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Objective: To describe the incidence and characteristics of injuries and illnesses among Team USA athletes competing at the Santiago 2023 Pan American Games (PAG) and Parapan American Games (PPAG), with a particular focus on the incidence of respiratory illnesses and on injuries for sports new to the Olympic and Paralympic programmes., Methods: Illnesses and injuries occurring among the 870 Team USA athletes competing in the Santiago 2023 PAG or PPAG were documented within Team USA's Injury and Illness Surveillance system. Illness and injury incidence per 1000 athlete-days (ADs) and incidence ratios (IR) were calculated, both with 95% CIs., Results: Illness (IR 2.5, 95% CI 1.6, 3.9) and injury (IR 1.8, 95% CI 1.3, 2.5) rates were greater during PPAG compared with PAG. Illness rates were higher in the pre-opening ceremony period compared with the competition period for both PAG (IR 2.7, 95% CI 1.1, 5.9) and PPAG (IR 1.9, 95% CI 0.9, 3.8). Respiratory illness was the most common illness with 3.2% and 8.9% of all Team USA athletes reporting a respiratory illness during the PAG and PPAG, respectively. Sports that are relatively new to the Olympic/Paralympic programmes exhibited the highest injury rates during the Games: breaking (250.0 (91.7, 544.2) per 1000 ADs), Para taekwondo (93.8 (19.3, 274.0) per 1000 ADs) and surfing (88.9 (24.2, 227.6) per 1000 ADs)., Conclusion: Respiratory illness rates were the most common type of illness during both PAG and PPAG and were more likely to occur prior to competition starting. Our data have identified high injury risk populations (breaking, surfing, Para taekwondo) and timing (pre-opening ceremony period) for further risk factor analysis., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Students graduating from professional healthcare programs are expected to demonstrate competence in their area of study to enter the workforce and immediately start working with people. High expectations and a fast-paced environment are typical aspects of these professional positions and often result in higher rates of burnout, compassion fatigue, and lack of empathy, leading to an overall decrease in patient satisfaction. As a result, patients who face difficult situations may often feel as though their needs are not being addressed. The purpose of this study was to examine the effectiveness of a shared educational module and simulated patient encounters on improving student confidence and competence engaging in difficult conversations with patients regarding intimate partner violence, substance abuse, and suicidal ideation. Students in the social work (n=14), athletic training (n=7), and physician assistant degree programs (n=20) participated in a collective learning module focusing on patient-centered care (PCC) skills required for having difficult conversations with patients. After students completed the shared learning module and prior to the simulated experience, students were given the Inter-professional Teams in Difficult Conversations Self-Assessment survey, a self-assessment tool measuring level of competence in engaging in difficult conversations. Students were then assigned to one of three rooms at random and varied in topic from intimate partner violence, substance abuse, or suicidal ideation. After the simulation, students completed the Inter-professional Teams in Difficult Conversations Self-Assessment survey again. Standardized patients (SP) also completed the Patient-Professional Interaction Questionnaire (PPIQ) immediately after the simulated experience. As hypothesized, students self-reported very high confidence in their ability to engage in difficult conversations using PCC, but SPs reported feeling little empathy or understanding of their situation from the students. Findings from this research demonstrate the disconnect in transfer of knowledge from understanding what PCC skills are to implementing them during difficult conversations.

Context: Extensive research has exposed healthcare disparities regarding socioeconomic status (SES) and race/ethnicity demographics. Previous research has shown significant differences in access to athletic training services (AT access) in the secondary school setting based on SES, but with limited samples., Objective: This study investigated differences in AT access based on race/ethnicity and SES on a national scale., Design: Cross-sectional study., Setting: Database study using secondary analysis. Data were collected from the National Center for Education Statistics (NCES), Athletic Training Location and Services (ATLAS) database, and US Census Bureau., Patients or Other Participants: 10,983 public schools., Main Outcome Measure: Descriptive data was summarized by measures of central tendency. A one-way ANOVA determined differences between school characteristics: median household income (MHI), percent of students eligible for free and reduced lunch (%FRL), percent white students, and percent non-white students based on AT access: Full-time (FT-AT), part-time (PT-AT), and no athletic trainer (no-AT). A Bonferroni pairwise comparison was used for variables with significant main effects., Results: Across all schools included in the study, 43.8% had no-AT (n=4,812), 23.5% had PT-AT access (n=2,581), and 32.7% had FT-AT access (n=3,590). There were significant effects between AT access and MHI (p<.001), %FLR (p<.001), percent white (p<.001), and percent non-white (p<.001). FT-AT schools had a higher SES when compared to PT-AT and no-AT schools. Significant differences existed between AT access groups and race/ethnicity of schools. Schools with FT-AT had a significantly lower percent of non-white students (31.3%) compared to schools with no-AT (46.0%) (p<.001). No significant differences between FT-AT and PT-AT based on race/ethnicity demographics presented (p≥.13)., Conclusion: Schools with higher SES had greater AT access; whereas, schools with a higher percentage of non-white students were more likely to have no AT access, demonstrating the disparities in healthcare extends to athletic healthcare as well. To increase AT access, future initiatives should address the inequities where larger minority populations and counties of lower SES exist.

Background: The purpose of this report is to provide insight and details regarding the development and implementation of an injury and illness surveillance (IIS) system for the United States Olympic and Paralympic Committee (USOPC)., Methods: The development and deployment of the IIS employed a multiphase approach. First, researchers determined variables to include in the IIS using the recommendations from the 2020 IOC consensus statement for reporting sport epidemiological data. Second, the hosting and deployment platforms were comprehensively evaluated for their suitability, ease of use, flexibility, and backend data structure (for both capture and aggregation). Third, focus groups consisting of the Sports Medicine department leadership and clinicians piloted the IIS system and revisions were made based on their feedback. Pilot testing of the IIS and follow-up focus groups were then conducted among all departmental clinicians to solicit additional feedback and drive further revisions. Finally, the IIS system was piloted among providers working during the 2023 Pan American and Parapan American Games to refine the system for future Games. After reviewing all potential software platform options (electronic medical record [EMR] system, athlete management systems, secure data collection platforms), Qualtrics (Qualtrics, Provo, UT, USA) was selected to host the IIS system. This choice was made due to the inability of the EMR and athlete-management systems to make frequent updates, modify existing questions, and provide the necessary form logic for the variety of scenarios in which the IIS system would be deployed. Feedback from the department's leadership and clinicians resulted in a number of changes, most notably being the ability to enter multiple diagnoses for a single injury event. Additionally, clinician feedback resulted in the creation of additional diagnostic codes not currently present in the OSIICS v14.0 diagnostic coding system, adding "non-sport" as an additional variable for injury setting, and developing a system for reporting return-to-sport date for time-loss injuries., Discussion: A multi-stage process of extensive planning, stakeholder feedback, and ongoing updates is required in order to successfully develop and implement an IIS system within a National Olympic and Paralynpic Committee. This process can be used to inform the development and implementation of IIS systems in other sporting organizations., (© 2024. The Author(s).)

Context: California is the only state that does not regulate the athletic training profession, allowing unqualified personnel to be hired and call themselves athletic trainers. The benefits of employing a certified athletic trainer in the secondary school setting are numerous but efforts to push regulation legislation continue to fail in California., Objective: To describe the availability of certified athletic trainers in California secondary schools and explore factors influencing athletic trainer employment., Design: Cross-Sectional Study., Setting: Online survey., Patients or Other Participants: Participants from 1538 California Secondary Schools., Main Outcome Measures: Officials from member schools completed the 2022-2023 California Interscholastic Federation Participation Census. Participants provided information specific to enrollment, sport participation, access to AEDs, and whether the school had athletic trainers on staff. The athletic trainer's certification status was independently verified. Enrollment data specific to ethnicity, race, and percentage of students eligible for free meals was obtained through the California Department of Education Statistics., Results: More than half (51.6%) of California secondary schools did not employ a certified athletic trainer and 8.3% employed unqualified personnel as athletic trainers. Nearly half (43%) of student athlete participants were enrolled at schools with no certified athletic trainer. Schools that employed certified athletic trainers had a lower proportion of students eligible to receive free and reduced-price meals. The average percentage of Hispanic or Latino students was greater in schools with no certified athletic trainer and schools that employed unqualified personnel as athletic trainers than schools that employed certified athletic trainers., Conclusions: Data indicates that in a five-year period, access to athletic training services in California secondary schools has not improved. There are large gaps in access to athletic training services and there are clear socioeconomic and racial and ethnic disparities. Efforts to educate stakeholders on the importance of athletic training regulation in California should continue.

Context: Early sport specialization is a growing concern among youth sport athletes, particularly in baseball. Motivation to participate in sports is an important factor in determining which sports youth athletes participate in and why., Objective: To qualitatively investigate the youth sport participation behaviors and motivations of collegiate baseball players., Design: Qualitative study., Setting: Online teleconference., Patients or Other Participants: We conducted 25 semistructured interviews with collegiate baseball athletes who were classified as high-level (n = 8), moderate-level (n = 9), or low-level (n = 8) specialists before college., Data Collection and Analysis: Participants completed individual semistructured interviews to allow us to develop an understanding of their youth and high school sports experiences and associated motivations to engage in those experiences. A framework analysis approach was used to analyze the transcript data and identify themes among the 3 specialization groups., Results: From our interview analysis, 6 overall themes emerged: (1) motivation, (2) stress, (3) quitting, (4) barriers, (5) facilitators of success, and (6) future directions. Moderate- and high-level specialists described greater levels of passion, participating in deliberate practice, greater levels of performance-related stress, and more desire to quit sports than low-level specialists. None of the groups cited parents as an overbearing external motivator to participate in sport at an early age., Conclusions: Participants who were classified as low-, moderate-, or high-level specialists noted different experiences related to their motivation, stress level, desire to quit, barriers to participating in baseball, facilitators of success, and their overall future career goals after completing baseball. This information may be useful for parents, coaches, and health care professionals to better communicate the benefits and risks associated with sport specialization to youth athletes. Future research is needed to determine if differences in motivation levels exist in younger populations., (© by the National Athletic Trainers' Association, Inc.)

