Research on the Structure and Characteristics of Adolescent Physical Health Policy in China Based on Policy Text Tool

Abstract

The health of young people is an important guarantee for national development and rejuvenation. In the past five years, the Chinese government has issued a series of policies on adolescent physical health, which have effectively promoted the development of adolescent health. In this study, we collected national policies on adolescent physical health from 2016 to 2022 as research objects. Based on the theory of policy instruments, this paper constructs a three-dimensional framework of “policy instrument-adolescent physical health contents-adolescent physical health policy target audience”. The study found that the use of adolescent health policy tools in China is uneven, as most policies are biased towards supply-side policies. The lack of targeted protection policies for adolescents’ physical health is due to the lagging development of physical standards, lack of monitoring technology, and complex governance policies. Policy use by governments, schools, and communities is widely distributed, resulting in a lag in the overall effectiveness of adolescent physical health policies. To this end, we put forward the following suggestions: First, the use of policy instruments should be optimized. Secondly, on the basis of adolescent health monitoring, the physical health standards suitable for national conditions should be formulated. Moreover, we should improve the governance model and guarantee a system to fill the policy blank of the implementation of adolescent physical health. Finally, we should promote the coordinated development of mental health with “moral” as the core.

1. Introduction

When the youth is strong, China is strong, and when the country is prosperous, sports will be prosperous [1]. The health of young people is the hope for the future of a country and a nation. The State General Administration of Sport promulgated the 13th Five-Year Plan for Youth Sports in 2016, aiming to improve youth physical health and improve the youth sports public service system. Since the 1980s, height, weight, waist circumference and other indicators of physical health among Chinese adolescents have been on the rise. The physical fitness indicators such as endurance, speed and explosive power of Chinese adolescents show a downward trend. The number of obese and myopic children is increasing rapidly [2]. Although Chinese adolescent physical health policies are gradually improving, the 8th National Student physical health survey shows that there are still many problems in adolescent physical health, such as myopia, overweight, and physical decline. In particular, myopia, a type of refractive error, has reached a staggering 85% of myopia and high myopia among 16–18 year olds in China since 2013 [3]. Judging from the results, the physical health of Chinese teenagers does not appear to have improved significantly [4]. The survey also showed that only about one-third of adolescents met the MVPA recommended guidelines of 60 min of exercise per day [5], only three-tenths of adolescent children meet the national physical fitness standards [6], and more than 12% of teens are diagnosed as obese, 14% of children and teens are overweight, and about 37% have more than 2 h of screen time per day [7]. New health problems such as lumbar spine disease, hypertension, and hyperlipidemia are also affecting younger people [8].

Since the founding of the People’s Republic of China, the adolescent health policy has always been health first. However, there is still room for improvement in the professional and systematic nature of policy content [9]. Qin, J analyzed the effectiveness of adolescent health policies from the perspective of macro measures through policy tools. Some suggestions were put forward, such as building a complete system, strengthening top-level design, and guaranteeing complete supporting measures [10]. According to Cheng, C, Z’s research on the development of adolescent health policies, the policy’s response to adolescent health problems has inherent limitations, which leads to the cognitive bias in the implementation of adolescent health policies [11]. Miao, L, Jiang X, H believed that China lacks specific laws and policy refinement ability in overall sports policy governance. Therefore, it is necessary to strengthen the monitoring component in policy implementation [12,13]. Zion C and D believe that in the diffusion model of adolescent health policies in China, the higher the political potential, the higher the effectiveness of the policies. The diffusion of selective policies makes the policy issued by the central government more effective, which can realize the alignment of political potential with the physical health of adolescents [14]. Li, Q summarized the policy problems in the evolution process, including the main body confusion, difficult implementation, and low effectiveness. Li, Q also put forward improvement suggestions, such as strengthening departmental cooperation, establishing a long-term evaluation mechanism, and increasing capital investment [15]. Wang, Y thought that the new era of adolescent health promotion policies regarding the collaborative governance mechanism is not smooth, and pointed to policy implementation deviation from the main vision [16]. Under the background of deepening the integration of physical education, it is undoubtedly the right choice to improve the top-level design of adolescent physical health policy and clarify the policy objectives.

The current academic research on adolescent health policy is carried out from many angles, such as theory, method, and pathology. The published papers have summarized the current situation and dilemma of adolescent health policy evolution in China and expounded the path and strategy of adolescent health policy development. However, there is less literature analyzing the problem from the policy content perspective. There are few studies on the nature and characteristics of policy content through policy instruments. At the same time, the in-depth understanding of policies and the interpretation of the implementation of policy tools lack certain literature research, and relevant theoretical suggestions are difficult to be applied in practice. Therefore, on the basis of existing literature, this paper explores the relationship between the background, specific types, and contents of adolescent physical health policies. It also provides a perspective for the formulation of adolescent health policy in China. This paper promises to analyze the effectiveness of adolescent health policy through policy tools and puts forward some strategies for implementing adolescent health policy.

