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Context: As youth sport participation grows, athletic trainers (ATs) continue to be important health care providers in managing growth-related injuries. Objective: To examine secondary school ATs' reported knowledge on diagnosing and treating growth-related injuries and reported confidence for determining growth status and to report methods secondary school ATs use to determine patient growth status. Design: Cross-sectional. Setting: An online questionnaire was distributed to secondary school ATs in the United States. Data collection occurred in the summer of 2021 over a 6-week period. Patients or Other Participants: A total of 430 secondary school ATs (highest degree earned: master's degree 5 66%). Main Outcome Measures: The questionnaire contained secondary school ATs' confidence in determining if an athlete was going through a growth spurt, level of knowledge on diagnosing and treating growth-related injuries, methods secondary school ATs use to determine growth status in their athletes, and demographics. Results: Most secondary school ATs believed that growth spurts affected sport-related injury risk (88%); however, only 37% of secondary school ATs were "fairly" or "completely" confident in their ability to determine if an athlete was going through a growth spurt. For those 37% of secondary school ATs, 89% of them used history or observation over time, but no formal method, for determining growth status of their patients. Patient self-assessed Tanner stages (32%) and clinical evaluation of Tanner stages (28%) were the next most used methods for assessing growth. Conclusions: In accord with Domain I of athletic training, secondary school ATs could benefit from improved knowledge on how to measure and manage growth in their patient population. To aid education in this area, future researchers should focus on assessing barriers secondary school ATs face in implementing methods for measuring growth and exploring secondary school ATs' knowledge levels on risk management programs for youth athletes going through growth spurts.

Sport specialization was thought to affect a relatively small number of elite athletes, but it is now a common practice in youth sport culture. Recent research in the field of sport specialization has led to a better understanding of the influence this issue is having on youth (ie, younger than 19 years of age) today. This review focuses on sport specialization from a public health perspective to elucidate the effect that this practice is having within the United States. The specific goals of this review are to describe (1) the prevalence of sport specialization and the factors that may affect the decision to specialize, (2) the costs of youth sport-related injuries in the context of sport specialization, (3) the financial costs that sport specialization has for families, and (4) how sport specialization may be affecting physical literacy.

Context: Studies have illustrated that overuse injuries occur in adolescent athletes more often than previously reported. The general purpose of this study was to provide a thorough report of secondary school athletic trainers encounters, practices, and perceptions of overuse injury in adolescent athletes. Design: Cross-sectional. Methods: An anonymous online questionnaire was distributed via email to athletic trainers in the secondary school setting. The questionnaire was sent to participants during the summer of 2021 and 430 participants (highest educational degree earned: master's degree = 66%) completed the survey. Various survey methods were used to evaluate athletic trainers (1) demographics, (2) estimations about what percentage of injuries evaluated and treated were classified as overuse, (3) methods for treating overuse injuries, (4) confidence in treating overuse injuries and the complete implementation of their treatment plan, (5) perceptions of various barriers to treating overuse injuries, and (6) perception as to why patients did not want to reduce activity to treat their overuse injuries. Results: Participants reported that about half of all evaluations and treatments in a year were overuse injuries and they were "fairly" or "completely" confident (90%) in their ability to treat these injuries. The most common treatments cited were stretching (91%) and reducing activity (90%). Only 61% of participants were "fairly" or "completely" confident in the complete implementation of their treatment plan. Participants believed that patients' reluctance to reduce sport activities (82% "moderate" or "extreme" barrier) was the most significant barrier to treatment. Participants cited athletes' avoidance of missing games as the most common reason athletes were reluctant to reduce sporting activity. Conclusions: Participants felt confident in treating overuse injuries yet faced significant barriers in treating these injuries. Clinicians should be prepared to have conversations about the importance of reducing sporting activity to allow proper healing for overuse injuries in adolescent athletes. [ABSTRACT FROM AUTHOR]