Context: Research that has examined the association between specialization and injury in basketball has been limited to cross-sectional or retrospective studies., Objective: To determine whether specialization is a risk factor for injury among high school basketball athletes., Design: Prospective cohort study., Setting: Basketball players from 12 high schools participating in the National Athletic Treatment, Injury, and Outcomes Network Surveillance Program (NATION-SP) were recruited prior to the 2022-2023 interscholastic basketball season., Patients or Other Participants: 130 athletes (mean age (SD) = 15.6 (1.3); girls' basketball: n=68 (52.3%))., Main Outcome Measures: Participants completed a questionnaire prior to the start of their school basketball season that had questions regarding participation in various specialized sport behaviors. During the basketball season, the school's athletic trainer reported all athletic exposures (AEs) and injuries (regardless of time loss) for participating athletes into NATION-SP. Injury incidence (IR) and incidence rate ratios (IRR) with 95% confidence intervals [95%CI] were calculated for the specialized sport behaviors previously described., Results: There was no difference in injury risk between highly specialized and low specialized athletes (IRR [95%CI]: 1.9 [0.9, 3.7]). Players who participated in basketball year-round were twice as likely to sustain an injury compared to those who did not play year-round (IRR [95%CI]: 2.1 [1.1, 3.6]). Similarly, players who reported participating in basketball skills camps were at increased risk of injury compared to athletes who did not participate in basketball skill camps (IRR [95%CI]: 2.5 [1.2, 5.7])., Conclusion: Injury risk related to sport specialization in basketball may be specific to certain behaviors such as year-round play and participation in skills camps. Validated measures of comprehensive sport activity are needed to better measure specialization in youth sports to better determine injury risk related to sport specialization and develop injury prevention programs for basketball athletes., Competing Interests: Declarations of Interest: None.

Objective: To report epidemiological data regarding injury and illness among the Team USA staff during the Tokyo 2020 Summer Olympic and Paralympic Games and Beijing 2022 Winter Olympic and Paralympic Games., Methods: A retrospective review of all Team USA staff (total staff, N=1703 (62.5% female); total staff days (SD)=34 489) medical encounters during the Tokyo 2020 Games and Beijing 2022 Games was conducted. Details related to injury and illness were evaluated. Incidence with 95% CI per 1000 staff days were calculated., Results: A total of 32 illnesses (incidence [95% CI] 0.9 [0.6, 1.2]) and 23 injuries (incidence 0.7 [0.4, 0.9]) were sustained by the Team USA delegation staff members during the Tokyo 2020 Games and Beijing 2022 Games. Female staff reported more illnesses (illnesses proportion (IP) 2.9%; incidence 1.4 [0.8, 2.0]), while male staff incurred more injuries (IP 1.8%; incidence 0.9 [0.5, 1.3]). When stratified by physiological system, dermatological and infectious were the most common systems involved with illness (IP 0.5%; incidence 0.2 [0.1, 0.4]). Injuries to the upper limb were most common (IP 0.3%; incidence 0.3 [0.1, 0.5])., Conclusion: Injury and illness rates among the Team USA staff during the Tokyo 2020 Games and Beijing 2022 Games were low, but notable. Knowledge of injury and illness risks contributes to staffing decisions and prevention strategies for staff supporting athletes during competition., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Context: The social determinants of health (SDOH) are circumstances under which individuals are born, work, and live that influence health outcomes. Previous researchers have examined 1 determinant of economic stability and found disparities in socioeconomic status and athletic trainer (AT) availability., Objective: To examine the SDOH characteristics of Indiana secondary schools and AT availability., Design: Cross-sectional study., Setting: Database secondary analysis., Patients or Other Participants: A total of 426 secondary schools., Main Outcome Measure(s): All data were collected from publicly available databases. The independent variable was AT availability, and schools were classified as having a full-time AT, a part-time AT only, or no AT. The SDOH variables were gathered for each school (at the school and county levels). Data were summarized using measures of central tendencies, 1-way analysis of variance, and Kruskal-Wallis tests., Results: School enrollment was larger in schools with greater AT availability (P< .001). The proportion of non-White students was greater in schools with more AT availability (P= .002). Greater AT availability was present in counties with higher graduation rates (P= .03). Post hoc comparisons revealed differences in graduation rates between schools with a part-time AT and those with no AT (P= .04). Schools with less AT availability were located in counties with a slightly higher percentage of the population uninsured (P= .02). Schools with greater AT availability were located in counties with a higher ratio of population to primary care physicians (P= .03). Schools with less AT availability were located in counties with a higher population experiencing severe housing problems (P= .02). No differences were found in AT availability based on the 3 social and community context variables (P> .05)., Conclusions: Differences were noted in AT availability and SDOH characteristics at the secondary school level. We observed less AT availability where high school graduation rates and the population of primary care providers were lower. Strategies should be implemented to improve access to athletic health care in underresourced communities., (© by the National Athletic Trainers’ Association, Inc.)

Adequate sleep is crucial for elite athletes' recovery, performance readiness, and immune response. Establishing reference ranges for elite athletes enables appropriate contextualization for designing and targeting sleep interventions., Purpose: To establish sleep-quality reference ranges for Olympic and Paralympic cohorts using the Pittsburgh Sleep Quality Index (PSQI) and explore differences based on sex and sport types., Methods: Team USA athletes (men = 805, women = 798) completed the PSQI as part of a health-history questionnaire. Descriptive statistics were used to create reference ranges and linear models, and χ2 test of independence determined differences in PSQI global and component scores between sex, games, season, and participation., Results: Six hundred thirty-two (39.43%) athletes reported poor sleep (PSQIGlobal ≥ 5). Men displayed later bedtimes (P = .006), better global PSQI scores, shorter sleep latency, less sleep disturbance, and less use of sleep medication than women (all P < .001). Winter Games participants had later bedtime (P = .036) and sleep offset time (P = .028) compared with Summer Games athletes. Team-sport athletes woke earlier than individual-sport athletes (P < .001). Individual-sport athletes were more likely to have low (P = .005) and mild (P = .045) risk for reduced sleep duration than team-sport athletes., Conclusion: These data provide PSQI-specific reference ranges to identify groups at greatest risk for poor sleep, who may benefit most from targeted sleep interventions.

Purpose: Transmeridian travel is common for elite athletes participating in competitions and training. However, this travel can lead to circadian misalignment wherein the internal biological clock becomes desynchronized with the light-dark cycle of the new environment, resulting in performance decrement and potential negative health consequences. Existing literature extensively discusses recommendations for managing jet lag, predominantly emphasizing light-based interventions to synchronize the internal clock with the anticipated time at the destination. Nevertheless, visually impaired (VI) athletes may lack photoreceptiveness, diminishing or nullifying the effectiveness of this therapy. Consequently, this invited commentary explores alternative strategies for addressing jet lag in VI athletes., Conclusions: VI athletes with light perception but reduced visual acuity or visual fields may still benefit from light interventions in managing jet lag. However, VI athletes lacking a conscious perception of light should rely on gradual shifts in behavioral factors, such as meal timing and exercise, to facilitate the entrainment of circadian rhythms to the destination time. Furthermore, interventions like melatonin supplementation may prove useful during and after travel. In addition, it is recommended that athlete guides adopt phase-forward or phase-back approaches to synchronize with the athlete, aiding in jet-lag management and optimizing performance.

Objective: To describe the incidence of injuries and illnesses among paediatric Team USA athletes competing in the Tokyo 2020 Olympic and Paralympic Games, and the 2022 Beijing Olympic and Paralympic Games., Methods: An electronic medical record system documented all injuries and illnesses that occurred while competing in the four Games periods. Incidence (IR) with 95% CI per 1000 athlete days were calculated for both injuries and illnesses. Incidence rate ratios (IRR) were calculated to compare injury and illness rates based on age (paediatric vs non-paediatric) sex, Games period and sport type., Results: Two hundred paediatric athletes (age range, 15-21 years) competed across the four Games periods, representing 16.1% of all Team USA athletes. The overall injury IR (95% CI) was 13.4 (9.8 to 18.1), and the overall illness IR was 5.5 (3.3 to 8.7). There were no differences in incidence between paediatric and non-paediatric athletes for either injury (IRR (95% CI): 0.9 (0.6 to 1.2)) or illness (IRR (95% CI): 0.9 (0.5 to 1.5)). Female paediatric athletes were more likely to sustain an injury compared with male paediatric athletes (IRR (95% CI): 2.4 (1.1 to 5.3)). The most common mechanism of injury was gradual onset (IR, 4.3 (2.3 to 7.2)), and injuries most commonly occurred during practices (IR, 7.0 (4.5 to 10.5))., Conclusion: Paediatric athletes account for a substantial proportion of Team USA athletes. It is essential that paediatric sports medicine experts are included in the medical team given that paediatric Team USA athletes are just as likely as their adult teammates to sustain an injury or illness., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: While previous studies have examined the impact of family socioeconomic characteristics on a child's sport specialization behaviors, this research has been limited to affluent communities with limited sociodemographic diversity., Hypothesis/purpose: The purpose of this study was to examine associations of parent income and education with child sport specialization behaviors among a nationally representative sample of youth sport parents in the United States., Study Design: Cross-sectional., Methods: Parents of youth athletes in the United States (n=236, age: 39.2±8.1 years, 57.2% female) were recruited to complete an online questionnaire by Qualtrics Online Samples (Qualtrics, Provo, UT) using a combination of actively managed, double-opt-in market research panels. The questionnaire used for this study consisted of: 1) parent demographics (including parent age, race/ethnicity, biological sex, gender identity, household income, and educational status), and 2) child sport participation characteristics and sport specialization behaviors., Results: Parents who reported an annual household income of $75,001 or more were more likely than parents making less than $75,000 to report that their child participated on an organized club team (OR [95%CI]: 1.94 [1.15-3.27]), participated on multiple organized teams at the same time (OR [95%CI]: 1.85 [1.10-3.11]), or specialized in a single sport (OR [95%CI]: 2.45 [1.45-4.14]). Parents who reported receiving a Bachelor's degree or higher were more likely than parents who did not to report that their child participated on an organized club team (OR [95%CI]: 3.04 [1.78-5.18]), participated on multiple organized teams at the same time (OR [95%CI]: 2.42 [1.43-4.10]), or specialized in a single sport (OR [95%CI]: 1.94 [1.15-3.26])., Conclusions: Thes results suggest that in the modern youth sport culture, family resources may serve as a major determining factor in the type of experiences available for a youth athlete., Level of Evidence: III., Competing Interests: The authors have no conflicts or disclosures to report.

