Play provides important health benefits for children as well as providing opportunities for exploration, joy, and expression. In particular, children’s opportunities for outdoor play and adventurous play, where they can explore risks, have been linked to a range of health behaviors and outcomes including increases in habitual and acute physical activity1,2 as well as better mental health and positive mood.3
The British Children’s Play Survey (BCPS) was conducted in 2020 to provide a detailed assessment of the play of 5- to 11-year-old children living in Britain (England, Scotland, and Wales).4 This national survey examined how frequently children played in a range of locations as well as how long and how adventurously they played in each place. The BCPS provided important national data that can be used to track changes and trends in play over time and to identify where inequalities in outdoor play exist, which is important for informing public health interventions. No comparable data are available for younger, preschool-aged children living in Britain. International research has also focused primarily on school-aged children’s play,5,6 although recent research from the United States found that preschool children’s ethnicity, sex, and the area where they live are associated with outdoor play.7 Where data on the outdoor play of preschoolers exists, it often focuses exclusively on childcare settings8 or relies on basic information about play.7,9
Outdoor play during the preschool years is vitally important, as the foundations for a healthy life are laid in early childhood. The most recent guidance from the UK Chief Medical Officer recommends that preschool-aged children are physically active for at least 180 minutes per day,10 with outdoor play specifically noted as an important way for children to attain this goal. The Physical Activity Guidelines for Americans similarly suggest that 3 hours per day is a reasonable target for preschool children and recommend that adults support active play in children of this age.11 Indeed, preschool-aged children themselves describe that their physical activity occurs primarily through play.12 Physical activity during the early years is associated with healthy development including improved adiposity, motor skill development and cardiometabolic health indicators,13 reduced likelihood of overweight,14 and improved bone mineral density and content in middle childhood.15 Similarly, children who have better mental health as preschoolers are less likely to have a mental health disorder in middle childhood.16,17
Given the absence of research on preschool-aged children’s outdoor play, the aim of this study is to provide the first nationally representative data on preschoolers play in Britain. We first examine how much time preschool-aged children spend playing in a range of indoor and outdoor spaces. Second, we explore how adventurously preschool-aged children play in each place. Finally, we examine how time spent playing, including playing outdoors and playing adventurously, varies across sociodemographic groups and geographic locations.
Methods
Participants
Participants were recruited via YouGov, which is a public opinion research company with over 1 million adult panelists in the United Kingdom. They were commissioned by the authors to collect data from a sample who were approximately national representative. YouGov panelists are recruited from a range of sources to ensure that there is diversity on the panel. For the present study, they drew on a subsample of the national panel that is representative of British adults and used active sampling, inviting specific panelists (ie, those with children in the target age range) to complete the survey. Participants gave informed consent (Cambridge University Ethics HSSREC.22·312), completed the survey online, and were given YouGov reward points in compensation for their time. Once data collection was complete, the final data set was weighted to the national profile of all adults aged 18+, including those without internet access. YouGov weighted the data based on age, gender, social class, region, and level of education. Analyses are conducted in a manner that takes these survey weights into account. Full demographic details of the final sample (without weights) are shown in Table 1.