Evidence suggests that lower socioeconomic status (SES) and negative social determinants of health (SDOH) contribute to health care disparities. Due to their accessibility in the high school setting, secondary school athletic trainers (SSATs) may encounter patients who are historically underserved in health care, such as patients with low SES. However, a significant gap in knowledge exists regarding how SDOH and SES may influence SSATs' clinical management decisions. To describe SSATs' perceptions of how patient SDOH and SES influence clinical management decisions and to identify barriers to athletic health care. Cross-sectional study. Online survey. National Athletic Trainers' Association SSATs (6.7% response rate). Secondary school athletic trainers were asked about their perceptions of patient SDOH and SES (content validity index = 0.83 for relevancy). The levels of relevance and agreement were answered on a 4-point Likert scale. Data were summarized using means and SDs, frequencies and proportions (%), and median scores. A total of 380 SSATs participated (mean years of experience = 14.9 ± 11.7 years). When providing care, most (71.3%) SSATs believed their patients' health or health care access to be the most relevant of the 5 SDOH, whereas the other 4 SDOH were less than 60% relevant. Most SSATs agreed or strongly agreed that patient SES affected both referral (67.4%) and the reliance on conservative treatment before referral (71.2%). Secondary school athletic trainers identified patient or guardian compliance (70.2%) and type of health insurance (61.5%) as barriers to providing care to patients with low SES. Secondary school athletic trainers perceived health or health care access as the most relevant social determinant when providing care to patients with low SES. When SSATs further considered the SES of patients, they identified all SDOH as barriers that they were ill equipped to navigate as they delivered care and engaged in patient referral. [ABSTRACT FROM AUTHOR]

Although the return to sports during COVID-19 has been associated with improvements in mental health and quality of life (QOL), whether these benefits are primarily due to increases in physical activity (PA) is unknown. To determine whether PA increases were responsible for the improvements in mental health and QOL among adolescents who returned to sport during the COVID-19 pandemic. Cross-sectional study. Wisconsin secondary schools. A total of 559 adolescent athletes (age = 15.7 + 1.2 years, females = 43.6%) from 44 schools completed a survey in October 2020. Demographic information, whether they had returned to sport participation, school instruction type, anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-9), QOL (Pediatric Quality of Life Inventory 4.0), and PA (Hospital for Special Surgery Pediatric Functional Activity Brief Scale). Mediation analysis was used to assess whether the relationships between sport status and anxiety, depression, and QOL were mediated by PA. At the time of the study, 171 (31%) had returned to play and 388 (69%) had not. Athletes who had returned to play had less anxiety (3.6 ± 0.4 versus 8.2 ± 0.6, P <.001) and depression (4.2 ± 0.4 versus 7.3 ± 0.6, P <.001) and higher QOL (88.1 ± 1.0 versus 80.2 ± 1.4, P <.001) and more PA (24.0 ± 0.5 versus 16.3 ± 0.7, P <.001). Physical activity explained a significant, but small, proportion of the difference in depression (22.1%, P =.02) and QOL (16.0%, P =.048) but not anxiety (6.6%, P =.20) between athletes who had and those who had not returned to play. Increased PA was responsible for only a small portion of the improvements in depression and QOL among athletes who returned to sports. This suggests that most of the mental health benefits of sport participation for adolescents during the COVID-19 pandemic were independent of the benefits of increased PA. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the changes in mental health, quality of life (QOL) and physical activity (PA) among adolescent athletes during the COVID-19 pandemic as organised sports resumed.Methods: Adolescent athletes completed surveys including demographic and sport participation information, 7-item Generalized Anxiety Disorder, 9-item Patient Health Questionnaire, Pediatric Quality of Life Inventory and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale in May 2020 following COVID-19-related sport cancellations (Spring20) and after returning to sports in May 2021 (Spring21). The groups were balanced by inverse propensity score weighting and compared using analysis of variance models and ordinal regression models.Results: 17 421 participants were included (Spring20=13 002; Spring21=4419; 16.2±1.2 years; 53% female). Anxiety was significantly lower (better) in Spring21 (Spring20=7.0, 95% CI 6.9 to 7.1; Spring21=4.9, 95% CI 4.8 to 5.0, p<0.001), as was the prevalence of moderate to severe anxiety (Spring20=29.4%, Spring21=17.1%, p<0.001). Depression was significantly improved in Spring21 (Spring20=7.6, 95% CI 7.5 to 7.7; Spring21=4.6, 95% CI 4.5 to 4.8, p<0.001), as was the prevalence of moderate to severe depression (Spring20=32.2%, Spring21=15.4%, p<0.001). Athletes in Spring21 reported higher QOL (Spring20=79.6, 95% CI 79.3 to 79.9; Spring21=84.7, 95% CI 84.4 to 85.0, p<0.001) and increased levels of PA (Spring20=13.8, 95% CI 13.6 to 13.9; Spring21=22.7, 95% CI 22.6 to 22.9, p<0.001).Conclusion: Early COVID-19 sports restrictions were associated with worsening mental health in adolescents. In 2021, after returning to sports, athletes reported significant improvements in mental health, QOL and PA, although mental health adversities remain an important priority. [ABSTRACT FROM AUTHOR]