Context: Despite the many challenges posed by the COVID-19 pandemic, athletic programs have sought ways to persevere and deliver sport programming. This process has strained the psychosocial health of all sport stakeholders but especially those entrusted with promoting the health of participants and enforcing safety protocols. Athletic trainers (ATs) have been a major influence in striving to achieve these goals by expanding their typical roles to lead in promoting the safe delivery of sport programs., Objective: To examine the psychosocial lived experiences of ATs as they practiced during the COVID-19 pandemic., Design: Qualitative study., Setting: National Collegiate Athletic Association Divisions I, II, and III., Patients or Other Participants: A total of 27 ATs practicing at the collegiate level (Divisions I, II, and III) who were actively involved in planning and implementing return-to-sport protocols during the COVID-19 pandemic., Data Collection and Analysis: Semi-structured interviews were conducted via Zoom. Inductive conventional content analysis identified emerging themes that characterized participants' narratives. Three members of the research team were involved in the analysis process and used field notes, continuous member checking, peer review, and multiple-researcher triangulation to establish data credibility and confirmability., Results: Three higher-order themes related to ATs' psychosocial lived experiences emerged: (1) internalized experience, (2) interpersonal interactions, and (3) AT identity. Several subthemes were also identified to further organize elements that characterized or differentiated participants' lived experiences., Conclusions: Athletic trainers encountered significant challenges in maintaining their psychosocial health during the pandemic as they strived to assist others in this regard. Providing effective psychological and social support resources and strategies for ATs may not only allow them to better support themselves but may also enhance their ability to deliver professional services and promote psychosocial health among their athletes and other stakeholders in their respective sport systems in the future., (© by the National Athletic Trainers’ Association, Inc.)

Background: Early sport specialization is associated with increased risk of overuse injuries in several sports, including baseball. However, limited evidence exists evaluating how early sport specialization affects patient-reported outcome measures as they age. The purpose of this study was to determine differences in Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow Scores among collegiate baseball players based on the grade when a participant first reported high specialization behaviors., Hypothesis: Baseball players who were highly specialized at a younger age will have worse throwing arm health while participating in college., Study Design: Cross-sectional study., Level of Evidence: Level 3., Methods: A total of 752 college baseball players was contacted through their institution's athletic trainer. We measured baseball specialization and KJOC scores using the validated Baseball and Sport Experience survey. Data were summarized using means and SDs, medians and interquartile ranges (IQRs), and frequencies and percentages. A Kruskal-Wallis test was used to determine differences in mean KJOC scale scores based on the earliest time the participant reported high-level specialization., Results: A total of 294 baseball players completed the survey (response rate: 39.1%). Of the 294 participants, 280 completed the KJOC scale questions to generate a total KJOC score (median: 90.5; IQR: 76.6-97.2). No significant differences in KJOC total scores ( P = 0.78) existed based on the grade period in which the athlete was first highly specialized., Conclusion: Early baseball specialization as a youth baseball player may not impact throwing arm health in college baseball athletes., Clinical Relevance: Early specialization has been linked to increased risk for overuse injuries in certain sports, but may not lead to poorer throwing arm health in college baseball players. Sports medicine clinicians and researchers may use this information to educate various stakeholders about the benefits and risks associated with early sport specialization.

Context: Sport specialization, or focused participation in a single sport, is associated with an increased rate of overuse injury and burnout. Medical associations and sport organizations have published recommendations for sport specialization aimed at reducing its negative consequences. Health care providers (HCPs) are often identified as individuals who can educate athletes and parents about these important recommendations., Objective: To compare knowledge, perceptions, awareness, confidence in knowledge, and use of sport specialization recommendations among HCPs who work with pediatric athletes., Design: Cross-sectional study., Setting: An online web-based survey was developed to assess HCPs' knowledge, perceptions, awareness, confidence in knowledge, and clinical use of sport specialization recommendations., Patients or Other Participants: Participants were recruited from the research survey services of 4 professional organizations., Main Outcome Measure(s): Dependent variables were responses for awareness, perceptions, confidence in knowledge, use, and barriers sections of the survey. Data were analyzed with descriptive statistics; comparisons among HCPs were made through χ2 and Kruskal-Wallis tests., Results: The survey was completed by 770 HCPs (completion rate = 95.1%). Respondents lacked awareness specific to recommendations surrounding the maximum number of sport participation months per year (39.5%), maximum hours per week (40.7%), and maximum number of teams on which youth athletes should participate concurrently (43.9%). Physicians were the most aware of medical organization recommendations generally (48%-68.8%) and confident in their knowledge (41.5%-75.1%). All HCPs were less aware and confident in their knowledge of sport organization recommendations, with no differences among HCPs. Physicians did not perceive many barriers to the use of the recommendations, whereas athletic trainers felt that patient (39.9%) and parent (45.3%) behaviors were the greatest barriers to usage., Conclusions: Awareness, perceptions, and use of sport specialization recommendations varied by discipline, but most respondents believed they were associated with a decreased risk of injury. Future researchers should focus on improved education and implementation of recommendations across all roles., (© by the National Athletic Trainers' Association, Inc.)

Context: Significant health care disparities exist in the United States based on socioeconomic status (SES), but the role SES has in secondary school athletes' access to athletic training services has not been examined on a national scale., Objective: To identify differences in access to athletic training services in public secondary schools based on school SES., Design: Cross-sectional study., Setting: Database secondary analysis., Patients or Other Participants: Data for 3482 public high schools., Main Outcome Measure(s): Data were gathered from the Athletic Training Locations and Services (ATLAS) database, US Census Bureau, and National Center for Education Statistics. We included schools from 5 states with the highest, middle, and lowest poverty percentages (15 states total) and collected county median household income, percentage of students eligible for free or reduced-price lunch, race and ethnicity demographics, and access to athletic training services (full-time athletic trainer [AT], part-time AT only, no AT) for each school. Data were summarized in means, SDs, medians, interquartile ranges (IQRs), frequencies and proportions, 1-way analyses of variance, and Kruskal-Wallis tests., Results: Differences were present in school SES between schools with full-time, part-time-only, and no athletic training services. Schools with greater access to athletic training services had fewer students eligible for free or reduced-price lunch (full time: 41.1% ± 22.3%, part time only: 45.8% ± 24.3%, no AT: 52.9% ± 24.9; P < .001). Similarly, county median household income was higher in schools with increased access to athletic training services (full time median [IQR]: $56 026 [$49 085-$64 557], part time only: $52 719 [$45 355-$62 105], and no AT: $49 584 [$41 094-$57 688]; P < .001)., Conclusions: Disparities in SES were seen in access to athletic training services among a national sample of public secondary schools. Access to ATs positively influences student-athletes' health care across several measures. Pilot programs or government funds have been used previously to fund athletic training services and should be considered to ensure equitable access, regardless of school SES., (© by the National Athletic Trainers' Association, Inc.)

Objectives: Previous studies of parents of adolescent athletes identified a belief among parents of the importance of early specialization for skill development. However, it is unclear if these attitudes and beliefs are also held among parents of baseball athletes, which is the second-most popular boy's sport in the United States. The purpose of this study was to describe the knowledge, attitudes, and beliefs of parents of Little League baseball players regarding sport specialization and college scholarships., Methods: Two-hundred and forty-four parents of Little League baseball players (female parents: 60.7%, parent age: 41.1 ± 6.2 years old, male children: 98.0%, child age: 9.5 ± 1.6 years old) completed an anonymous online questionnaire regarding parent attitudes and beliefs on sport specialization and college scholarships., Results: Most parents (72.4%) felt that specialization would increase their child's baseball ability either 'quite a bit' or 'a great deal.' Fewer than half of all parents (42.0%) reported that specialization was either 'quite a bit' or 'a great deal' of a problem. Parents underestimated the availability of Division I college baseball scholarship availability (median [IQR]: 5 [4-10]), compared to the actual value of 11.7 scholarships per Division I roster. Only 10.2% of parents (N = 25) reported that they believed it was 'somewhat' or 'very' likely that their child would receive a college baseball scholarship., Conclusion: Further efforts are needed to understand parent attitudes and beliefs regarding sport specialization and college scholarships in various sports to better understand current trends in youth sport participation.

Background: Adolescent athletes report that sports specialization improves their ability to receive a collegiate athletics scholarship, though this is not well-understood. The purpose of this study was to examine self-reported trends in high school specialization and influences for sport participation between Division I (D-I) and college-aged club (club) athletes., Hypothesis: There would be no difference in high school sport specialization or sport participation influences between D-I and club athletes., Study Design: Retrospective cross-sectional study., Level of Evidence: Level 3., Methods: A survey included specialization classification (low, moderate, and high) for 9th to 12th grade, age that the athlete started organized sport and his or her collegiate sport, and several influential factors for participation in one's primary high school sport (1 = no influence to 5 = extremely influential). Chi-square analyses were used to compare specialization classifications between groups. Nonparametric tests were used to determine significant differences in age-related variables and influential factors between D-I and club athletes. All analysis were also conducted with boys and girls separately., Results: Participants included 266 D-I (girls, 155; 58%) and 180 club (girls, 122; 68%) athletes. Club athletes were more likely to be classified as low specialization at every grade in high school, and this difference was more pronounced between D-I and club female athletes than male athletes. The number of years an athlete was classified as highly specialized in high school was not different between D-I and club athletes. Club athletes were more influenced by playing with friends than D-I athletes and D-I athletes were more influenced by pursuing a collegiate scholarship than club athletes., Conclusion: High levels of specialization in high school sport may not be necessary for playing at the collegiate level, though some level of specialization in high school might be necessary., Clinical Relevance: Clinicians should advocate for healthy long-term athlete development, which does not support high specialization in high school sports.