Sample Characteristics
| Characteristic | N | % |
|---|---|---|
| Respondent sex | 1166 | |
| Male | 398 | 34 |
| Female | 768 | 66 |
| Child sex | 1166 | |
| Male | 604 | 52 |
| Female | 562 | 48 |
| Respondent age | 1166 | |
| 18–24 | 57 | 5 |
| 25–34 | 356 | 31 |
| 35–44 | 702 | 60 |
| 45–54 | 40 | 3 |
| 54+ | 11 | 1 |
| Child age | 1166 | |
| 2 y old | 327 | 28 |
| 3 y old | 418 | 36 |
| 4 y old | 421 | 36 |
| Relationship to child | 1166 | |
| Mother | 738 | 63 |
| Father | 379 | 33 |
| Stepparent | 26 | 2 |
| Grandparent | 15 | 1 |
| Child birth order | 1166 | |
| First-born | 632 | 54 |
| Second-born | 379 | 33 |
| Third or more | 155 | 13 |
| Respondent ethnicity | 1144a | |
| White | 1003 | 88 |
| Minority | 141 | 12 |
| Prefer not to say | 22 | 2 |
| Employment status | 1166 | |
| Working full-time | 592 | 51 |
| Working part-time | 311 | 27 |
| Student | 19 | 2 |
| Retired | 8 | 1 |
| Unemployed or not working | 181 | 16 |
| Other | 55 | 5 |
| Education level | 1137a | |
| Low | 176 | 15 |
| Medium | 340 | 30 |
| High | 621 | 55 |
| Marital status | 1166 | |
| Married or living as married | 980 | 84 |
| Separated, divorced or widowed | 51 | 4 |
| Never married | 135 | 12 |
| GB region | 1166 | |
| England | 1010 | 87 |
| London | 273 | 23 |
| North | 203 | 17 |
| Midlands | 112 | 10 |
| East | 137 | 12 |
| South | 285 | 24 |
| Wales | 54 | 5 |
| Scotland | 102 | 9 |
| Location | 1160a | |
| Urban | 919 | 79 |
| Town or fringe | 128 | 11 |
| Rural | 113 | 10 |
| Social class | 1166 | |
| Middle class (ABC1) | 739 | 63 |
| Working class (C2DE) | 427 | 37 |
| Respondent disability | 1140a | |
| Yes, limited a lot | 131 | 11 |
| Yes, limited a little | 73 | 6 |
| No | 936 | 82 |
| Child learning disability | 1166 | |
| Yes | 72 | 6 |
| No | 1000 | 86 |
| Prefer not to say | 38 | 3 |
| Don’t know | 56 | 5 |
| Child physical disability | 1166 | |
| Yes | 26 | 2 |
| No | 1078 | 92 |
| Prefer not to say | 34 | 3 |
| Don’t know | 28 | 2 |
Abbreviation: GB, Great Britain.
aThere is missing data on this variable. Full sample = 1166 respondents.
Procedure
YouGov used active sampling to invite members of their research panel via email to complete the survey online. This means that only those members who sent the invite were able to participate. Participants were initially asked to indicate whether they were parents of children aged 2–4 years. Those who indicated they had children within this age range were then presented with the full survey and asked to answer for their oldest child within the age range. All respondents were given YouGov points for completing the survey. These can be redeemed for payment once a certain number of points has been reached. Sample size was pragmatic and driven by available funding; it is one of the largest studies to examine preschool-aged children’s play internationally.
Measures
The survey was designed to closely mirror the BCPS to support comparisons across data sets. Detailed explanations of each of the measures are provided in the original BCPS paper.4 This paper uses the following measures, which formed part of the wider survey.
Outcome Variables: Children’s Play Scale
The Children’s Play Scale (CPS)4,18 is designed to give an approximation of the number of hours children spend playing in a range of locations during a typical year, excluding screen play and play while at school/childcare. Parents indicate how frequently their child plays in a series of places when they are not in childcare (at home or in other people’s homes, outside at home or at other people’s homes [eg, garden/yard/balcony], at a playground, in trees/forests/woodland/grassy spaces [not including the garden at home or other people’s homes], in the street or public places close to home, outdoors near water [eg, at the beach, in the sea, near a river, lake or cliffs], indoor play centers and pools [eg, soft play, trampoline parks, swimming pools, etc]). For conciseness, the “trees/forests/woodland/grassy spaces” category will be referred to as “green space,” “street or public places” will be referred to as “street,” and the final category will be referred to as “indoor play centers.” Parents were then asked how long their child typically plays for in each place.
For both frequency and length of time, parents were asked about autumn/winter and about spring/summer separately because during the development of the measure parents said that their responses would differ by season. Supplementary Table S1 (available online) shows the breakdown of play by seasons; as expected children spent more time playing in all outside locations in the spring/summer compared with autumn/winter, and children spent more time playing inside at home during the autumn/winter. No seasonal difference was found for indoor play centers (Supplementary Table S1 [available online]). Because the CPS is designed to give overall play hours per year, we focus on this for the main analyses. Responses were converted into number of hours per year each child spends playing in each place. Using these data, we created 2 outcome variables: (1) total time spent playing (derived by summing the amount of time children spent playing in all locations in both autumn/winter and spring/summer), and (2) total time spent playing outdoors (derived by summing the time spent playing at outdoor locations).
The adventurous play supplement of the CPS was also used. This asked parents to indicate how adventurously their child plays at each play location using a scale from 1 (very low levels of adventure) to 5 (maximum levels of adventure). Responses were used to create a third outcome variable: (3) total time spent playing adventurously (derived by adding together the time spent playing in places where the child was reported to play with at least a mild level of adventure [2 on the Likert scale]).