Girls' high school volleyball is very popular across the United States. Prospective data are limited regarding the incidence and risk factors of time-loss (TL) and non–time-loss (NTL) injuries sustained in this population. To estimate the incidence and describe the characteristics of injuries (TL and NTL) sustained in a girls' high school volleyball season. Descriptive epidemiology study. Convenience sample of 78 high school interscholastic volleyball programs. Female high school volleyball players participating during the 2018 interscholastic season. Injury rates, proportions, and rate ratios were measured for TL and NTL injuries with 95% CIs. A total of 2072 girls enrolled in the study, and 468 participants (22.5%) sustained 549 injuries (TL = 71.6%, NTL = 28.4%) for an overall injury rate of 5.31 (95% CI = 4.89, 5.79) per 1000 athlete-exposures. The competition injury rate was greater than the practice injury rate for all injuries (injury rate ratio [IRR] = 1.19; 95% CI = 1.00, 1.41) and TL injuries (IRR = 1.31; 95% CI = 1.07, 1.60). Players with a previous musculoskeletal injury had a higher rate of TL than NTL injuries (IRR = 1.36; 95% CI = 1.12, 1.65). Ankle injuries accounted for the greatest proportion of TL injuries (n = 110, 28%), while the greatest proportion of NTL injuries occurred in the hand or fingers (n = 34, 22%). Ligament sprains accounted for 40% of TL injuries (n = 156), whereas muscle or tendon strains (n = 79, 51%) accounted for more than half of all NTL injuries. Although most injuries sustained by adolescent girls' volleyball athletes were TL in nature, nearly a third of all injuries were NTL injuries. Injury characteristics differed widely between TL and NTL injuries. Understanding the most common types and characteristics of injuries among high school volleyball players is critical for the development of effective injury-prevention programs. [ABSTRACT FROM AUTHOR]

Sport cancellations early in the COVID-19 pandemic had a significant negative effect on the health of US adolescents. The effect of restarting sports during the pandemic has not been described. To identify the effect of sport participation on the health of adolescents before and during the COVID-19 pandemic. Cross-sectional study. Sample recruited via social media. Wisconsin adolescent athletes. Participants provided information regarding their age, sex, and sport(s) involvement and completed the Patient Health Questionnaire-9 Item to assess depression symptoms, the Hospital for Special Surgery Pediatric Functional Activity Brief Scale to measure physical activity, and the Pediatric Quality of Life Inventory 4.0 to measure quality of life (QoL). Data were collected in spring 2021 (Spring21; n = 1906, age = 16.0 ± 1.2 years, females = 48.8%), when interscholastic sports had fully resumed, and were compared with similar cohorts of adolescent athletes at 2 time points: (1) spring 2020 (Spring20; n = 3243, age = 16.2 ± 1.2 years, females = 57.9%) when sports were cancelled and (2) 2016–2018 (PreCOVID-19) before the pandemic (n = 5231, age = 15.7 ± 1.1 years, females = 65.0%). Comparisons were conducted via analysis-of-variance models and ordinal regressions with age and sex as covariates. The prevalence of moderate to severe depression was lower in Spring21 than in Spring20 but higher than in PreCOVID-19 (PreCOVID-19 = 5.3%, Spring20 = 37.8%, Spring21 = 22.8%; P <.001). Physical activity scores (mean [95% CI]) were higher in Spring21 than in Spring20 but lower than in PreCOVID-19 (PreCOVID-19 = 23.1 [22.7, 23.5], Spring20 = 13.5 [13.3, 13.7], Spring21 = 21.9 [21.6, 22.2]). Similarly, QoL scores were higher in Spring21 than in Spring20 but lower than in PreCOVID-19 (PreCOVID-19 = 92.8 [92.5, 93.1], Spring20 = 80.7 [80.3, 81.1], Spring21 = 84.3 [83.8, 84.8]). Although sports have restarted, clinicians should be aware that physical activity, mental health, and QoL are still significantly affected in adolescent athletes by the ongoing pandemic. [ABSTRACT FROM AUTHOR]