Context: Athletic trainers (ATs) were critical personnel in the development of policies and procedures for the safe return to campus and resumption of sport during the 2020-2021 academic year. Policies focused on preventing the potential spread of COVID-19, as well as screening, testing, and management of cases; however, which aspects of implementation were successful or more challenging was unknown., Objective: To identify successes and challenges in the implementation of return-to-sport policies and procedures during the 2020-2021 academic year amid the COVID-19 pandemic., Design: Qualitative study., Setting: National Collegiate Athletic Association Divisions I, II, and III., Patients or Other Participants: A total of 27 ATs (9 women [33.3%], mean age = 48.5 ± 9.8 years, years of experience = 25.0 ± 10.5) who were in positions of leadership or who were actively involved in developing and then implementing COVID-19 return-to-sport policies and procedures completed Zoom interviews., Data Collection and Analysis: Semistructured Zoom interviews were audio and video recorded and later transcribed. The data were analyzed by a team of 4 experienced researchers using the consensual qualitative research approach. Field notes, intercoder reliability, and multiple-analyst triangulation were used to establish data credibility., Results: Emerging themes were implementation of public health interventions, interprofessional collaboration, and advancing the profession of athletic training. Participants described establishing and strengthening collaborations with other health care professionals as well as key stakeholders on campus as a positive outcome of the pandemic, but variations in policies among institutions and states made policy communication and enforcement more challenging., Conclusions: The ATs played a pivotal role in policy development, communication, and enforcement. Overall, participants took pride in serving as health care leaders for their universities and opening the eyes of colleagues to the breadth of their athletic training skill sets., (© by the National Athletic Trainers' Association, Inc.)

Purpose: To describe youth sport participation behaviors during the COVID-19 pandemic as reported by parents of youth sport athletes, to examine the association of family demographics with the likelihood of children resuming sports, and to qualitatively report the factors influencing parental decision-making regarding youth sport participation during the COVID-19 pandemic., Methods: A national sample of parents of youth athletes from across the United States (n=236, age: 39.2±8.1 years, 57.2% female) were recruited to complete an online questionnaire by Qualtrics Online Samples (Qualtrics, Provo, UT) using a combination of actively managed, double-opt-in market research panels. The questionnaire focused on changes in child sport participation and family finances as a result of COVID-19 and included both close-ended and open-ended questions., Results: Most parents (63.1%) reported the time their children spent participating in organized youth sports had decreased because of the COVID-19 pandemic. Three-quarters of parents (75.5%) reported that it was likely that their children would fully resume participating in organized youth sports within the next year. Parents whose financial situation was worsened by COVID-19 were less likely to report that their children would resume sports in the upcoming year. Three domains related to parental decision-making emerged from the open-ended responses: safety, fear, and normalcy., Conclusions: Understanding the factors influencing changes in youth sport participation during the pandemic can allow systems to implement strategies for safe participation in youth sport and physical activity among children. Encouraging participation in outdoor sports with appropriate safety precautions such as masking, social distancing, and hygiene may reduce fear of participation among parents., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Context: With 8 million annual US high school student-athletes, the epidemiology of sport-related injuries has garnered significant interest. The most recent studies examining overuse injury rates in high school sports were based on data from 2012 to 2013 and, therefore, may not reflect current overuse injury rates in high school sports., Objective: To (1) determine overuse time-loss (TL) and non-time-loss (NTL) injury rates among high school student-athletes using National Athletic Treatment, Injury and Outcomes Network Surveillance Program (NATION-SP) data collected from 2014-2015 to 2018-2019 and (2) compare overuse injury rates based on student-athlete sex defined by whether it was a boys' sport or a girls' sport, the sport itself, and the injury location., Design: Descriptive epidemiology study., Setting: Online injury surveillance from 211 high schools (345 individual years of high school data)., Patients or Other Participants: Athletes who participated in secondary school-sponsored boys' or girls' sports., Main Outcome Measure(s): Boys' and girls' overuse injury data from the NATION-SP during the 2014-2015 to 2018-2019 school years were analyzed. Overuse injuries were identified using a combination of the reported injury mechanism and diagnosis. Time-loss injuries resulted in restriction from participation beyond the day of injury; NTL injuries did not result in restriction from participation beyond the day of injury or involved no lost time due to the injury. Injury counts, rates, and rate ratios (IRRs) were reported with 95% CIs., Results: The total overuse injury rate was 5.3/10 000 athlete-exposures (AEs; 95% CI = 5.1, 5.7), the NTL overuse injury rate was 3.4/10 000 AEs (95% CI = 3.1, 3.6), and the TL overuse injury rate was 2.0/10 000 AEs (95% CI = 1.8, 2.2). The overuse injury rate was greater in girls' sports compared with boys' sports (IRR = 1.9; 95% CI = 1.7, 2.1). The highest rates of overuse injury were observed in girls' cross-country (19.2/10 000 AEs; 95% CI = 15.0, 24.2), girls' track and field (16.0/10 000 AEs; 95% CI = 13.5, 18.8), and girls' field hockey (15.1/10 000 AEs; 95% CI = 10.2, 21.6). Overuse injury rates were higher for the lower extremity than the upper extremity (IRR = 5.7; 95% CI = 4.9, 6.7) and for the lower extremity than the trunk and spine (IRR = 8.9; 95% CI = 7.3, 10.8)., Conclusions: Awareness of the overuse injury risk, as well as prevention and intervention recommendations, is necessary and should be specifically targeted at cross-country, field hockey, and track and field athletes., (© by the National Athletic Trainers' Association, Inc.)

Background: There is significant emerging evidence that early sport specialization is a potential risk factor for injury in youth sports. Despite basketball being the most popular youth team sport in the United States, sport specialization research, specifically in youth basketball players, has been limited. The purpose of this paper was to examine the association of sport specialization behaviors with injury history by surveying a nationally representative sample of parents of youth basketball athletes. We hypothesized that athletes who specialized in basketball, participated on multiple teams at the same time, and traveled regularly for basketball competitions would be more likely to report a basketball-related injury in the previous year., Methods: A nationally representative sample of 805 parents of 805 youth basketball players (female N=241, 29.9%; age: 12.9±2.5 y old) completed an online questionnaire that had 3 sections: (1) parent/child demographics, (2) child basketball participation information for the previous year, and (3) child basketball injury history in the previous year. Multivariate logistic regression examined the associations between variables of interest and injury history, adjusting for covariates. Odds ratios (ORs) with 95% confidence intervals (95% CI) were calculated for the variables of interest from the logistic regression model., Results: Highly specialized athletes were more likely than low specialization athletes to report history of basketball injury in the previous year [OR (95% CI): 2.47 (1.25-4.88), P=0.009]. The odds of reporting an injury in the previous year were twice as great among athletes who played on a basketball team at the same time as another sport team compared with those who played basketball only [OR (95% CI): 1.98 (1.30-3.01), P=0.001]. The odds of reporting an injury in the previous year were 3 times greater among athletes who received private coaching compared with those who did not receive private coaching [OR (95% CI): 2.91 (1.97-4.31), P<0.001]., Conclusion: Specialization in basketball, along with several other behaviors that have become typical of modern youth sport participation, were associated with reported injury history. Further prospective research is necessary to determine whether sport specialization behaviors increase the risk of injury in youth basketball., Level of Evidence: Level III-cross-sectional study., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Previous surveys of youth sport parents have revealed that while parents believe early sport specialization is beneficial for improving sport ability, they also overestimate their child's chances of receiving a college scholarship., Purpose: To (1) describe knowledge, attitudes, and beliefs of parents of youth basketball players regarding sport specialization and college scholarships and (2) examine potential differences in child basketball participation characteristics based on parent income., Study Design: Cross-sectional study., Methods: A total of 805 parents (mean age, 39.9 ± 7.1 years; 353 female [43.9%]) of youth basketball players (mean age, 12.9 ± 2.5 years; 241 female [29.9%]) were recruited via Qualtrics Online Panels to complete an anonymous online questionnaire. Participants were required to be a parent of a child between 8 and 18 years of age who participated in organized youth basketball (ie, school, club, or recreational/local league). Participants were recruited to be nationally representative with regard to race/ethnicity (White, 62.7%; Hispanic/Latino of any race, 15.3%; African American/Black, 13.3%; Asian, 4.6%; ≥2 races, 2.9%; American Indian/Alaskan Native, 1.1%; Native Hawaiian/other Pacific Islander, 0.1%). The questionnaire was adapted from previous research on parent knowledge, attitudes, and beliefs and consisted of 3 sections: (1) parent and child characteristics; (2) child basketball participation information (months per year of basketball participation, sport specialization status, receiving private coaching, traveling regularly for basketball competitions, participating on multiple teams at the same time); and (3) parent attitudes, beliefs, and knowledge regarding sport specialization and college basketball scholarships., Results: Most parents believed specialization increased their child's chances of making a high school (71.4%) or college team (69.7%). Parents underestimated the availability of college basketball scholarships at the National Collegiate Athletics Association (NCAA) Division I and II levels (8.9 ± 5.1 vs reality of 13-15 per team) but overestimated availability at the Division III level (8.6 ± 5.7 vs reality of 0 per team). High-income parents spent significantly more money ($4748 USD [$1214-$10,246]) than middle-income ($2250 USD [$727-$5079]; P < .001) and low-income ($1043 USD [$368-$2444]; P < .001) parents., Conclusion: Parents believed specialization was important for sport success, but they underestimated college scholarship availability at the NCAA Division I and II levels while overestimating scholarship availability at the Division III level., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This project was funded by an internal grant provided by the San Diego State University–University Grants Program. San Diego State University played no role in study design, collection/analysis/interpretation of data, writing of the manuscript, or decision to submit the manuscript for publication. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2021.)