Sociodemographic and Geographic variables
Respondents completed a range of questions regarding sociodemographic and geographic characteristics (see Table 1 for full list). From these, we derived 9 child-level exposures of interest: child age, child sex, child ethnicity, child birth order, child region, child location (urban/rural/town and fringe), child learning disability, child physical disability, and social grade. These variables and hours in childcare per week were also considered as confounders where appropriate, based on existing literature.
Analysis
Descriptive characteristics of the sample were derived and distributions of the outcome variables (total time spent playing, time spent play outdoors, and time spent playing adventurously in hours/year) were assessed. A breakdown of time spent playing and adventure level by location was derived. There were notable outliers in the total time spent playing variables at location level, so the data were winsorized at the 5% and 95% quantile. These winsorized variables were used to create the main outcome variables (time spent playing, time spent play outdoors, and time spent playing adventurously).
To examine how each exposure variable related to our 3 outcome variables, a series of generalized linear models were fitted to the data using the svyglm command in the survey package in R.19 This allowed us to account for survey weights and, by using factors such as child and responser sex, location, and ethnicity, align the sample to be representative of the British population. We generated Directed Acyclic Graphs (DAGitty software),20 for each exposure—outcome relationship, to inform which covariates were included in each model (see Supplementary Material [available online]). We ran both unadjusted univariable analyses, and multivariable analyses adjusted for relevant covariates. Results are provided for direct effects only. For these generalized linear models, square-root transformed versions of the outcome variables were used to account for significant skew. Additional post hoc exploratory analyses were planned to facilitate understanding of any significant exposure–outcome associations; each such exposure was evaluated in relation to time spent playing in each of the 7 play locations. All analyses were conducted in R Studio (version 2023.12.0) running R (version 4.3.2). The analysis script, data, and output are available via http://doi.org/10.5255/UKDA-SN-9308-1.
Missing Data
Some participants opted not to provide all demographic information. Table 1 shows the total number of participants who responded to each demographic item. There was missing data for ethnicity (2%), education level (2.5%), location (<1%), and respondent disability (2%). There was also some missing data for adventurous play level where parents were able to respond “don’t know.” This ranged from 2% to 3% across locations. Given the low rates of missing data and the large sample size, no imputation was conducted21 and analyses used all available data.
Results
Participants were 1166 parents or carers of children aged 2–4 years (mean = 3.08 y, SD = 0.8 y) living in Britain (England, Scotland, or Wales); Table 1 shows the sociodemographic and geographic characteristics of the total sample.
Total hours spent playing (mean = 1467, SD = 736) was correlated with time spent playing outside (mean = 641, SD = 409), r = .71, P < .001, and hours playing adventurously (mean = 1165, SD = 812), r = .67, P < .001; hours spent playing outside correlated with hours spent playing adventurously, r = .64, P < .001. Outside of formal childcare, on average, preschool-aged children were reported to spend around 4 hours a day playing. Of this, around 1 hour 45 minutes per day was reported to happen outside.
Time Spent Playing Across Play Locations
Figure 1 shows the average number of hours preschool-aged children were reported to spend playing in each place. Children were reported to spend substantially more time playing at home than anywhere else (F1,6 = 602.44, P < .001). Away from home, children spent the most time playing in playgrounds, followed by green space; relatively little time was spent playing at indoor play centers, on the street near their home or near water across the course of the year.
—Mean time spent playing in each place per year (error bars show 2 SEs).
Citation: Journal of Physical Activity and Health 21, 11; 10.1123/jpah.2024-0155
Adventure Levels Across Play Locations
Figure 2 shows the average levels of adventure respondents reported for each place. There was a significant difference in adventure level across locations (F1,6 = 138.19, P < .001), with the most adventurous play reported to happen in indoor play centers, followed by at playgrounds and in green space. Play at home was rated as the least adventurous.
—Mean levels of adventure report across play locations (error bars show 2 SEs).
Citation: Journal of Physical Activity and Health 21, 11; 10.1123/jpah.2024-0155
Correlates of Play Outcome Variables
Generalized linear model analyses presented focus on direct effects between child-level exposures and each of the 3 play outcome variables, adjusted for relevant covariates (see Table 2 for exposure–outcome results and Supplementary Material [available online] for covariates adjusted for in each model).