2. Data Collection and Methods

2.1. Research Data

In 2021, the development of youth sports was divided into a new stage in the 14th Five-Year Plan for Sports Development. The plan adhered to the concept of “health first” and promoted the combination of physical education, which laid a foundation for the development of young people’s physical health into a new progressive pattern. In this work, we take the national policies on youth physical health in China as samples for analysis, including the opinions, plans, outlines, and programs on youth sports development issued by The State Council, the Ministry of Education, and the General Administration of Sport since 2016. The database searches were completed in September 2022 and were conducted according to the following key words: (TS = (“Youth” OR “Adolescent” OR “Teenagers” OR “Young” OR “Young people” OR “Teens” OR “Children” OR “Youth’s”) AND TS = (“Physical health” OR “Physical fitness” OR “Sports” OR “School sports”)).

The Ministry of Education and the National Sports Administration provide a large number of adolescent physical health policies. In order to be more comprehensive, a policy search was also conducted on the website of The State Council.

Most policies on adolescent physical health are distributed in sports program documents. Therefore, the policy literature retrieved was screened, filtered, and deleted to ensure the validity of the data. In strict accordance with the above criteria, 12 adolescent health policy texts were obtained in

Table 1. Twelve adolescent health policy texts from 2016 to 2022.

No.	Department	Policy Name	Promulgation Time
1	State Council Office	<Opinions on strengthening school sports to promote the all-round development of students’ physical and mental health>	6 May 2016
2	General Administration of Sport	<The 13th Five-Year Plan for Youth Sports>	5 September 2016
3	State Council	<“Outline of the Health China 2030” Plan>	25 October 2016
4	State Council	<The 13th Five-Year Plan for National Education Development>	19 January 2017
5	State Council	<Medium- and Long-Term Youth Development Plan (2016–2025)>	13 April 2017
6	General Directorate of Sports and Ministry of Education	<Youth Physical Activity Promotion Programme>	28 November 2017
7	State Council Office	<Outline for building a strong sporting nation>	2 September 2019
8	General Directorate of Sports and Ministry of Education	<Opinions on deepening the integration of sports and education to promote healthy youth development>	31 August 2020
9	Office of the Ministry of Education	<Notice on Further Strengthening the Management of Primary and Secondary School Students’ Physical Fitness>	19 April 2021
10	State Council	<National Fitness Plan (2021–2025)>	18 July 2021
11	Directorate of Sports	<The 14th Five-Year Plan for Sports Development>	8 October 2021
12	State Council Office	<National Health Plan for the 14th Five-Year Plan>	20 May 2022

. Specific selection criteria are as follows:

Policy search site: (1) National Sports Administration Sports Policy and Regulations Document Retrieval Platform: http://sport.org.cn/search/system/ (accessed on 23 September 2022). (2) State Council Policy Document Library: http://www.gov.cn/zhengce/zhengcewenjianku/index.htm (accessed on 17 October 2022). (3) Ministry of Education Policy Document Library: http://www.moe.gov.cn/was5/web/search?channelid=239993 (accessed on 19 October 2022).

Policy level: Select policies and regulations issued by national government departments and remove local policies and regulations.

Policy content: Select the policy content related to youth sports, including youth physical health indicators, youth physical health development, and other text content closely related to the above key words.

Policy years: Policies issued from 2016 to 2022.

2.2. Methods

Content analysis: The content analysis method is based on the assumption that the texts under study are a rich database and have the potential to reveal a number of features and patterns [17]. Content analysis is often defined as the interpretation of the hidden content within a text, which is the process of parsing the text, classifying it into relevant groups of categories, and considering the relationship of the participating subjects to the context [18]. Because of its widespread use, this method is considered efficient in both qualitative and quantitative research, while it is important to note that the terminology of the content analysis method is distinct in the qualitative and quantitative literature, which can lead to confusion for some researchers [19]. Policy texts are usually rich in content and cover multiple dimensions. Content analysis is a quantitative inductive analysis of a certain type of information in a certain type of literature. As a method of text mining, the content analysis method starts from qualitative problems, carries out quantitative statistical analysis on texts, and draws research conclusions [20]. The research steps of content analysis are as follows: First, formulate research questions and carry out sampling. Then, select the analysis unit and determine the analysis category. Furthermore, quantitative processing and calculation are carried out, including the coding, classification, and quantitative statistics of analysis units. Finally, the analysis results are explained and tested. Text coding is an important technology in the content analysis method. By classifying and labeling the content of the analysis unit [21], the text is quantitatively analyzed. Based on the text content analysis, this study made a quantitative analysis of the text of Chinese adolescent physical health policy.

