Background
Numerous settings, such as school, home, and parks and open spaces, offer opportunities for promoting physical activity and quality of life for youth. However, additional research is still needed regarding factors in the physical environment that affect children’s participation in physical activity. Only limited research has studied children’s own perceptions of places for their active living and what constrains and facilitates their activity. One way to capture children’s opinions and generate more insight is through photo-voice, which allows participants to represent their point of view by taking pictures then used for discussion.

Objectives
The objective of this study was to explore children’s perceptions of the places they are active by gathering information about the places they play, their likes and dislikes regarding those places, and constraints regarding their physical activity.  in addition to examining perceptions of the places children engage in activity during their free time, the study also sought to understand children’s relationship with and attitudes towards the play equipment and recreation areas in their school playgrounds.

Methods
Participants included 80 fifth graders from four elementary schools in Columbia, Missouri. Photo-voice methodology was used involving a combination of youth-generated photography and follow-up individual interviews. The youth were given digital cameras and directed to take pictures of places they go for physical activity over 10-day periods during April and May of 2012. Next, semi-structured interviews were conducted using pictures the children took.  The youth were asked to describe each of the places they photographed as well as their likes and dislikes about them.  The youth were also shown several general pictures of their school playground and asked about their likes and dislikes, activities, and where they spend their time with regard to the playground. Although beyond the scope of this abstract, these questions also allowed for examination of school playground interventions that included new equipment/facilities (e.g., soccer field, track, frisbee golf). Finally, youth were asked if there were places they would like to go but do not and why they choose not to.  Pictures and interview transcriptions were dual coded and examined for emergent themes.

Results
Five themes related to places youth engage in physical activity emerged: School (e.g., basketball court, gym), Home Environment (e.g, backyard, friend’s house), Neighborhood (e.g., street, block), Public Open Space/Parks (e.g., trail, state parks, creek), and Other Recreational Facilities (e.g., amusement parks, swimming pool).  for instance, regarding the home environment, pictures depicted examples such as basketball hoops in the driveway and tree houses in the backyard.Seven themes emerged regarding “likes” when discussing both the youth pictures and the playground pictures: Physical Benefits, Natural Conditions, Social Interaction, Freedom/Choices, Equipment, Space to Play, and Fun. for example, under Freedom/Choices, several youth mentioned enjoying having a lot of options. “They got a lot of different stuff to play with,” one said. Five additional themes emerged in the youth photographed pictures, but were not discussed when youth were shown the general school playground pictures: Emotional Connections, Solitude, Safety, Proximity to Play Areas, and Challenge/Competition. As an example of Challenge/Competition, one youth explained that they “get to play against each other and try to defend the ball from each other.”Among “dislikes,” themes emerged describing Physical Environment (e.g., playground conditions, lack of desired/age appropriate equipment, natural obstacles, cars/busy traffic, lack of space, distance from play space, uncleanliness), Social Issues (i.e. no one to play with, crowding, conflicts), Personal Preferences (e.g., boredom, injury, exhaustion, lack of proficiency) and Policy/Rules. for example, one student said that the swing in her back yard is too old and low for her to play with. Regarding the school playground pictures, students mentioned a lack of benches and shade and having outgrown playground equipment.  Regarding Policy/Rules, it emerged that playground monitors were serving as a barrier to student access to more remote areas of the playground, including the facilities created as an intervention through this project.Beyond the photographs, students described places they would like to go but cannot or do not. Reasons largely fell into Physical Constraints (e.g., distance, lack of equipment, seasonally unavailable) and Social Constraints (e.g., peer influence, family or friends’ time conflicts, crowding, not enough supervision), as well as Financial Constraints. As an example of Peer Influence, one student described forgoing swinging because friends preferred Four Square.

Conclusions
Few studies have examined children’s use of places for their physical activity through the filter of their own perceptions. Through youth-generated photography, children are empowered to take part in this study as “experts” and to voice their own perspectives regarding places for physical activity. A better understanding of the influences of physical environments, as well as what facilitates or constrains youth’s physical activity in the context of their physical environment, offers an opportunity to better promote active living and improve health among young people. Such insights are important resources for future school playground planning and innovation.

Support / Funding Source
Funding for this project was provided by Robert Wood Johnson, Active Living Research Program, Grant #68506.