Coefficients and 95% Confidence Intervals for Each Exposure–Outcome Association (Bold Indicate Statistical Significance)
| Time spent playing | Time playing outside | Time spent playing adventurously | |
|---|---|---|---|
| Child age | B = −0.52 | B = 0.64 | B = −0.27 |
| −1.34 to 0.30 | −0.02 to 1.30 | −1.40 to 0.87 | |
| Child sex (ref males) | B = −0.83 | B = −1.28* | B = −1.29 |
| −2.08 to 0.43 | −2.31 to −0.25 | −3.00 to 0.41 | |
| Child ethnicity | B = −4.83*** | B = −2.57* | B = −2.37 |
| −7.24 to −2.41 | −4.60 to −0.54 | −5.75 to 1.02 | |
| Child birth order | B = −0.17 | B = −0.40 | B = −1.10 |
| −1.40 to 1.06 | −1.42 to 0.62 | −2.82 to 0.62 | |
| Learning disability | B = −1.02 | B = −0.79 | B = −2.76 |
| −3.94 to 1.90 | −3.10 to 1.51 | −6.96 to 1.43 | |
| Physical disability | B = −1.34 | B = −0.12 | B = 0.30 |
| −5.89 to 3.21 | −4.98 to 4.74 | −6.18 to 6.78 | |
| Location (ref cat: urban) | |||
| Town/fringe | B = 0.83 | B = −0.08 | B = 2.59 |
| −1.23 to 2.89 | −1.78 to 1.62 | −0.15 to 5.34 | |
| Rural | B = 2.64** | B = 1.04 | B = 0.29 |
| 0.87 to 4.42 | −0.43 to 2.51 | −2.42 to 3.00 | |
| Social grade | B = 0.67 | B = 0.03 | B = −0.87 |
| −0.69 to 2.02 | −1.10 to 1.16 | −2.71 to 0.98 | |
| Region (ref cat: Scotland) | |||
| London (England) | B = −0.71 | B = −1.65 | B = −2.15 |
| −3.21 to 1.80 | −3.71 to 0.41 | −5.36 to 1.07 | |
| North (England) | B = 0.37 | B = −1.94 | B = −0.40 |
| −2.27 to 3.02 | −4.06 to 0.18 | −3.84 to 3.03 | |
| Midlands (England) | B = 0.43 | B = −1.16 | B = 0.04 |
| −2.40 to 3.27 | −3.52 to 1.19 | −3.82 to 3.91 | |
| East (England) | B = −2.25 | B = −1.65 | B = −2.72 |
| −5.19 to 0.68 | −4.10 to 0.80 | −6.54 to 1.09 | |
| South (England) | B = 0.23 | B = −0.64 | B = −0.62 |
| −2.32 to 2.78 | −2.72 to 1.44 | −3.84 to 2.59 | |
| Wales | B = −2.10 | B = −1.11 | B = 0.07 |
| −5.56 to 1.37 | −3.87 to 1.66 | −4.06 to 4.21 | |
Abbreviation: ref cat., reference category. Note: Child age adjusted for childcare, physical disability, and learning disability. Child sex adjusted for physical disability and learning disability. Child ethnicity adjusted for childcare, social grade, region, location, birth order, physical disability, and learning disability. Child birth order adjusted for childcare, social grade, and ethnicity. Child learning disability adjusted for childcare, child age, child sex, physical disability, ethnicity, and social grade. Child physical disability adjusted for childcare, child age, child sex, learning disability, ethnicity, and social grade. Location adjusted for childcare, ethnicity, region, and social grade. Social grade adjusted for childcare, ethnicity, physical disability, learning disability, and region. Region adjusted for childcare, ethnicity, location, and social grade.
*P < .05. **P < .01. ***P < .001.
Ethnicity and location were significant predictors of total time spent playing, after controlling for their respective confounding variables. Children living in rural areas were reported to spend more time playing overall than children living in urban areas. Children who were described as belonging to a minority ethnic group spent less time playing overall than children who were identified as being white.
For total time spent playing outdoors, child sex and ethnicity were significant predictors after controlling for their respective confounding variables. Girls spent less time playing outdoors than boys. Children who belonged to a minority ethnic group spent less time playing outside than children who were identified as being white.
