Health behaviour and health behaviour change theories that focus on individual characteristics, and are not put into the broader context in which an individual lives, will leave many factors that influence health unexplained (Nutbeam 1998). The Ottawa Charter for Health Promotion advocates a comprehensive approach to public health and health promotion practice by, for example, emphasising the role of healthy public policy, the social and physical aspects of the health environment, and community education in health advocacy and action (O'Connor 1995). To encompass this, many health promotion initiatives utilise the settings in which people live, work or play to bring about healthy behaviour change. Sporting organisations as settings have been recognised for their potential to promote and create health promoting environments, and are the focus of this review.

Globally, over 60% of adults do not participate in a sufficient amount of sport and physical activity (UN 2003). Participation in sport is being addressed by the authors in a concurrent review entitled "Interventions implemented through sporting organisations for increasing participation in sport" (Howes 2004). Participation in sport or physical activity alone may or may not lead to other healthy behaviours such as smoking cessation and healthy eating. However, health promotion theory and evidence from successful health promotion campaigns show that environmental and policy changes must accompany behavioural change approaches to make the 'healthy choice the easy choice'. Policy interventions used within the sporting organisation setting are another means of targeting risk behaviours such as: smoking, harmful or hazardous alcohol consumption, excess sun exposure, unhealthy eating, and discrimination.

These risk factors are prevalent and have significant health consequences. In the developed world, smoking is considered the single most important preventable health risk and is an important cause of death worldwide (Fagerstrom 2002). Globally, the estimated number of deaths attributable to smoking in the year 2000 was 4.9 million (over one million more than it was in 1990), with the increase being most marked in developing countries (WHO 2002).

Alcohol consumption has increased worldwide in recent decades, with most or all of this occurring in developing countries (WHO 2002). The proportion of deaths and global disease burden however, was greatest in the Americas and Europe. Alcohol has been estimated to cause, worldwide, 20 to 30% of oesophageal cancer, liver disease, epilepsy, motor vehicle accidents, homicide and other intentional injuries (WHO 2002).

Skin cancer rates in Australia are the highest in the world (PHAA 2002) and it is the most common form of cancer in the United States (CDC 2003). Exposure to the sun's ultraviolet rays appears to be the most important environmental factor involved in its development (CDC 2003).

The overall burden of disease associated with diet is difficult to assess (Mathers 1999). Overweight and obesity lead to adverse metabolic changes including increases in blood pressure, unfavourable cholesterol levels and increased resistance to insulin, raising the risks of cardiovascular disease, stroke, diabetes mellitus and many forms of cancer (WHO 2002). According to the American Cancer Society, about one third of all cancer deaths in the United States are attributable to dietary risk factors (CDC 2002). Adopting healthy behaviours to prevent or delay disease onset is well illustrated in the case of type 2 diabetes. A multi‐centre randomised controlled trial demonstrated that lifestyle changes reduced the risk of developing type 2 diabetes, in those at high risk of developing the disease, by 58% (Knowler 2002).

Krieger (2000) outlined the health consequences of discrimination. They include social deprivation and socially inflicted trauma (mental, physical or sexual). Also relevant are the health consequences of peoples' responses to discrimination, which may include internalised oppression and the use of psychoactive substances (Krieger 2000).

Many sporting organisations derive funding from governments and health promotion associations. Funding to the sport sector can be quite substantial. The United Kingdom, for example, has allocated two billion pounds sterling of Government and lottery money to sport over three years (UKG 2002). Australia's annual investment in sport and recreation in 2001‐2002 was just over 758 million pounds (ABS 2000‐2001), and South Africa invested just over 737 million pounds in the same time period (SRSA 2001‐2002). Contractual funding agreements may require the introduction of health promoting policies (Corti 1996), therefore reviewing the effects of health promotion interventions within the sport sector is important.

In Australia, the National Health and Medical Research Council (NHMRC) has recognised sporting organisations as an important setting for improving the health outcomes of individuals (Corti 1996). Sport settings are considered appropriate for the conduct of health promotion activities because: participation is likely to benefit physical, mental and social health; there is the potential to reach large numbers of people; those who access sport settings have elevated risk behaviours (cross‐sectional data from the Western Australian Health Promotion Foundation, Healthway, found that those involved in sport had elevated risk behaviours in nearly all areas except physical activity participation, such as consumption of alcohol at unsafe levels and poor sun protection); many issues of importance to public health can be aligned to sport sector interests; and physical venues can be health promoting through structural and environmental policies (Corti 1996).

The World Health Organization (WHO) identified settings as a means for health promotion as they offer practical opportunities for the implementation of comprehensive strategies (WHO 1997). The settings approach is consistent with the view that health and health behaviour are greatly influenced by environments (Kelleher 1998). Health promotion theory underpins the relationship between settings and the behaviour of individuals. For example, Social Learning Theory defines human behaviour as a triadic, dynamic, and reciprocal interaction of personal factors, behaviour and the environment. An individual's behaviour is uniquely determined by each of these three factors (Stone 1998). This theory avoids overly simple solutions to health problems which focus on behaviour in isolation from the physical and social environment (Nutbeam 1998). Nutbeam and Harris (1998) provide a case in point when illustrating Social Learning Theory: a young woman who is quitting smoking may be very confident in her ability to abstain at work where smoking is banned and none of her workmates smoke, but she may be less confident when she goes out (to a sporting fixture where smoking is not banned) with her friends who are heavy smokers (own example in italics).

Evaluation of policy level interventions is difficult. Ideally one wants to show that the intervention strategy led to policy change, the policy change produced the desired behaviour and the behaviour then contributed to the health outcome (Clark 1998). Making clear connections may be impossible and the challenge may be to identify indicators that most would accept as reliable and valid signs that change is occurring in the desired direction (Clark 1998). Hence, immediate and intermediate behavioural outcomes are often used to measure the effectiveness of interventions. These may include intention to change behaviour, or increased knowledge and shifts in attitudes and beliefs. This review will include these outcomes as well as actual behaviour change.

Process factors are also important to include. A survey carried out in sports clubs found that clubs had difficulty with developing healthy policies due to lack of training and resources, and if they had limited control over their facilities (Dobbinson 2002). These issues need to be identified to determine factors important to the effectiveness of interventions. Historical and socio‐political contextual factors are also of relevance, as these factors may influence the effects of interventions in particular settings and at particular times.

In this review, policies will be defined as laws, regulations, formal or informal rules and understandings that are adopted on a collective basis to guide individual and collective behaviour. This includes legislation and organisational policy. Legislation includes formal, documented policies that influence laws enacted by relevant governing bodies. Organisational policies are policies implemented within specific organisations that define and establish appropriate behaviour within the realms of the organisation (Salmon 2000). We will consider policies that alter either the physical environment (eg. erection of a sun‐shade cloth), and/ or the socio‐cultural environment (eg. anti‐vilification policies).

Participation will be defined as per the Active Australia framework. Thus participation is "not just confined to a role as a player, but includes involvement as a coach, instructor, teacher, administrator, manager, official and volunteer, etcetera" (SRMC 1997). The definition for sporting organisation has been modified from that used in the Australian Sports Commission Amendment Bill 1999 (ASCAB 1999): sporting organisations include any organisation that controls sports or sporting events; organises or administers sports or sporting events; accredits people to take part in sporting competition; provides teams to compete in sporting competition; or trains, or provides finance for people to take part in sporting competition, and encompasses professional and amateur sporting bodies.

The authors are currently unaware of any systematic reviews of policy interventions implemented through sporting organisations for promoting healthy behaviour change.