Background: Baseball is one of the most popular boy's youth sports, and there has been a rise in the rates of certain overuse injuries among players. Specialization has been identified as a risk factor for overuse injury in high school athlete populations, but there is little understanding of the prevalence or consequences of sport specialization in Little League baseball players., Hypothesis: Sport specialization will be highly prevalent among Little League baseball players and specialization will be associated with worse throwing arm health., Study Design: Cross-sectional study., Level of Evidence: Level 3., Methods: A total of 246 Little League baseball players (male; N = 241; age, 9.5 ± 1.6 years) between 7 and 12 years old completed an anonymous, online questionnaire with their parent's assistance. The questionnaire consisted of participant demographics and baseball participation information, including sport specialization status and the Youth Throwing Score (YTS), a valid and reliable patient-reported outcome measure for youth baseball players., Results: Only 29 (11.8%) players met the criteria for high specialization. Approximately one-third of all players (n = 77; 31.3%) reported participating in baseball year-round or receiving private coaching outside of their league (n = 81; 32.9%). Highly specialized athletes demonstrated worse scores on the YTS on average compared with low-specialization athletes (mean [SE]: 56.9 [1.6] vs 61.1 [1.2]; P = 0.01). Similarly, pitching in the previous year ( P < 0.01) or traveling overnight regularly for showcases ( P = 0.01) were associated with a worse score on the YTS., Conclusion: While the prevalence of high sport specialization was low among Little League baseball players, other behaviors associated with specialization such as year-round play and the receiving of private coaching were more common. Highly specialized Little League players demonstrated worse throwing arm health compared with low-specialization players., Clinical Relevance: Little League players and their parents may represent a potential target audience for dissemination campaigns regarding sport specialization.

Objective : To compare: 1) history of sport-related concussion (SRC), 2) Return to learn (RTL) timelines, 3) Return to play (RTP) timelines, and 4) SRC reporting behaviors in high-school student athletes based on school type (public vs. private). Methods : A total of 2,998 athletes recruited from eleven private (n = 2121) and two public schools (n = 877) during the 2018-2019 school year completed an online questionnaire regarding sport participation and SRC history. The questionnaire examined self-reported history of SRC, reporting behavior, and RTL and RTP timelines. Results : Private school athletes were approximately twice as likely to report a history of SRC compared to public school athletes (OR [95% CI]: 2.01 [1.61-2.50], p < .001). There were no significant differences in RTL or RTP timelines between public and private-school athletes ( p > .05). For those who did not report their SRC (22.4%), the most common reasons were "a desire to keep playing" (53.7%) and "not believing it was serious enough to report" (52.1%). Conclusions : Athletic trainers and healthcare professionals should be aware of the factors that may influence secondary student athletes' SRC reporting behavior, and associated RTL, and RTP timelines, so they can better target concussion education and overall management for student-athletes. Abbreviations: SRC: Sport-related concussion; RTP: Return to play; RTL: Return to learn.

Background and Hypothesis: There is increasing concern about the role sport specialization might play in the increasing injury rates observed among youth baseball pitchers. However, existing research on specialization in baseball has focused on high school and professional baseball populations. We hypothesized that pitchers who were highly specialized, reported pitching more than eight months in the past year, received private coaching, or pitched with pain or fatigue in the previous year would report worse throwing-arm health., Methods: One-hundred eighty-four Little League pitchers (boys N = 181, age 9.8 ± 1.6 years old) between 7 and 12 years of age completed an anonymous, online questionnaire with their parents' assistance. The questionnaire consisted of participant demographics, sport specialization status, months of pitching per year, whether they traveled regularly to participate in showcases, if they received private coaching, whether they pitched with elbow or shoulder pain, whether they pitched with fatigue, and the Youth Throwing Score (YTS), a valid and reliable patient-reported outcome measure for youth baseball players. The associations between variables of interest and YTS were examined using multivariable linear regression, adjusting for covariates., Results: Sport specialization, pitching year-round, and receiving private coaching were not associated with the YTS ( P > .05). Pitching with pain in the previous year was associated with a worse YTS score than pitching without pain (least square mean [standard error]: 49.6 [1.8] vs. 57.8 [1.1], P < .001). Similarly, pitching with fatigue in the previous year was associated with worse YTS scores (least square mean [standard error]: 52.1 [1.4] vs. 55.3 [1.3], P  = .01). Pitchers who reported traveling regularly for showcases scored worse on the YTS compared with those who did not travel regularly for showcase events (least square mean [standard error]: 51.0 [2.0] vs. 56.4 [0.9], P  = .01)., Conclusions: Pitching with pain or fatigue was associated with worse throwing-arm health in Little League baseball pitchers. While traveling at least once a month to participate in showcases was also associated with worse throwing-arm health, specialization and private coaching were not related to worse throwing health. Clinicians working with pediatric patient populations should be aware that while the factors examined in this article were reported relatively infrequently, screening for Little League pitchers who participate in showcases or pitch with pain or fatigue may be an effective strategy for identifying these individuals who are at higher risk of injury., (© 2021 The Author(s).)

Objective: Determine the association between concussion and subsequent contact, non-contact, and overuse lower extremity (LE) injuries in a cohort of adolescent athletes. Secondarily, to identify this association between males and females., Study Design: Cross-sectional., Setting: Summer athletic events with participants ages 12-18., Main Outcome: Anonymous survey included sport-related injuries (injury month/year) and participants classified injuries as a contact, non-contact, overuse injury, or concussion. Multivariable logistic regression analyses were used to examine associations between a concussion event and a subsequent LE injury while controlling for age and any previous LE injury., Results: A concussion was reported in 219 athletes (Female = 96, 44%) and were matched with 219 non-concussed athletes (438 total participants). Concussion was not association with a specific injury mechanism but was significant for any subsequent LE injury (OR = 1.58 95%CI = [1.03-2.41]; p < 0.05). Concussed females were more likely to report any subsequent LE injury compared to non-concussed female athletes (2.49[1.31, 4.74]; p < 0.01). This relationship was not observed between concussed and non-concussed males (1.11[0.62-1.99]; p > 0.5)., Conclusion: A history of concussion was associated with any subsequent LE injury, but not associated with a specific mechanism of injury. The association with concussion and a subsequent LE injury was different between males and females., Competing Interests: Declaration of competing interest The authors have no potential conflicts of interest to disclose., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: To conduct a survey of parents to determine their knowledge of sport volume recommendations and examine their perceptions toward sport specialization., Design: Cross-sectional survey., Setting: Youth sport athletic tournaments, competitions, and practices., Patients or Other Participants: Parents (n = 1000, 614 women, age: 44.5 ± 6.7 years) of youth athletes completed the survey. Parents had to have a child between 10 and 18 years of age who participated in organized sport in the previous 12 months., Interventions: The survey was anonymous and consisted of yes/no and Likert-scale questions and consisted of background of parent and child and perceptions and knowledge of safe sport recommendations. An expert panel validated the survey., Main Outcome Measures: Data were summarized by frequencies, proportions (%), and mean values and SDs, when appropriate. Chi-square analyses were used to determine if parent sex influenced distributions., Results: Over 80% of parents had no knowledge of sport volume recommendations regarding h/wk (84.5%), mo/yr (82.2%), or simultaneous participation in multiple leagues (89.9%). Twenty-four percent of parents considered it appropriate to participate in multiple leagues in the same sport, whereas 60.5% considered it appropriate to participate in multiple leagues of a different sport. Thirty-four percent of parents indicated that they were concerned about the risk of injury in youth sports. Although 55% of parents considered sport specialization a problem in youth sports, only 43.3% thought that year-round sport participation increased the chances of sustaining an overuse injury. Female parents were more likely to be concerned about injury and believe that year-round sport participation results in overuse injury compared with men., Conclusions: Recommendations associated with youth sport participation are not well known. However, parents are concerned about the risk of injury and consider sport specialization a problem.

Context: A growing number of high-school-aged athletes participate on club sport teams. Some, but not all, state concussion laws apply to both interscholastic and private sport organizations. However, concussion education, management plans, and knowledge have not been examined in club coaches who coach high school-aged athletes., Objective: To determine if differences in concussion education, management plans, and knowledge exist between high school coaches and coaches of club sport teams., Design: Cross-sectional study., Setting: Online survey., Patients or Other Participants: A total of 769 coaches (497 high school coaches, 272 club coaches coaching high school-aged athletes; 266 women [34.6%], 503 men [65.4%]) completed an anonymous online questionnaire., Main Outcome Measure(s): The questionnaire consisted of demographic and team information, requirements for concussion-education and -management plans, and concussion knowledge., Results: High school coaches were more likely than club coaches to report that their organizing bodies or leagues required them to receive concussion-education information (97.4% versus 80.4%; P < .001) and that their organizing bodies or leagues had a concussion-management plan (94.0% versus 70.2%; P < .001). High school coaches were more likely than club coaches to correctly agree that most concussions resolve in 7 to 10 days (48.6% versus 40.1%; P = .02) and disagree that loss of consciousness is required to diagnose a concussion (87.1% versus 80.9%; P = .02)., Conclusions: Club coaches were less likely to be aware of requirements for concussion-education and -management plans from their parent organizations and scored lower on specific concussion-knowledge questions than high school coaches despite the same education requirements across groups under their state concussion laws. These results raise concerns regarding the proper management of concussions in club sports and suggest a need for greater oversight and enforcement of state laws in the club sport setting., (© by the National Athletic Trainers' Association, Inc.)

Post, EG, Trigsted, SM, Schaefer, DA, Cadmus-Bertram, LA, Watson, AM, McGuine, TA, Brooks, MA, and Bell, DR. Knowledge, attitudes, and beliefs of youth sports coaches regarding sport volume recommendations and sport specialization. J Strength Cond Res 34(10): 2911-2919, 2020-Overuse injuries in youth athletes are becoming increasingly common, which may be a result of the prevalence of year-round specialized sport participation. Previous research has identified sport volume recommendations related to months per year, hours per week, and simultaneous participation in multiple sports leagues. Coaches are a primary influence on a youth athlete's decision to specialize in a single sport. Therefore, identifying coaches' baseline beliefs and perceptions is important for developing strategies to educate coaches about safe sport participation. A total of 253 youth sport coaches (207 males) completed an anonymous online questionnaire regarding knowledge of sport volume recommendations and attitudes and beliefs regarding sport specialization. Eligible participants were required to serve as a head or assistant coach of a youth sport team in the past 12 months whose members were between the ages of 12 and 18 years. Most coaches were unaware of recommendations regarding the maximum number of months per year (79.4%), hours per week in 1 sport (79.3%), or number of simultaneous leagues for an athlete to participate in to reduce injury (77.6%). Fewer than half (43.2%) of all coaches were "very" or "extremely" concerned about the risk of injury in youth sports. A majority (60.1%) believed that sport specialization was either "quite a bit" or "a great deal" of a problem. Two-thirds (67.2%) responded that year-round participation in a single sport was either "very" or "extremely" likely to increase an athlete's risk of injury. Although the responses to this survey were predominantly from coaches from 1 state, our results suggest that coaches are unaware of sport volume recommendations but are concerned about specialization. Future efforts are needed to communicate these recommendations to coaches to reduce the risk of overuse injury in youth sports.