None of the exposures explored were significantly associated with time spent playing adventurously (P > .05).
Exploratory Post Hoc Analyses
To further explore the significant effects in more detail, we examined location, ethnicity, and child sex as predictors of time spent playing in each of the 7 play locations (retaining the same confounders as indicated in the Directed Acyclic Graphs, see Supplementary Material [available online]). Location was a significant predictor of time spent playing at home, in the garden, and near water. Relative to children in urban areas, children in rural areas played more at home (B = 152.00; 95% confidence interval [CI], 46.89 to 257.12; P = .005), more in the garden (B = 46.18; 95% CI, 2.37 to 89.99; P = .039), and less near water (B = −11.72; 95% CI, −22.65 to −0.79; P = .036). Furthermore, children living in town/fringe areas spent slightly less time playing at playgrounds relative to those living in urban settings (B = −20.89; 95% CI, −41.32 to −0.45; P = .045). Children from non-white ethnicities played less at home (B = −212.15; 95% CI, −320.97 to −103.33; P < .001), in the garden (B = −59.36; 95% CI, −109.59 to −9.12; P = .021), and in green space (B = −34.83; 95% CI, −57.51 to −12.14; P = .003), but more on the street close to their home (B = 26.07; 95% CI, 4.32 to 47.81; P = .019), relative to children from white ethnicities. Girls play less in green spaces compared to boys (B = −19.72; 95% CI, −32.93 to −6.51; P = .003), with no significant child sex differences found for the other 6 play locations.
Discussion
This is the first national study of preschool children’s play in Britain. We examined where children play, how adventurously they play in different locations, and how time spent playing varied by child-level sociodemographic and geographic characteristics.
Our findings demonstrate that preschool-aged children living in Britain spend, on average, more time playing inside than they do outside, with the majority of play happening inside at home. When outdoor play does occur, it most often takes place in gardens or in other outside space at home, followed by at playgrounds and in green space. Given associations between outdoor play and children’s health,1 these findings demonstrate how inequalities in access to outdoor space could translate to inequalities in children’s health.
The most adventurous play in preschool-aged children was reported to happen at indoor play centers, playgrounds, and in green spaces, corresponding to the top 3 locations for adventurous play in school-aged children.4 These findings further emphasize the importance of playgrounds and green spaces for supporting children’s play. Interestingly, they also suggest that indoor play experiences such as soft play and trampoline parks provide opportunities for young children’s adventurous play. These commercial play opportunities are a relatively new addition to western societies and their popularity is growing.22 This popularity may be driven by indoor play centers providing adventurous play experiences for children that overcome some of the barriers to outdoor adventurous play such as traffic, weather, and safety concerns.23–25 They may also be perceived by parents and carers to be “safer” than traditional outdoor spaces, although injuries are in fact quite common.26 While indoor play centers may provide opportunities for thrilling and adventurous play, they cannot compensate for the overall decline in outdoor, adventurous play for a number of reasons.4,27,28 Firstly, because children spend relatively little time in these spaces. Secondly, because they typically charge an entrance fee and are therefore not accessible to everyone. Thirdly, because they do not support connection with the natural environment or local community. Thus, indoor play centers may offer children of all ages new and exciting adventurous play opportunities, but do not replace the need for local, easily accessed outdoor adventurous play opportunities.
Children who were described as belonging to a minority ethnic group were reported to spend less time playing overall and less time playing outdoors in this sample. This aligns with findings in US preschoolers, where children belonging to all minority groups were reported to spend less time playing outdoors than white children,7 and in British school-aged children.4 When we examined group differences by individual play location, children belonging to minority ethnic groups were found to spend less time playing across a range of spaces. We were not able to explore the reasons for these differences, but drawing on previous research, they may be driven by a broad range of factors such as the availability of local green space, 29,30 exclusion from green space on the grounds of race,31,32 differential emphasis on academic learning versus unstructured play, and parenting pressures.33 In England, individuals of black, Asian, or minority ethnic origin are more than twice as likely to live in areas most deprived of green space, relative to those who are white.34 Although our sample aligns with the British population as a whole, we were unable to explore differences between different ethnic minority groups due to small sample sizes in each group, combining all non-white groups for analyses. This inability to assess between-group variation potentially masks important differences that exist between ethnic groups. For example, data from the UK Millennium cohort showed differences in children’s overall levels of physical activity by ethnic group.35 Furthermore, even broad ethnic group categories are likely to be overly simplistic; Bautistia et al33 found that, within Asia, different sociocultural characteristics affect children’s play opportunities (or lack thereof) within distinct jurisdictions. Further research focused on the experiences of specific minority ethnic groups, ideally using a mixed methods approach, would enable a more nuanced understanding of our overarching findings.