Social network analysis: The social network analysis method is derived from graph theory, which uses quantitative tools to visualize the interactions between individuals [22,23]. The use of visual knowledge networks provides a clear understanding of content relationships. Social network analysis emphasizes the importance of structure as a way to characterize the social environment [24]. Social network analysis can be applied in many concepts and domains, be it individuals, communities, events, or even countries. Individual relationships between social networks affect the positions and lines in the network structure, and the main task of this approach in social sciences is to explore the overall shapes and connections between networks using visual graphs, positional relationships, and two-dimensional views [25]. A key word co-occurrence network can effectively present the relationship between feature members and the position structure between key words in content mining research [26].When two key words appear in the same text, there must be a connection between the two key words. When the co-occurrence frequency is higher than expected, the distance and relationship between key words are closer than normal. Therefore, in order to explore the relationship between key words in Chinese adolescents’ physical health policy texts, this study constructed a key word co-occurrence matrix and analyzed the network relationship.

3. A Three-Dimensional Framework for Chinese Youth Physical Health Policy Analysis

Policy tools are the methods and measures that emerge to achieve policy objectives in concrete terms [27]. How effectively policy tools are used is a key bridge to reaching policy goals and a pathway for moving from the text of policy from theory to practice.

The current theory of classification of policy instruments originated in the 1960s, when German economist Kirsechen first classified policy instruments [28]. Since then, various economists and sociologists have classified policy instruments according to different contexts and dimensions. We mainly used the classification of policy instruments proposed by Rothwell and Zegveld, which is relatively reliable in the academic circle. According to the factors affecting policy implementation, policy tools can be divided into supply side, demand side, and environment side [29]. The supply side is the force that directly influences policy objectives. The demand side is what drives policy goals. The environmental end is the vehicle through which policy objectives are achieved. These three policy instruments are inter-related and can be most effective if they work together. These three kinds of policy tools fully embody the methods, measures, and tools to achieve policy goals in the process of policy implementation [30].

Therefore, Rothwell and Zegveld’s type of policy instrument was used for analyzing youth physical health policies as the X-dimension. Based on the textual content of the youth physical health policies, their policy content was interpreted into four areas: youth physical health standards, youth physical health monitoring, youth physical health governance, and youth physical health assurance as the Y-dimension. The target audience of the policies was used as the Z-dimension of the youth physical health policy analysis.

3.1. Dimension X: Policy Tools

According to Rothwell and Zegveld’s policy theory, there are three types of policies: supply side, demand side, and environment side. The supply-side policy tools of Chinese adolescent health policies mainly refer to the government promoting macro-management, further expanding financial security, and actively guiding social forces to help promote the development of adolescent health. The development of young people’s physical health is promoted from all aspects through a series of measures, such as team building, teachers, sports organizations, and extra-curricular exercises. The demand-side policy tools of adolescent health policy in China mainly refer to the use of various government services to guide adolescent health towards a more ambitious goal. Specific areas covered are public services, special education, scientific and technological innovation, sports, and mental health. The main task is to provide a good guarantee for the healthy development of young people, train students’ sports skills, establish the core goal of moral education, and cultivate young people’s health from all aspects of personnel, process, and aspects. Environmental policy tools of adolescent health policy in China mainly refer to the healthy environment constructed by the government and relevant functional departments to ensure the improvement of adolescent health, which can be divided into five aspects: indicator formulation, school management, constructive measures, system, and evaluation. The main task of environmental policy tools is to coordinate the environmental regulations among different subjects in the physical health development of adolescents, so as to build a stable and sustainable environment for the physical health development of adolescents. The role of three types of policy tools are shown in Figure 1.

3.2. Dimension Y: Youth Physical Health Standards, Monitoring, Governance, and Assurance

Although these three types of policy tools reflect the specific functions of policy implementation, they do not fully reveal the characteristics of adolescent health policies. Therefore, the content of adolescent physical health policy is taken as the Y-dimension, and the policy content is divided into standards, monitoring, governance, and security to explore the characteristics of the policy.

Adolescent physical health standard is the national regulation of adolescent physical health level, established at the macro and micro levels. At the macro level, health standards are formulated according to the overall physical quality level of Chinese teenagers. At the micro level, physical health standards for adolescents are formulated according to their growth and development characteristics, aiming at different ages, genders, and goals.

