent in Colombian culture. These results highlight the need for more sport programs that focus on marginalized girls in Latin American countries where women and girls remain a neglected population.

This study examined the intersection of rurality and community area deprivation using a nine-state sample of inpatient hospitalizations among children (<18 years of age) from 2011. One state from each of the nine US census regions with substantial rural representation and varying degrees of community vulnerability was selected. An area deprivation index was constructed and used in conjunction with rurality to examine differences in the rate of ACSC hospitalizations among children in the sample states. A mixed model with both fixed and random effects was used to test influence of rurality and area deprivation on the odds of a pediatric hospitalization due to an ACSC within the sample. Of primary interest was the interaction of rurality and area deprivation. The study found rural counties are disproportionality represented among the most deprived. Within the least deprived counties, the likelihood of an ACSC hospitalization was significantly lower in rural than among their urban counterparts. However, this rural advantage declines as the level of deprivation increases, suggesting the effect of rurality becomes more important as social and economic advantage deteriorates. We also found ACSC hospitalization to be much higher among racial/ethnic minority children and those with Medicaid or self-pay as an anticipated source of payment. These findings further contribute to the existing body of evidence documenting racial/ethnic disparities in important health related outcomes.

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