Background and Hypothesis: Sport specialization is increasingly common in youth sports and is a risk factor for lower-extremity overuse injuries. However, limited data exist on whether specialization is associated with upper-extremity (UE) overuse injuries, specifically in youth baseball players. We hypothesized that specialization in baseball and being a pitcher would be associated with poorer arm health and UE overuse injury history in the previous year., Methods: During the 2019 spring baseball season, 551 high school baseball athletes (aged 15.9 ± 1.3 years) from 3 states (Alabama, n = 200; California, n = 188; and Michigan, n = 163) completed an anonymous questionnaire. Athletes were recruited from 5 high schools in each state, with schools matched based on factors that influence specialization rates. The questionnaire consisted of (1) demographic characteristics, (2) baseball participation information (including sport specialization status), and (3) throwing-arm health and UE injury history in the previous 12 months. Throwing-arm health was assessed using the Youth Throwing Score (YTS), a validated and reliable outcome measure for youth baseball players. Multivariate regression analyses were used to examine the association between variables of interest and the YTS or UE overuse injury history, adjusting for covariates., Results: After adjustment for covariates, highly specialized athletes were more likely to report a UE overuse injury in the previous year compared with low-specialization athletes (odds ratio [OR], 3.77; 95% confidence interval [CI], 1.39-10.2, P = .009). Both athletes who reported playing baseball for more than 8 months per year (OR, 2.03; 95% CI, 1.12-3.65; P = .019) and athletes who reported being a pitcher (OR, 2.11; 95% CI, 1.20-3.72; P = .010) were more likely to report a history of UE overuse injury. Highly specialized players reported lower (worse) YTS values compared with low-specialization players (least-squares mean estimate ± standard error, 56.5 ± 1.1 vs. 53.3 ± 0.7; P = .034). Players who reported pitching as one of their positions scored worse on the YTS than non-pitchers (least-squares mean estimate ± standard error, 51.6 ± 0.8 vs. 57.2 ± 0.6; P < .001)., Conclusion: Although baseball recommendations that discourage sport specialization are widely available for parents, athletes, and coaches, high rates of sport specialization were reported in our sample. We found that being highly specialized in baseball was associated with UE overuse injury history and worse throwing-arm health in high school baseball athletes. Continued education for baseball parents, athletes, and coaches is necessary to raise awareness of the risks associated with high specialization., (Copyright © 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Objective: Determine the association of sport specialization in female volleyball athletes with previous injury history and determine the association of sport specialization with volleyball participation opportunities., Design: Cross-sectional., Setting: Recruitment occurred from 83 Wisconsin high schools during the 2018 volleyball season., Participants: Female volleyball athletes (N = 1,588, grades 9-12, age = 15.6 ± 1.1 years)., Main Outcomes: Participants completed a pre-season questionnaire soliciting information regarding 1) demographics, 2) sport specialization, 3) sport participation, and 4) sport-related injuries in the previous 12 months. Univariable logistic regression models were used to identify associations with previous injury. Chi-square analyses were used to investigate associations between sport specialization classification and other sport participation opportunities., Results: Both moderately and highly specialized athletes were more likely to report a previous injury compared to low specialized athletes (moderate OR: 1.84 [1.29-2.62]; p < 0.001 and high OR: 2.30 [1.64-3.24]; p < 0.001). Highly specialized athletes were more likely to report participating in club volleyball, summer tournaments, and training camps in the past 12 months. Participants who reported participating in club volleyball, summer competitions, and training camps last year were more likely to report an injury., Conclusions: Specialization was associated with injury history and year-round volleyball opportunities among female adolescent volleyball athletes., Competing Interests: Declaration of competing interest The authors have no potential conflicts of interest to disclose., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objectives: The purpose of this study was to compare the association of sport specialization with previous overuse and acute injuries between male and female adolescent athletes., Design: Cross-sectional study., Methods: Questionnaires were completed by adolescent athletes from various sports at sport club summer events in the state of Wisconsin. Adolescent athletes (12-18 years old) who were active in organized sports in the previous year were recruited. The questionnaire contained demographics, sport participation, sport specialization classification, and previous injury history. Sport specialization classification was determined using common methods in sport specialization research. Previous injury was restricted to athletic injuries that occurred in the past year., Results: Two-thousand and eleven participants (age=13.7±1.6 years, females=989) completed the questionnaire. Highly specialized athletes were more likely to report both acute and overuse injuries compared to low specialization athletes. However, this relationship differed by sex, with only moderate and highly specialized females being more likely (Moderate: OR [95%CI]=1.74 [1.18-2.58], p=0.005; High: OR [95%CI]=1.69 [1.14-2.53], p=0.010) to report an overuse injury compared to low specialization females. Highly specialized female athletes were more likely to report an acute injury (High: OR [95%CI]=1.46 [1.06-2.02], p=0.022) compared to low specialization females. Highly specialized male athletes were not associated with overuse or acute injuries., Conclusions: Highly specialized athletes were more likely to report acute and overuse injuries. However, when this analysis was separated by sex, only highly specialized females were more likely to report a previous overuse or acute injury., (Copyright © 2020 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Context: Sport specialization among youth athletes has been associated with increased risk of overuse injuries. Previous research demonstrates that children perceive specialization to be beneficial in making their high school team and receiving athletic college scholarships. Previous research demonstrates that parents play a significant role in their child's sport experience. However, it is unknown if parents and children answer questions related to specialization factors in a similar manner., Objective: To evaluate the beliefs of youth athletes and parents on factors related to sport specialization and evaluate the level of agreement between dyads on sports specialization., Design: Cross-sectional., Setting: Online and paper surveys., Patients or Other Participants: Aim 1: 1998 participants (993 children and 1005 parents). Aim 2: 77 paired parent-child dyads., Interventions: Self-administered survey., Main Outcome Measures: The responses were summarized via frequency and proportions (%). Chi-squares were calculated between parent and child responses. Kappa coefficients were calculated for dyads to determine level of agreement. Sport specialization was classified using a common 3-point scale., Results: The parents were more concerned about risk of injury in sports compared with children (P < .001, χ2 = 231.4; parent: extremely: 7.1%; child: extremely: 3.7%). However, children were more likely to believe that specialization was associated with their chances of obtaining an athletic college scholarship compared with parents (P < .001, χ2 = 201.6; parent: very/extremely likely: 13.7%; child: very/extremely likely: 15.8%). Dyad subanalysis indicated a moderate level of agreement for "quitting other sports to focus on one sport" (κ = .50) and a low level of agreement for "identifying a primary sport" (κ = .30) and "training >8 months per year in primary sport" (κ = .32)., Conclusions: Parents and youth athletes had differing beliefs on the factors related to sport specialization. Dyad analysis shows that parents and children answer sport specialization classification questions differently. Health care providers should be aware of these differences, and messaging should be individualized to the audience.

Background: Significant evidence has emerged that sport specialization is associated with an increased risk of overuse injury in youth athletes. Several recommendations exist to reduce the risk of overuse injury in youth sports, but the risk of overuse injuries may be dependent on specific movements required by a given sport., Hypotheses: Associations between specialized sport participation and overuse injury will exist in volleyball athletes but not soccer or basketball athletes. Female athletes will be more likely to report an overuse injury in the previous year, regardless of sport., Study Design: Cross-sectional study., Level of Evidence: Level 3., Methods: Youth athletes between the ages of 12 and 18 years were recruited in-person at club team tournaments, competitions, and events around the state of Wisconsin during the 2016-2017 school year. Participants were asked to complete an anonymous questionnaire that consisted of (1) participant demographics, (2) sport specialization status, (3) monthly and weekly sport volume, and (4) sport-related injury history in the previous year., Results: A total of 716 youth athletes completed the questionnaire (70.8% female; mean age, 14.21 ± 1.50 years; 43.2% basketball, 19.4% soccer, 37.4% volleyball; 41.8% highly specialized; 32.3% reported overuse injury in the previous year). Sex was associated with overuse injury among basketball athletes, with female basketball athletes nearly 4 times more likely to report an overuse injury compared with male basketball athletes (odds ratio, [OR], 3.7; 95% CI, 2.1-6.6; P < 0.001). High specialization (OR, 2.3; 95% CI, 1.1-4.9; P = 0.02) and participating in a single sport for more than 8 months per year (OR, 2.0; 95% CI, 1.1-3.5; P < 0.05) were associated with overuse injury only among volleyball athletes., Conclusion: Specialization and exceeding 8 months per year in a single sport was associated with overuse injury in volleyball, which is one of the most popular youth sports for female athletes. Specialization was not associated with overuse injury in basketball or soccer athletes. Female basketball athletes were nearly 4 times more likely to report a history of overuse injury compared with male basketball athletes. The sex of a youth athlete and the sport that he or she plays may influence the risk of overuse injury associated with sport specialization., Clinical Relevance: Youth athletes, parents, and clinicians should be aware that the potential risks of specialization might vary based on the athlete's sport and sex.

Adolescent athletes are increasingly encouraged to specialize in a single sport year-round in an effort to receive a college scholarship. For collegiate baseball, only 11.7 scholarships are available for a 35-player team. The beliefs of the parents of baseball athletes towards sport specialization are unknown, along with whether they have an accurate understanding of college baseball scholarship availability. The parents of high school baseball athletes were recruited to complete an anonymous questionnaire that consisted of (1) parent and child demographics, (2) child baseball participation information, and (3) parent attitudes and beliefs regarding sport specialization and college baseball scholarships. One hundred and fifty-five parents participated in the questionnaire (female: 52.9%, age: 49.4 ± 5.5 years old). The parents spent a median of 3000 USD [Interquartile Range (IQR): 1500-6000] on their child's baseball participation. Most parents believed that specialization increased their child's chances of getting better at baseball (N = 121, 79.6%). The parents underestimated the number of college baseball scholarships available per team (median [IQR]: 5 [0-5]), but 55 parents (35.9%) believed it was likely that their child would receive a college baseball scholarship. Despite having a realistic understanding of the limited college scholarships available, the parents were optimistic that their child would receive a baseball scholarship.