Adolescent physical health monitoring is real-time feedback of the implementation of adolescent physical health policy. The monitoring result is an important basis for government departments to know the health status of adolescents and formulate relevant health policies.

Adolescent health management is an inevitable requirement of Chinese social governance modernization. The governance of youth physical health policy helps to solve a series of problems related to physical health development in the process of youth growth.

Management team construction, site facilities, fund guarantee, system, etc., are the preconditions for adolescent health protection. The process of formulating adolescent health policies depends on the synergistic operation of various elements to promote the overall improvement of adolescent health in China.

3.3. Dimension Z: Youth Physical Health Policy Subjects

The main body of adolescent physical health policy is the object of policy implementation. The content of adolescent health policy involves government, community, and school. The government is the designer and promulgator of policy, and also the object of policy implementation. The government promotes policy operation through macro-management supervision, assessment monitoring, rewards, and punishments. The community is an external force to promote the physical health of adolescents, which will play a fundamental role in policy implementation. Companies, clubs, and public activities are essential elements for communities to promote healthy youth development. School is the primary environment for the healthy growth of teenagers, and it is also the specific promoter and supervisor of the implementation of the policy, which will play a major role in the implementation of the policy.

To sum up, based on the three dimensions of X, Y, and Z, the three-dimensional framework for the analysis of Chinese adolescents’ physical health policy is shown in Figure 2.

4. Analysis of Policy Tools for Youth Physical Health Policy in China

4.1. Youth Physical Health Policy Text Content Coding

The 12 selected policies are coded using Nvivo12 according to “Policy Number—Section/Section—Specific Content”. For example, the code “1-2-4” stands for Article 2, Section 4 of the first policy. By analyzing 12 adolescent health policies in Table 1, a total of 168 analyzed contents and codes are obtained. Due to the large content, only part of the corresponding analysis code is listed in

Table 2. 12 Chinese youth physical health policy text analysis module codes.

Number	Name	Content	Code
1	<Opinions on strengthening school physical education to promote the all-round development of students’ physical health>	(IV) Improving the physical education curriculum. Focusing on cultivating students’ interest, developing exercise habits, mastering sports skills, and enhancing their physical fitness. Improve the national curriculum standards for physical education and health and establish a system for bridging the physical education curricula of primary schools.	1-2-4
		(V) Improving teachers’ pedagogical standards. Physical education should strengthen health knowledge education, focus on motor skills learning, scientific arrangement of exercise load, and emphasis on practical exercises. Research and development of sport teaching guidelines to enable students to become proficient in one or two sport skills. Form a “one school, one mode” or “one school, more modes” of teaching, and strive to improve the quality of physical education.	1-2-5
		(VI) Intensive extra-curricular exercises. Improve the physical activity system for students. Schools should incorporate extra-curricular physical activities conducted for students in school into their teaching plans, include them in their work and rest schedules, and link them to the content of physical education classes. It is important to ensure the one hour of daily school physical activity.	1-2-6
…	…	…	…
12	<The 14th Five-Year Plan for National Health>	To enhance screening, diagnosis, and intervention for risk factors and diseases such as anemia, poor vision, obesity, dental caries, abnormal psychological development, hearing impairment, and scoliosis in children and adolescents. To guide schools and parents to implement comprehensive interventions for students to prevent and control myopia in children and adolescents.	12-1-1
		Promote youth health education work and sex education for adolescents.	12-1-2
		Coordinating and promoting school health teams and capacity building of disease prevention and control agencies at all levels.	12-1-3

.

4.2. Key Word Co-Occurrence Network

Key words are the core content of adolescent health policy text. Key word extraction and frequency statistics are helpful to quickly mine the key content information of adolescent health policy texts. As a visual research tool of text mining, a key word co-occurrence network can effectively present the relationship and location structure of key words. A key word co-occurrence analysis is an effective method to study the relationship between policy texts. The focus of adolescent health policy can be expressed through a combination of key words. Therefore, we constructed a key word co-occurrence network. We used Python to extract and obtain 32 high-frequency key words of adolescent health policies to form a key word co-occurrence matrix. We used Netdraw to visualize the key word co-occurrence matrix. Figure 3 shows the recessive relationship between the key words of the policy and the physical health policy of Chinese adolescents by using the high-frequency key word co-occurrence network.

In the key word co-occurrence network, the node size represents the centrality of the key word network. The thickness of the connection line indicates the degree of correlation between key words. In Figure 3, key words such as health, organization, government, youth, standard, and school are not only clustered in the center of the network, but also strongly correlated with other key words, indicating that these key words play a key role in the physical health development network of Chinese adolescents. The overall co-occurrence network of adolescent health key words indicates that the adolescent health policies in China constitute a complex network. In addition, the different relationships between different key words promote the development of adolescent health policies in China.