As seen with physical activity, clear sex differences were apparent in preschool-aged children’s play, with girls spending less time playing outdoors. Again, this finding has been noted for older British children4 and preschoolers in the United States.7 Importantly, closer examination of sex differences by play location revealed that this difference was driven by preschool-aged girls spending significantly less time playing in green spaces than boys. Time spent in nature shows robust positivity associated with a range of health benefits, including mental well-being, overall health, and cognitive development,36 and exposure to biodiverse forest floor vegetation and sod may lead to better immune system regulation.37 Early differences in time spent in nature may therefore have long-term implications for the health of girls. This is particularly important because girls have lower levels of physical activity and higher prevalence of emotional problems such as anxiety and depression, relative to boys.38,39 While we cannot confirm why these sex differences were reported, gender socialization and stereotyped roles are already present in preschool-aged children.40 It is therefore possible that identified sex differences are driven by gender-role perceptions that girls should not get dirty or by perceptions about the different types of play that girls and boys (should) engage in. 41,42 Further research aiming to understand why these differences emerge is needed, given the large apparent disparities at such a young age and the known persistence of gender differences in physical activity throughout childhood.
Strengths and Limitations
This research is the first study to assess play and potential correlates in a nationally representative sample of British preschool-aged children. It uses a robust validated tool to assess types and levels of children’s play and explores a range of potential exposures. It highlights where play opportunities may be limited in some groups, potentially exacerbating health inequalities, and, in turn, where there are opportunities to reduce inequalities through the provision of improved play opportunities. It uses population-level survey weights to ensure the sample is representative of British children, reducing the risk of sampling bias, and also samples from a breadth of geographical locations, socioeconomic strata, gender of child, and respondents and ethnic groups. Play data were collected using parent report: while this is an efficient means of collecting large-scale national data, it often lacks the detail required to provide a complete understanding of the factors that underpin some of the group level differences found. Furthermore, parent-report provides only the parent’s perception of the child’s play and is necessarily only an estimate of their total time spent playing. Diary measures, device-based assessment of physical activity, and geolocation tagging may be ways to provide greater evidence of where children are playing and how, as well as qualitative research that explores caregivers’ decision making and motivations regarding their child’s play. Finally, as outlined previously, although the sample size was one of the largest, if not the largest to explore play in preschool-aged children, we did not have adequately sized groups to examine differences in children’s play across specific ethnic groups.
Conclusion
British preschool-aged children were reported to spend 4 hours per day on average playing outside of childcare, with 1 hour 45 minutes spent playing outdoors. The majority of this play was reported to happen at home, with children most often playing in playgrounds and green spaces when not at home. Indoor play centers were reported to offer opportunities for the most adventurous play, whereas homes provided the least. Ethnicity, child sex, and geographical location significantly predicted play, with children belonging to minority ethnic groups and girls spending less time playing outdoors. The results highlight inequalities in play even in the youngest age group, which may exacerbate existing inequalities in health.
Acknowledgments
The authors would like to acknowledge the contributions of Dr Lily FitzGibbon and Dr Rachel Nesbit whose work on the British Children’s Play Survey facilitated the conduct of this research. Availability of Data and Materials: The data set supporting the conclusions of this article and the analysis code is available in the osf repository at: http://doi.org/10.5255/UKDA-SN-9308. Competing Interests: Dodd has been an unpaid trustee of Play England since autumn 2022. Hesketh has not competing interests. Funding Source: Dodd was supported by a UKRI Future Leaders Fellowship (MR/S017909/1 and MR/X015033/1), Hesketh was supported by the Wellcome Trust (107337/Z/15/Z) and the Medical Research Council (MC_UU_00006/5). For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising from this submission. Author Contributions: Conceptualizing the design of the study and developing the survey questions: Dodd, Hesketh. Analysis of data: Dodd, Hesketh. Drafting of the manuscript: Dodd. Editing of the manuscript: Hesketh. Reading and approval of the final version of the manuscript: Dodd, Hesketh.
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