Context: California is currently the only state that does not regulate who can and cannot call themselves athletic trainers (ATs). Therefore, previous national or state-specific investigations may not have provided an accurate representation of AT availability at the secondary school level in California. Similarly, it is unknown whether the factors that influence AT availability in California, such as socioeconomic status, are similar to or different from those identified in previous studies., Objective: To describe the availability of ATs certified by the Board of Certification in California secondary schools and to examine potential factors influencing access to AT services in California secondary schools., Design: Cross-sectional study., Setting: Online survey., Patients or Other Participants: Representatives of 1270 California high schools., Main Outcome Measure(s): Officials from member schools completed the 2017-2018 California Interscholastic Federation Participation Census. Respondents provided information regarding school type, student and student-athlete enrollment, whether the school had ATs on staff, and whether the ATs were certified by the Board of Certification. The socioeconomic status of public and charter schools was determined using the percentage of students eligible for free or reduced-price lunch., Results: More than half (54.6%) of schools reported that they either did not employ ATs (47.6%) or employed unqualified health personnel (UHP) in the role of AT (7.0%). Nearly 30% of student-athletes in California participated in athletics at a school that did not employ ATs (n = 191 626, 28.9%) and 8% of student-athletes participated at a school that employed UHP in the role of AT (n = 54 361, 8.2%). Schools that reported employing ATs had a lower proportion of students eligible for free or reduced-price lunch than schools that did not employ ATs and schools that employed UHP (both P values < .001)., Conclusions: With ongoing legislative efforts to obtain regulation of ATs in California, secondary school administrators are encouraged to hire ATs with the proper certification to enhance the patient care provided to student-athletes and improve health outcomes.

Context: Recent studies suggested that a large population of high school-aged athletes participate on club sport teams. Despite attempts to document emergency preparedness in high school athletics, the adherence to emergency and medical coverage standards among club sport teams is unknown., Objective: To determine if differences in emergency preparedness and training existed between coaches of high school teams and coaches of high school-aged club teams., Design: Cross-sectional survey., Setting: Online questionnaire., Patients or Other Participants: A total of 769 coaches (females = 266, 34.6%) completed an anonymous online questionnaire regarding their emergency preparedness and training., Main Outcome Measure(s): The questionnaire consisted of (1) demographics and team information, (2) emergency preparedness factors (automated external defibrillator [AED] availability, emergency action plan [EAP] awareness, medical coverage), and (3) emergency training requirements (cardiopulmonary resuscitation/AED, first aid)., Results: High school coaches were more likely than club sport coaches to be aware of the EAP for their practice venue (83.9% versus 54.4%, P < .001), but most coaches in both categories had not practiced their EAP in the past 12 months (70.0% versus 68.9%, P = .54). High school coaches were more likely to be made aware of the EAP during competitions (47.5% versus 37.1%, P = .02), but the majority of coaches in both categories indicated that they were never made aware of EAPs. High school coaches were more likely than club coaches to (1) have an AED available at practice (87.9% versus 58.8%, P < .001), (2) report that athletic trainers were responsible for medical care at practices (31.2% versus 8.8%, P < .001) and competitions (57.9% versus 31.2%, P < .001), and (3) be required to have cardiopulmonary resuscitation, AED, or first-aid training ( P < .001)., Conclusions: High school coaches displayed much greater levels of emergency preparedness and training than coaches of high school-aged club teams. Significant attention and effort may be needed to address the lack of emergency preparedness and training observed in club coaches.

Sport specialization is a training method now commonly used by young athletes who hope to achieve elite-level success. This may be defined as (1) choosing a main sport, (2) quitting all other sports to focus on 1 sport, and (3) year-round training (greater than 8 months per year). A number of sports medicine organizations have published recommendations based on the limited evidence available on this topic. The objective of this article was to perform a narrative review of the currently available evidence and sports medicine organizational recommendations regarding sport specialization and its effects on health to guide athletic trainers and sports medicine providers. To accomplish this goal, we conducted a narrative review of articles and position statements on sport specialization published from 1990 through 2018. Injury, overuse injury, serious overuse injury, and lower extremity injury were likely associated with higher degrees of sport specialization in various populations. Sports medicine organizations in general recommended against sport specialization in young athletes and instead promoted multisport participation for physical and psychological benefits. Few long-term data suggest that sport specialization has negative health-related quality-of-life consequences. Higher degrees of sport specialization likely pose risks of overuse injury; however, the age of specialization at which this risk occurs is not known. Because different populations and sports activities may put children at risk for certain injuries, future researchers should monitor large populations with sport-specific prospective active surveillance.

Context: Previous researchers have identified sport specialization as being associated with various negative outcomes (eg, overuse injuries and adverse psychosocial outcomes). However, little is known regarding how the underlying attitudes, beliefs, and values of sport stakeholders may be shaping this trend., Objective: To examine the perceptions of coaches in the high school versus club sport setting and compare their attitudes and behaviors toward sport specialization., Design: Cross-sectional survey., Patients or Other Participants: A total of 769 coaches (497 high school coaches, 272 club sport coaches)., Main Outcome Measure(s): Participants completed a novel measure that surveyed their perceptions regarding various aspects of youth sport specialization. Additionally, each coach completed a questionnaire detailing his or her relevant demographic and sport background information., Results: High school coaches and club sport coaches differed in their perceptions of sport specialization ( t 767 = 1.41, P < .001); club coaches (2.43 ± 0.25) were more likely than high school coaches (2.31 ± 0.21) to rate specialization as a positive, adaptive practice. The multiple linear regression equations for both the high school and club coaches indicated that no educational, experiential, or demographic factors predicted coaches' perceptions of specialization ( P values > .05)., Conclusions: Club sport coaches were more likely to possess attitudes in favor of sport specialization. Additionally, coaches' background characteristics did not predict their perceptions of specialization, suggesting that the competitive context itself (high school versus club) may be the most salient influencer of these perceptions. Athletes and sports medicine practitioners should be aware of the heightened expectation of specialized participation and resulting increased injury risk in these contexts. Pediatric sport researchers and practitioners should continue to explore how these different group perceptions manifest in participation behaviors and may link to overall athlete health, wellbeing, and development.

Background: Club sport participation is increasingly common among high school athletes. Sport participation characteristics may vary widely between the high school and club sport settings. However, there have been no large-scale comparisons of sport participation volume between high school and club teams from similar sports., Purpose/hypothesis: The purpose of this study was to compare the sport participation characteristics of high school and high school-aged club teams. We hypothesized that club team athletes would participate in more months per year and hours per week and would take more overnight trips than high school athletes and that club team coaches would be less likely to track their athletes' sport volume than high school coaches., Study Design: Cross-sectional study., Methods: A total of 769 coaches (266 female; 34.6%) from 3 sports (basketball, volleyball, soccer) completed an anonymous online questionnaire regarding their team's sport volume and their knowledge, attitudes, and beliefs regarding sport specialization. Coaches were eligible to participate if they had served as the head or assistant coach of a high school sport team or high school-aged club sport team in the past 12 months., Results: Overall, 64.6% (n = 497) were coaches of a high school team, and 35.4% (n = 272) were coaches of a club team with high school-aged athletes. Club coaches' teams played more months out of the year and took more overnight trips for competitions than high school coaches' teams but participated in fewer hours per week of practices or competitions during their season. There were no differences between club and high school coaches in tracking their athletes' sport volume, with most coaches in both settings reporting that they do not track the amount of time that their athletes participate in other sports., Conclusion: Significant differences in sport participation volume exist between the teams of high school and club coaches., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: M.A.B. has received research funding from DJO Global and AnthroTronix and has received a consulting fee from the National Basketball Association–GE Healthcare. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Objectives: To investigate the effects of sex as an effect modifier of objectively measured moderate-to-vigorous physical activity (MVPA) in individuals following ACLR and healthy controls., Design: Cross-sectional research study., Setting: University community., Participants: 59 participants (42.4% male) with a history of ACLR and 55 healthy control participants (40.0% male)., Main Outcome Measures: Participants were outfitted with an ActiGraph wGT3X-BT accelerometer for a period of 7 days to assess MVPA. Weekly time engaged in MVPA (in bouts≥ 10 min), % of total time engaged in MVPA, and odds of meeting national physical activity guidelines (MVPA≥ 150 min/wk) were compared between males and females with a history of ACLR and healthy controls., Results: There were significant sex X group interactions for weekly MVPA (p = 0.02) and % total time in MVPA (p = 0.01). The odds of a female ACLR participant meeting national physical activity guidelines were significantly worse (X 2  = 4.18, OR = 2.54, CI 95  = 1.03-6.27) when compared to participants without ACLR., Conclusions: Female participants with ACLR were found to be less active than healthy control participants and their odds of meeting national MVPA guidelines were also 2.54 times worse than healthy participants., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Context: In many US high schools, the athletic trainer (AT) has the responsibility to identify and manage athletes with concussions. Although the availability of ATs varies a great deal among schools, how the level of AT availability in high schools affects the reported incidence and management of sport-related concussions (SRCs) is unknown., Objective: To determine how the presence of an AT affects the reporting and management of SRCs., Design: Prospective cohort study., Patients or Other Participants: A total of 2459 (female = 37.5%, age = 16.1 ± 1.2 years) athletes from 31 Wisconsin high schools were categorized as having low availability (LoAT), mid availability (MidAT), or high availability (HiAT) of ATs. Athletic trainers recorded the incidence, days lost from sport, and postconcussion management through return to sport. The incidence of SRC reporting among categories was examined using a multivariate Cox proportional hazards model. Fisher exact tests were used to determine if postconcussion management differed based on AT availability., Results: The incidence of reported SRCs was lower for the LoAT schools (2.4%) compared with the MidAT (5.6%, hazard ratio = 2.59, P = .043) and HiAT (7.0%, hazard ratio = 3.33, P = .002) schools. The median time before the first AT interaction was longer for LoAT schools (24.0 hours) than for MidAT (0.5 hours, post hoc P = .012) and HiAT (0.2 hours, post hoc P = .023) schools. The number of post-SRC interactions was different in all groups (LoAT = 2 interactions, MidAT = 3, and HiAT = 4; all post hoc P values < .05). Days lost were greater for MidAT and HiAT (both 14 days lost) schools compared with LoAT schools (11.5 days lost, post hoc P = .231 and P = .029, respectively). Athletes at LoAT schools were less likely to undergo a return-to-play protocol (9/18 SRCs, 50.0%) than athletes at MidAT (44/47 SRCs, 93.6%; post hoc P = .001) or HiAT (64/64 SRCs, 100%; post hoc P < .001) schools., Conclusions: The level of AT availability positively influenced the reported incidence of SRCs as well as postconcussion management activities in this sample of high schools.