4.3. Analysis of Policy Tools for Youth Physical Health Policies in China

On the basis of coding the content of adolescent physical health policy, combined with the characteristics of the three types of policy instruments, the distribution proportion in the policy was distinguished by the supplement side, the demand side, and the environment side. The distribution of the use of adolescent health policy tools in China is shown in Figure 3.

The data showed that the formulation of adolescent health policies in China presented a relatively comprehensive trend. There were different policy directions on the supply side, demand side, and environment side. The results showed that the supply side policy tools were used most frequently, accounting for 48.21% (81 articles), followed by the use of environmental policy tools, accounting for 27.38% (46 articles). The use of demand-side policy tools accounted for the lowest proportion, accounting for 24.4% (41 articles). The percentage of policy tools used is shown in Figure 4.

It can be seen that the content of Chinese adolescent health policies was more biased to the supply side and environmental policy tools in the last 8 years. Government departments were more inclined to use supply-side and environmental policy tools to promote the healthy development of adolescents.

4.4. Analysis of Supply-Side Policy Tools

According to the results of a text analysis of adolescent physical health policy, supply-side policies account for 48.21% of the total analysis of adolescent physical health policy, among which facilities and sports organizations account for 10.12%, the largest number of policy tools, and physical education courses account for 1.79%, the smallest proportion. In terms of the structure of policy tools, facilities, sports organizations, sports activities, and economic support are used to a high degree, but teachers, team building, extra-curricular exercise, and sports courses are used to a low degree. From the overall analysis of the supply side, the supply-side type of adolescent health policy is used more frequently. While the structure is not balanced, there are two aspects that need to be strengthened: youth sports organization construction and extra-curricular exercise promotion.

On the one hand, the policy tools of facilities and sports organizations are used the most, which means that the supporting infrastructure for the physical and healthy development of Chinese youth in the past six years was not good enough and needs more attention from government departments. Facilities and sports organizations form the basis of national health strategies, and a strong foundation is necessary to ensure the healthy physical development of adolescents. From the current policy implementation, school sports facilities, community sports facilities, rural sports facilities, social sports organizations, youth sports clubs, and other related resources need to be improved and perfected.

On the other hand, policy tools are used more frequently in the areas of team building, economic support, teachers, and physical activities, which indicates that the key to improving the physical health of adolescents lies in how to formulate the physical health development model of adolescents. However, the incomplete teacher team leads to no one leading sports activities, which is the main contradiction in the healthy development of teenagers at the present stage. Therefore, the healthy development of teenagers needs a sound team of teachers, professional teachers. In terms of policy direction, strengthening leadership, expanding economic support, raising teachers’ salary level, and maintaining systematic physical activity are effective solutions.

Compared with other policies, the number of extra-curricular exercise and sports courses is smaller, which means that the government makes less use of the adolescent sports health education policy, and the development of extra-curricular activities and sports courses in China needs to be strengthened.

4.5. Analysis of Demand-Side Policy Tools

Demand-side policies accounted for 24.40% of the total analysis of adolescent physical health policy texts. Among them, the largest number of policy tools was public services, accounting for 7.74%, and the smallest was mental health, accounting for only 1.79%. The development of adolescent physical health is not only the improvement of physical quality, but also the gradual maturation of mental health. The comprehensive development of physical and mental health is the key to improve adolescent health. It can be seen that the number of demand-side policies for adolescents’ physical health is relatively small from the analysis of demand-side policy tools. Although public service policies are used more effectively, there are too few policies on mental health and physical fitness development, which means that the government is neglecting the overall physical health development of adolescents. Although the use of public service policy tools is the highest, the overall driving effect is not significant. Therefore, sports culture, sports guidance, sports activities, and other aspects of service management need to be strengthened.

The number of policy instruments for professional education and science and technology innovation is 11 and 9, respectively. In addition to the professional education of physical health theory and sports training, the new education of ice and snow sports was set up, which indicates that the government attaches great importance to the education of theoretical knowledge and skills related to ice and snow sports for young people in the context of the Beijing Winter Olympics. However, there are still some problems in the implementation process, such as insufficient quality service, imperfect industrial support, insufficient sports atmosphere, and regional differences [31]. Among the scientific and technological innovation policy tools, promoting the smart model of adolescent physical health is the best solution to improve the physical health of Chinese adolescents. Emerging technology tools, such as intelligent monitoring, scientific management, and online guidance, are of great significance to help the healthy development of adolescents and improve innovative policy tools.