High schools and youth sport organizations that restarted participation in the fall of 2020 during the COVID-19 pandemic relied on information sources to develop risk-mitigation procedures. To compare the risk-mitigation procedures and information sources used by high school athletic departments and youth sport organizations. Cross-sectional study. Surveys of high school and youth sport organization programs from across the United States. A total of 1296 high schools and 584 youth sport organizations, representing 519 241 adolescent athletes, responded to the surveys. Surveys regarding restarting sport, COVID-19 cases, risk-reduction procedures, and the information sources used to develop risk-reduction plans in the fall of 2020 were distributed to high school athletic directors and youth sport directors throughout the United States. The proportions of high schools and youth sport organizations using different risk-reduction procedures and information sources were compared using the χ2 test. High schools used more risk-reduction procedures than did youth sport organizations (high schools = 7.1 ± 2.1 versus youth sport organizations = 6.3 ± 2.4; P <.001) and were more likely than youth sport organizations to use symptom monitoring (high schools = 93% versus youth sport organizations = 85%, χ2 = 26.3; P <.001), temperature checks on site (66% versus 49%, χ2 = 53.4; P <.001), face masks for athletes during play (37% versus 23%, χ2 = 38.1; P <.001) and when off the field (81% versus 71%, χ2 = 26.1; P <.001), social distancing for staff (81% versus 68%, χ2 = 43.3; P <.001) and athletes off the field (83% versus 68%, χ2 = 57.6; P <.001), and increased facility disinfection (92% versus 70%, χ2 = 165.0; P <.001). Youth sport organizations relied more on information from sport national governing bodies than did high schools (youth sport organizations = 52% versus high schools = 10%, χ2 = 411.0; P <.001), whereas high schools were more likely to use information from sources such as the National Athletic Trainers' Association (high schools = 20% versus youth sport organizations = 6%, χ2 = 55.20; P <.001) and the National Federation of State High School Associations (high schools = 72% versus youth sport organizations = 15%, χ2 = 553.00; P <.001) for determining risk-reduction strategies. High schools and youth sport organizations reported using a broad range of risk-reduction procedures, but the average number was higher among high schools than youth sport organizations. Use of information from the Centers for Disease Control and Prevention and local health authorities was high overall, but use of information from professional health care organizations was low. Professional health care organizations should consider using additional measures to improve information uptake among stakeholders in youth sports. [ABSTRACT FROM AUTHOR]

The relationships among different sports, face mask use, and COVID-19 risk among high school athletes remain unknown. To evaluate the influence of sport characteristics and face mask use on the COVID-19 incidence among high school athletes. Descriptive epidemiology study. US high school athletic departments. Athletic directors. Surveys were completed regarding sport reinitiation, COVID-19 cases, and risk-reduction procedures in fall 2020. Separate mixed-effects Poisson regression models were developed to evaluate the associations between the reported COVID-19 incidence and (1) sport characteristics (indoor versus outdoor, individual versus team, contact versus noncontact) and (2) face mask use while playing (yes or no). A total of 991 schools had restarted fall sports, representing 152 484 athletes on 5854 teams. There were 2565 reported cases of COVID-19, representing a case rate of 1682 cases per 100 000 athletes and an incidence rate of 24.6 cases per 100 000 player-days. The COVID-19 incidence was lower for outdoor versus indoor sports (incidence rate ratio [IRR] = 0.54; 95% CI = 0.49, 0.60; P <.001) and noncontact versus contact sports (IRR = 0.78; 95% CI = 0.70, 0.87; P <.001), but not team versus individual sports (IRR = 0.96; 95% CI = 0.84, 1.1; P =.49). Face mask use was associated with a decreased incidence in girls' volleyball (IRR = 0.53; 95% CI = 0.37, 0.73; P <.001), boys' basketball (IRR = 0.53; 95% CI = 0.33, 0.83; P =.008), and girls' basketball (IRR = 0.36; 95% CI = 0.19, 0.63; P <.001) and approached statistical significance in football (IRR = 0.79; 95% CI = 0.59, 1.04; P =.10) and cheer or dance (IRR = 0.75; 95% CI = 0.53, 1.03; P =.081). In this nationwide survey of high school athletes, a lower COVID-19 incidence was independently associated with participation in outdoor versus indoor and noncontact versus contact sports but not team versus individual sports. Face mask use was associated with a decreased COVID-19 incidence among indoor sports and may be protective in outdoor sports with prolonged close contact among participants. [ABSTRACT FROM AUTHOR]