Context: Sport specialization is theorized to increase the risk of sustaining overuse musculoskeletal injuries., Objective: To complete a systematic review and meta-analysis of the literature to determine if sport specialization is associated with overuse musculoskeletal injuries., Data Sources: An electronic search was conducted using the search terms "specialization," "year-round," "overuse," "repetitive stress," "injury," "young," "pediatric," and "sports.", Study Selection: Studies were included if their population was ≤18 years of age, if they compared athletes with high or single-sport specialization with athletes with low or multisport specialization, and focused on overuse injuries., Data Extraction: Of the 12 articles that were identified for full-text review, 5 studies met all the inclusion criteria. Four studies provided adequate data for the meta-analysis. Quality scores on the modified Downs and Black scale ranged from 69% to 81%., Results: Athletes with high specialization were at an increased risk of sustaining an overuse injury compared with athletes with low (pooled relative risk [RR] ratio: 1.81; 95% confidence interval [CI]: 1.26-2.60) and moderate (pooled RR: 1.18; 95% CI: 1.05-1.33) specialization. Athletes with moderate specialization were at a higher risk of injury compared with athletes with low specialization (RR: 1.39 [95% CI: 1.04-1.87])., Limitations: Four of the 5 studies included in this systematic review were included in the meta-analysis because of the lack of access to the original data set for 1 article., Conclusions: Sport specialization is associated with an increased risk of overuse musculoskeletal injuries (Strength of Recommendation Taxonomy grade: B)., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2018 by the American Academy of Pediatrics.)

Objectives: To describe the socioeconomic status, measured by household income and educational attainment, of parents with children participating on youth club sport teams., Design: Cross-sectional survey., Setting: Local sport events., Participants: 949 parents (571 female) of youth athletes between 10 and 18 years old were recruited at club team events and practices to complete an anonymous questionnaire., Main Outcome Measures: SES variables included total household income (THI) and educational attainment. Sport specialization was classified as low, moderate, or high using a previously utilized 3-point specialization scale. Chi-square tests were used to compare frequencies SES categories with child specialization., Results: Parents reported spending a median of 1500 [500-3000] USD per year on their children's club sports activities. Most parents reported a THI greater than 100,000 USD per year and a bachelor's degree or higher level of education. Parents in the higher THI categories were more likely to have a child that is highly specialized in one sport., Conclusion: The current youth sports system in the United States, which emphasizes year-round participation on club teams, may be limiting the participation of families without the resources to participate in this system., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: There are a variety of proposed motivations for sport specialization, such as improving sport skills to an elite level, making all-star or travel teams, or receiving a scholarship or professional contract. However, there has not been a quantitative examination of the attitudes and beliefs that may be contributing to the trend of sport specialization and year-round sport participation., Purpose: The primary aim was to describe the attitudes and beliefs of youth club sport athletes regarding sport specialization and sport participation. A secondary objective was to investigate whether an association exists between the level of sport specialization and the belief in receiving a college scholarship., Study Design: Cross-sectional study; Level of evidence, 3., Methods: A total of 974 youth athletes (578 female; mean age, 14.2 ± 1.6 years) completed an anonymous questionnaire that focused on attitudes and beliefs toward sport specialization and sport participation. Questions were developed utilizing the feedback of a panel of content area experts and the University of Wisconsin Survey Center. Data were summarized using frequencies, proportions (%), and means ± SDs., Results: Fewer than half of all athletes (45.8%) believed that specialization increased their chances of getting injured either "quite a bit" or "a great deal." However, 91% of athletes believed that specialization increased their chances of getting better at their sport either "quite a bit" or "a great deal." Similarly, the majority of athletes believed that specialization increased their chances of making their high school team (80.9%) or a college team (66.9%) either "quite a bit" or "a great deal." Overall, 15.7% of athletes believed that they were either "very" or "extremely" likely to receive a college scholarship based on athletic performance. Highly specialized athletes were nearly twice as likely to have a high belief in receiving a college scholarship compared with low-specialization athletes (20.2% vs 10.2%, respectively; χ 2 = 18.8; P = .001)., Conclusion: Most youth athletes in this study believe that specialization increases their sport performance and ability to make not only a college team but also their high school team. Highly specialized athletes were more likely to believe that they will receive a college scholarship., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This study was supported by a grant that was cofunded by the American Medical Society for Sports Medicine and the American College of Sports Medicine. M.A.B. has received research funding from the National Collegiate Athletic Association, the Department of Defense, DJO Global, and AnthroTronix and has received consulting fees from the National Basketball Association–GE Healthcare to review scientific research proposals.

Background: Sport specialization has been associated with overuse injuries and is more common in larger high schools, which are often located in more urban/suburban settings. However, sport participation characteristics have not been compared between suburban and rural high schools., Purpose/hypothesis: The purpose of this study was to examine the differences in sport participation characteristics between athletes at suburban and rural high schools. It was hypothesized that suburban high school students would be more likely to be highly specialized, participate in more athletic competitions per year, and play in a league outside of school. We also hypothesized that suburban high school students would start playing their primary sport at a younger age, would have participated in their primary sport for longer, and would play more months per year and hours per week., Study Design: Cross-sectional study., Methods: High school athletes from 4 high schools (2 suburban and 2 rural) participated in this study (N = 354 [222 females]; mean age, 15.7 ± 1.2 years). Athletes were on a school-sponsored athletic team in 1 of 4 sports (volleyball, tennis, basketball, soccer). The suburban schools (study enrollment, n = 226) had total school enrollments of 2271 and 622 students, while the rural schools (study enrollment, n = 128) had total school enrollments of 443 and 297. Participants completed a questionnaire prior to the start of their high school sport season. The questionnaire consisted of demographic information, a sport specialization scale, and sport participation information. Primary sport competition volume in the previous 12 months was classified as high (>60 primary sport competitions), moderate (30-60), or low (<30). Sport specialization status was classified via a 3-point scale as low, moderate, or high., Results: As compared with athletes at rural schools, athletes at suburban schools started playing their primary sport at a younger age (suburban, 7.8 ± 2.9 years; rural, 9.7 ± 3.2 years; P < .001) and participated for more years (suburban, 7.9 ± 3.1 years; rural, 6.1 ± 3.3 years; P < .001), more months per year (suburban, 7.6 ± 3.6 months; rural, 5.6 ± 2.8 months; P < .001), and more hours per week (suburban, 15.2 ± 5.1 hours; rural, 12.9 ± 3.3 hours; P < .001). Athletes at suburban schools were more likely than rural athletes to be classified as highly specialized (χ 2 = 52.5, P < .001), participate in more competitions (χ 2 = 16.5, P < .001), play in a league outside of school (χ 2 = 18.4, P < .001), and train in their primary sport for >8 months per year (χ 2 = 27.8, P < .001) and >16 hours per week (χ 2 = 15.0, P < .001)., Conclusion: High school athletes at suburban schools are more likely to exhibit sport participation patterns that are associated with increased risk of overuse injury. These include being classified as highly specialized, playing their primary sport >8 months per year and >16 hours per week, engaging in a high competition volume, and participating in a sport league (eg, club) outside of school. Efforts aimed at safe sport participation should target these groups, as they seem more likely to violate safe sport recommendations., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This study was supported in part by a grant from the American Medical Society for Sports Medicine.

Background: High school athletes are increasingly encouraged to participate in 1 sport year-round to increase their sport skills. However, no study has examined the association of competition volume, club sport participation, and sport specialization with sex and lower extremity injury (LEI) in a large sample of high school athletes., Hypothesis: Increased competition volume, participating on a club team outside of school sports, and high levels of specialization will all be associated with a history of LEI. Girls will be more likely to engage in higher competition volume, participate on a club team, and be classified as highly specialized., Study Design: Cross-sectional study., Level of Evidence: Level 3., Methods: High school athletes completed a questionnaire prior to the start of their competitive season regarding their sport participation and previous injury history. Multivariable logistic regression analyses were used to investigate associations of competition volume, club sport participation, and sport specialization with history of LEI, adjusting for sex., Results: A cohort of 1544 high school athletes (780 girls; grades 9-12) from 29 high schools completed the questionnaire. Girls were more likely to participate at high competition volume (23.2% vs 11.0%, χ 2 = 84.7, P < 0.001), participate on a club team (61.2% vs 37.2%, χ 2 = 88.3, P < 0.001), and be highly specialized (16.4% vs 10.4%, χ 2 = 19.7, P < 0.001). Athletes with high competition volume, who participated in a club sport, or who were highly specialized had greater odds of reporting a previous LEI than those with low competition volume (odds ratio [OR], 2.08; 95% CI, 1.55-2.80; P < 0.001), no club sport participation (OR, 1.50; 95% CI, 1.20-1.88; P < 0.001), or low specialization (OR, 2.58; 95% CI, 1.88-3.54; P < 0.001), even after adjusting for sex., Conclusion: Participating in high sport volume, on a club team, or being highly specialized was associated with history of LEI. Girls were more likely to participate at high volumes, be active on club teams, or be highly specialized, potentially placing them at increased risk of injury., Clinical Relevance: Youth athletes, parents, and clinicians should be aware of the potential risks of intense, year-round participation in organized sports.