Policy tools for sportsmanship and mental health were used less frequently compared to other policy tools. It is an important task to carry out sports spirit education. How to set up the sports spirit, the spirit of patriotism, and the moral character of virtue is the main content of the physical health of young people. The results showed that the training of sports spirit, moral sentiment, and mental health of teenagers has not been carried out effectively.

4.6. Analysis of Environmental-Side Policy Tools

Environmental policies accounted for 27.38% of the total text analysis of adolescent physical health policies, among which the number of policy tools was the largest, accounting for 8.33%, and the proportion of indicators was the smallest, accounting for only 1.79%. It can be seen that the structure of adolescent health policy is polarized in the environmental category, and there is a lack of corresponding indicators and constructive measures. Therefore, the coordination ability of the environmental side as an intermediary is insufficient.

The institutional system is the guarantee of the physical health of Chinese teenagers. The implementation of adolescent health policy needs an institutional system. There are 14 institutional systems in

Table 3. The usage distribution of Chinese youth physical health policy tools.

Policy Tools	Tool Name	Text Encoding	Number (bars)	Percentage (%)
Supply side	Facilities	2-9-3, 6-3-2, 8-7-33, 2-9-1, 6-3-1, 11-5-9, 10-3-1, 10-7-2, 8-7-32, 8-7-34, 1-4-10, 2-9-2, 2-15-5, 2-15-7, 3-6-2, 5-1-4, and 6-3-3	17	10.12%	48.21%
	Teachers	8-6-28, 10-9-2, 7-1-7, 1-4-9, 11-5-3, 11-5-10, 8-6-27, and 6-5-1	8	4.76%
	Economic support	2-18-1, 8-1-3, 6-4-2, 6-7-2, 1-4-11, 2-15-2, 2-18-2, 8-1-6, 8-5-29, and 8-7-35	10	5.95%
	Sports organizations	11-5-7, 8-5-26, 6-2-2, 8-5-27, 2-8-2, 5-1-5, 6-2-3, 6-2-4, 10-9-3, 8-1-5, 8-5-25, 8-5-28, 7-1-6, 2-8-1, 2-8-3, 6-2-1, and 11-5-2	17	10.12%
	Team-building	2-16-4, 1-3-7, 8-1-4, 6-5-3, 2-15-6, 2-19-1, 11-5-1, and 6-5-2	8	4.76%
	Sports activities	2-7-6, 6-7-5, 6-7-7, 2-7-2, 2-7-3, 6-1-2, 11-5-8, 10-7-1, 7-1-1, 7-1-5, 6-1-1, 8-3-16, and 6-7-6	13	7.74%
	Extra-curricular exercise	1-2-6, 8-1-2, 6-1-4, 10-9-1, and 9-1-3	5	2.98%
	Physical education courses	1-2-4, 1-5-15, and 9-1-2	3	1.79%
Demand side	Public services	2-16-1, 2-21-2, 2-10-1, 5-3-3, 12-1-1, 2-7-5, 2-10-3, 5-3-2, 8-7-36, 6-7-3, 2-10-2, 2-15-1, and 5-3-1	13	7.74%	24.40%
	Specialized education	2-7-4, 3-5-1, 4-1-2, 6-1-5, 6-1-6, 12-1-2, 9-1-1, 7-1-4, 6-4-1, 6-6-3, and 8-1-11	11	6.55%
	STI	2-16-5, 2-22-2, 6-7-4, 2-20-1, 2-22-1, 11-5-5, 11-7-2, 6-6-4, and 2-20-2	9	5.36%
	Sportsmanship	6-6-2, 2-6-1, 5-1-3, 11-7-1, 6-6-1	5	2.98%
	Mental health	4-1-4, 5-2-1, and 5-2-2	3	1.79%
Environmental-side	Indicators	3-6-1, 5-1-1, and 8-7-30	3	1.79%	27.38%
	School Management	5-1-2, 7-1-2, 12-1-3, 8-1-8, 1-2-5, 4-1-3, 9-1-4, 8-3-17, 8-7-31, 1-4-13, 6-1-3, and 8-3-15	12	7.14%
	Macroscopic measures	11-5-6, 8-1-7, 9-1-6, 1-6-18, and 6-1-7	5	2.98%
	Institutional system	2-15-4, 8-6-29, 1-4-12, 1-3-8, 2-15-3, 8-7-37, 1-6-16, 2-7-1, 2-17-1, 2-21-1, 11-5-4, 9-1-7, 8-1-10, and 6-7-1	14	8.33%
	Appraisal and evaluation	1-5-14, 2-16-2, 9-1-5, 8-1-9, 7-1-3, 6-4-3, 1-6-17, 2-16-3, 4-1-1, 8-3-18, 6-7-8, and 9-1-8	12	7.14%
Total			168	100.00%

, which shows that the state attaches great importance to the institutional system of guaranteeing the healthy development of adolescents.

