Neighborhood Context as a Barrier to Sport Participation for Girls: Evidence From a Sport Diversity Index.

BACKGROUND: Evidence suggests neighborhood contexts play a vital role in shaping the availability and diversity of youth sport and participation rates, especially for African American or Black girls. Currently, no index captures interscholastic sport opportunities (eg, sport diversity) within and across school districts and specifically applied to African American or Black girls. OBJECTIVE: To visualize the inequalities present in interscholastic sport opportunities for girls across school districts using a novel index in a selected study area of St Louis City and County, Missouri, and discuss the implications for African American or Black girls. DESIGN: Cross-sectional study. SETTING: Database secondary analysis. PATIENTS OR OTHER PARTICIPANTS: Data for 47 public high schools in the 23 St Louis City and County school districts. MAIN OUTCOME MEASURE(S): We gathered data from the 2014-2018 American Community Survey and Missouri State High School Activities Association. We assessed sport diversity for girls by constructing a sport diversity index (SDI) that uses an entropy index as its foundation. Census-tract data were used to examine the association with neighborhood demographics and contributors to school district income and sport diversity. Descriptive spatial statistics were calculated to evaluate distributions in St Louis City and County, with the bivariate local indicator of spatial autocorrelation used to determine any correlations between variables of interest. RESULTS: The St Louis City school district, which has areas with high rates of renter-occupied housing and poverty and high percentages of non-Hispanic African American or Black students, had the lowest SDI for girls, contrasted with the school districts in St Louis County, which showed an inverse pattern on average. The SDI for girls was correlated with the percentages of renter-occupied housing and poverty. The SDI for girls was also correlated with race: an increasing presence of the non-Hispanic African American or Black population was associated with decreased sport diversity for girls. CONCLUSIONS: The SDI for girls demonstrated a spatial association with neighborhood-level determinants of sport-opportunity availability for non-Hispanic African American or Black girls in St Louis. The role of social and political determinants of health in shaping community context and resultant health in athletic training research, policy, and practice should be considered.

Is Cumulative Load Associated with Injuries in Youth Team Sport? A Systematic Review.

BACKGROUND: High cumulative external and internal load may predispose athletes to increased risk for injury across a variety of sports, competition levels, and age groups. However, evidence of an association between cumulative load and injury in youth sport remains inconclusive. The objective of this study was to determine the current evidence for cumulative load and injury risk relationships in youth team sport through a systematic review of the existing literature. METHODS: A systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Literature searches were conducted in PubMed, Web of Science, SCOPUS, and CINAHL for relevant articles published between January 2010 and April 2021. The authors conducted independent review and quality assessment of the eligible studies. Eleven articles evaluating youth (less than 18 years old) team sport were included for qualitative synthesis. RESULTS: Fifty-nine percent (n = 39/66) of the relationships assessed revealed an association between cumulative load and injury across the team sports studied, including the presence of load-injury associations in 84% (n = 16/19) of assessments in youth soccer. Of those relationships where an association was present, 79% (n = 31/39) were positive associations between cumulative load and injury. Risk of bias assessment scores ranged from three to six out of seven possible (median = 5) for cohort studies and from four to seven out of 10 possible (median = 5.5) for cross-sectional studies. CONCLUSIONS: There is some evidence for a positive association between load and injury in youth team sport. Youth soccer was the most studied team sport, and a substantial number of positive load-injury associations were reported. Current evidence lacks consistency in the measures and metrics used in defining load-injury relationships. Trial Registration PRISMA ID - CRD42020203622.

Sink or Swim: Virtual Life Challenges among African American Families during COVID-19 Lockdown.

This study explores African American parents' experiences with using technology to engage their children in meaningful activities (e.g., e-learning) during COVID-19 and its impact on family health. Eleven African American families were recruited through a local health department program from a rural Midwestern community to participate in semi-structured interviews. Majority of participants reported stresses from feelings of "sink or swim" in a digital world, without supports from schools to effectively provide for their children's technology needs. The COVID-19 pandemic underscored the importance of family-school collaborative engagement and empowerment. Digital technology needs to become part of our school education system so that technology use among African Americans is elevated and families protected against future outbreaks. Further research with a more diverse African American sample is needed.

Adverse childhood experiences (ACEs) & youth sports participation: Does a gradient exist?

BACKGROUND: Exposure to adverse childhood experiences (ACEs) may be an important factor in understanding sport participation in youth. Yet, very little research has examined this relationship directly using nationally representative data from the United States. OBJECTIVE: This study aimed to examine the associations between ACEs and sport participation in adolescents. METHODS: Using a 2017-2018 pooled dataset of the National Survey of Children's Health [NSCH], survey weighted chi-squared analysis and multivariable logistic regressions were implemented to assess the association between ACEs and sport participation among youth aged 10-17 years, comparing those without reports of ACEs (ref) to those reporting ACEs. The sample was also stratified to examine gendered differences. Models were adjusted for sociodemographic and child health covariates (physical activity, gender, age, BMI, race/ethnicity, parent reported child health, parental educational attainment, family structure, health insurance coverage, year and mental health conditions). RESULTS: Of 23,557 youth included in our study (12,454 boys [51%], 11,303 girls [49%]; 21.9% reported 1 ACE, 10.1% reported 2 ACEs, and 14.3% reported 3 or more ACEs. In fully adjusted models, we observed significant associations between all levels of ACE exposure and decreased sport participation. When examined by gender, adjusted models revealed that only boys reporting 1ACE exhibited decreased odds of participating in sport OR = 0.70 (95% CI: 0.56, 0.89). CONCLUSIONS: ACE exposure in adolescents is associated with reduced odds of sport participation. While sport is traditionally seen as an intervention for youth to build resilience, it may be prudent to consider targeted interventions that encourage sport participation in youth who experience ACEs. Special consideration may be needed for boys who experience ACEs. Additionally, the results suggest that utilising a trauma informed framework within the world of youth sport and sports medicine may be of value overall.

"The Tip of the Iceberg": Commentary on Sports, Health Inequity, and Trauma Exacerbated by COVID-19.

OBJECTIVE: To discuss the relevance of system-level health inequities and their interplay with race in sports and athletic training, particularly during and after the coronavirus disease 2019 (COVID-19) pandemic. BACKGROUND: Health inequity is a systemic and longstanding concern with dire consequences that can have marked effects on the lives of minority patients. As a result of the unequal consequences of the COVID-19 pandemic, the magnitude of the outcomes from health inequity in all spheres of American health care is being brought to the fore. The discourse within athletic training practice and policy must shift to intentionally creating strategies that acknowledge and account for systemic health inequities in order to facilitate an informed, evidence-based, and safe return to sport within the new normal. CONCLUSIONS: To continue to evolve the profession and solidify athletic trainers' role in public health spaces post-COVID-19, professionals at all levels of athletic training practice and policy must intentionally create strategies that acknowledge and account for not only the social determinants of health but also the effects of racism and childhood trauma on overall health and well-being.

Filling the Gaps in Adolescent Care and School Health Policy-Tackling Health Disparities through Sports Medicine Integration.

The School-Based Health Centre (SBHC) model of healthcare delivery in community health is designed to address the unique needs of adolescents. Through a collaborative interprofessional approach, they aim to provide comprehensive care with the goal of reducing health disparities in underserved, at-risk adolescents. Integration of sports medicine health professionals is a novel approach to increasing available services, as well as patient utilization, while addressing multiple public health issues, including lack of athletic training services for youth athletes.