The use of school management and evaluation policy tools is also frequent, indicating that the evaluation of school sports work and youth physical health is not high in China. At present, adolescents’ physical health testing is mainly carried out by schools, which needs to be promoted from the perspective of school leadership and management, students’ physical health work, physical health assessment innovation, and other aspects.

The development of indicators relies on data feedback on the physical health status of young people. Surveys in households, communities, and schools help to improve the reliability of indicator development. The elimination of single indicators and the development of diversified indicators are aimed at promoting diversity in adolescent physical health. In order to improve the overall development of adolescent health, we can start from schools with a large number of teenagers.

4.7. Analysis of the Content for Youth Physical Health Policies in China

Based on the analysis of the content of adolescent health policies in China, health standards, health monitoring, health management, and health security are adopted as the Y-dimension. The distribution of policy tools in the cross-analysis chart is shown in Figure 5. Youth health policies had an impact on all four dimensions of the Y-dimension. Different types of policy tools involve different levels of intervention. The percentage of the four dimensions of the Y-dimension are governance, protection, standards, and health monitoring from highest to lowest, respectively. Health management policy tools accounted for the highest proportion, accounting for 42.26%. Health protection accounted for 30.95%. Health standards accounted for 13.69%. Health surveillance policy tools accounted for the least, accounting for 13.10%. Figure 6 showed the proportion of policy tools used in the content of adolescent physical health policies.

Among the policy tools used to promote adolescent physical health standards, government departments pay more attention to standard setting. Sports organizations and institutional systems tools, especially assessment and evaluation tools, are largely distributed in the health criteria of adolescent physical health policies. It can be said that the government wants to use the results of the assessment of adolescent physical health as a basis for the development of adolescent physical health standards. In the context of adolescent physical health monitoring policies, environmental policy tools are more dominant than supply-side policy tools, which indicates that the government pays more attention to indicators, measures, systems, and evaluations in adolescent physical health monitoring. At the same time, the use of demand-side policy tools mainly focuses on psychology, technology, and public services, indicating that the government’s monitoring of adolescent physical health is becoming more scientific and advanced. The use of policy tools is evenly distributed in the adolescent physical health policy, but there are no physical education curriculum and indicators of the policy, which indicates that the adolescent physical health management mainly takes education and activities as the main governance methods. To ensure the healthy and sustainable development of young people through economic support, improved facilities, and enhanced teachers, sports activities, and special education learning, the government hopes to use policy instruments to play fundamental and operational roles in the physical health development of adolescents.

4.8. Analysis of the Subjects for Youth Physical Health Policies in China

The implementation of adolescent health policy is divided into government, society, and school. Through cross-tabulation with X-dimension policy tools, we can see the relationship between the distribution of adolescent health policies in different policy tools and the implementation subjects. The Z-dimension analysis of adolescent physical health policy was shown in Figure 7. There was no significant difference in the number of policy instruments used. The number of policies in descending order is government, society, and school. Government policies accounted for the highest proportion at 38.69%. Social policies accounted for 30.95% of the total. School-related policies were the least, accounting for 30.35 percent. Figure 8 shows the proportion of policy tools used by Chinese adolescent health policy subjects.

There is no significant difference in the distribution of the three policy instruments at the government level. Institutional systems and assessment categories have the largest number of policy tools, while there are fewer policies on team building, mental health, and extra-curricular exercises for adolescent physical health. It can be seen that policy tools at the government level are more about managing policies. The government hopes to achieve the goal of adolescent physical health by reforming the system, improving the evaluation system, and upgrading services. However, the lack of government policies on team building, mental health, and extra-curricular exercise has produced unsatisfactory results in improving the physical health of teenagers. The distribution of these three policy instruments at the social level differs greatly. Supply-side policy instruments accounted for more than half of the total, while there were three environment-side policies. Sports organizations, sports activities, and facilities account for the largest proportion of policies. Therefore, the government hopes to improve the environment for youth fitness through social activities, leagues, and sports facilities. The allocation of the three types of policy instruments at the school level is mostly supply-side dominated and least demand-side dominated. There were more policies on teacher capacity, team building, facilities, and school management, but there was no significant increase in the number of policies on mental health and sexually transmitted infections. The above shows that the government does not pay attention to the demand side of the adolescent physical health policy, especially adolescent mental health.

5. Discussion

From the above analysis, it can be seen that the supply-side policy tool is the driving force of Chinese adolescents’ physical health policy. When making policy in the future, we should strengthen the supply-side policy tools to maintain their position. Demand-side policy tools are the engine driving adolescent health policy development and can be increased as appropriate to ensure improved adolescent health. Environmental policy tools are the medium to coordinate the use of policies, so the use of environmental policy tools should be reasonably guaranteed. When formulating adolescent physical health policies in the future, the government should monitor the development of adolescent physical health through scientific and technological means. Under the supervision and protection of adolescents’ physical health, an assessment mechanism for adolescents’ physical health needs should be established.

In the future, the policy shortcomings of the main body of adolescent health should also be made up. Governments should introduce policies that directly affect the health of young people. It is undoubtedly the right choice to strengthen the evaluation and management of physical health of young people at the grass-roots level. At the same time, it is equally important to carry out school sports activities and attach importance to school mental health education.

Moreover, in addition to employing content analysis and quantitative methods, this study also incorporated qualitative research on policy documents. Particularly in the context of investigating adolescent physical health policy in China, qualitative research methods have the potential to provide a more comprehensive and in-depth understanding by delving into the intentions, values, and underlying motivations within policy texts. They can assist researchers in uncovering the goals and intentions embedded within policy documents, as well as in revealing the motivations of policy makers and their desired outcomes. Furthermore, qualitative research can shed light on the influence of values in policy formulation. While policy documents typically present the finalized policy content, qualitative research can help us understand the process of policy formulation and the roles played by different stakeholders in it.

In studies focusing on adolescent physical health, we might also want to consider the relationship between sport, physical education, and broader forms of physical culture/physical culture. While sport, physical education, and broader forms of physical culture/body culture have distinct characteristics, they are interconnected and mutually beneficial, as physical education programs can introduce students to a variety of sports and physical activities, promoting skill development and fostering an appreciation for physical culture. In the context of adolescent physical health policy in China, it is crucial to recognize the potential synergies between these elements. Policies should strive to integrate sport, physical education, and broader forms of physical culture/body culture to provide a comprehensive and inclusive approach to promoting adolescent physical health. This integration can facilitate a holistic development of physical abilities, encourage lifelong engagement in physical activities, and cultivate a positive attitude towards physical well-being among Chinese adolescents.

It is important to note that while it is right to promote sports to help adolescents and children improve their physical health, it does not mean that all youth and children need to be physically active, as some sports can lead to developmental injuries that can hinder normal physical development and make it difficult for them to make lifelong physical progress. In addition, there are some adolescents who need a specific body type or height to help them reach some of their goals, such as rugby players who need to be overweight and gymnasts who need a lower height.

6. Limitations

In the process of analyzing the 12 policies, we must acknowledge certain limitations in the study. Firstly, the reliance on policy text analysis as the primary method may overlook the nuances and complexities that exist beyond the written policy documents. Implementation gaps and discrepancies between policy intent and on-ground practices may not be adequately captured through this approach. Furthermore, this study focuses only on the physical health benefits of exercise in the policy text and may overlook other beneficial effects of exercise on adolescent children as they grow up, such as mental health, moral health, and social relationships. Lastly, the research’s generalizability may be limited to the specific timeframe and geographical context in which the policy texts were analyzed, as policy frameworks and priorities can evolve over time and differ across regions.

7. Conclusions

This paper investigated the overall application of physical health policy tools, contents, and subjects. At the same time, this paper discussed the characteristics of the current application of adolescent health policy. Our study contributed to a better understanding of the experiences and strategies of adolescent physical health management in China. The results of this study can provide guidance for policy makers to formulate future adolescent physical health policies, which will promote adolescent physical fitness and mental health development.

The following are the conclusions of this study:

(1)

China needs to further expand the demand-side and environment-side supply of youth physical health policies and further optimize the distribution of policy structures.

(2)

China’s youth physical fitness policy is gradually increasing its content on “health governance” and “physical safety”, but there is less content on the power of science and technology and the creation of an environment to improve youth physical fitness.

(3)

Schools no longer bear the primary responsibility for the physical health of young children. The use of supply-side policies by government and society is gradually increasing.

(4)

In the future, we should strengthen the development of demand-driven policy tools, increase demand-side and environment-side policies, and give full consideration to policy synergy.

In addition, there are no specific studies on adolescent health policies in different regions and ethnic groups. We are unable to further understand the situation and characteristics of Chinese adolescent health policies in specific regions under such restrictions. Future research should collect more textual data, including data of different countries, different regions, and different ethnic groups, and explore the characteristics and application effects of these data.