Reported COVID-19 Incidence in Wisconsin High School Athletes in Fall 2020

(STATE-XXX = Wisconsin) ABSTRACT Objective: To describe the incidence of COVID-19 in STATE-XXX high school athletes, and to investigate the relationship of COVID-19 incidence with sport and face mask use. Design: Retrospective survey. Setting: High schools across STATE-XXX during September, 2020. Participants: Athletic directors representing 30,074 high school athletes with and without SARS-CoV-2. Independent Variables: COVID-19 rates among athletes, counties, and STATE-XXX, school instruction type (virtual vs in-person), sport type, face mask use. Main Outcome Measurements: Reported athlete case rates compared to their county's general population. Associations between COVID-19 incidence and sport type and face mask use, adjusting for each school's county incidence using multivariable negative binomial regression models. Results: COVID-19 incidence rates for 207 of 244 responding schools were 32.6 cases per 100,000 player-days. Reported case rates for athletes in each county were positively correlated with the county's general population case rates (β=1.14±0.20, r=0.60, p<0.001). One case (0.5%) was attributed to sport contact by the reporting schools. No difference was identified between team and individual sports (incidence rate ratio (IRR)=1.03 [95% CI=0.49–2.2], p=0.93) or between non-contact and contact sports (IRR=0.53 [0.23–1.3], p=0.14). Outdoor sports had a lower incidence rate than indoor sports, although this did not reach statistical significance (IRR=0.52 [0.26–1.1], p=0.07). There were no significant associations between COVID-19 incidence and face mask use during play for those sports with greater than 50 schools reporting on face mask use (p>0.05 for all). Conclusions: Incidence of reported COVID-19 among high school athletes was related to county incidence and most cases were attributed to non-sport contact. A lower COVID-19 incidence in outdoor sports approached statistical significance. The lack of a significant benefit of face mask use may be due to relatively low rates of COVID-19 in STATE-XXX during September 2020. Further research is needed to better define COVID-19 transmission risk factors during adolescent sport participation.

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Reported COVID-19 Incidence in Wisconsin High School Athletes During Fall 2020

10.1101/2021.02.18.21251986 ◽

2021 ◽

Author(s):

Phillip Sasser ◽

Timothy McGuine ◽

Kristin Haraldsdottir ◽

Kevin Biese ◽

Leslie Goodavish ◽

...

Keyword(s):

High School ◽

General Population ◽

Negative Binomial ◽

Statistical Significance ◽

Negative Binomial Regression ◽

Face Mask ◽

Incidence Rates ◽

High School Athletes ◽

Outdoor Sports ◽

The Difference

ABSTRACTIntroductionThe purpose of this study was to describe the reported incidence of COVID-19 in Wisconsin high school athletes in September 2020, and to investigate the relationship of COVID-19 incidence with sport and face mask use.MethodsSurveys were sent to athletic directors of all Wisconsin high schools regarding sports during September 2020. The association between reported case rates in athletes in each county and the county general population were evaluated with a weighted linear model. Multivariable negative binomial regression models evaluated the associations between COVID-19 incidence and sport type and face mask use by players, adjusting for the county COVID-19 incidence for each school.Results207 schools that had reinitiated sport reported 270 COVID-19 cases among 30,074 players, for case and incidence rates of 809 cases per 100,000 players and 32.6 cases per 100,000 player-days, respectively. The case rates for athletes in each county were positively correlated with the case rates for the county’s general population (β =1.14±0.20, r=0.60, p<0.001). One hundred fifteen (55%) of cases were attributed to household contact, 85 (41%) to contact outside sport or school, 5 (2.4%) to school contact, and 1 (0.5%) to sport contact. No difference was identified between team and individual sports (incidence rate ratio (IRR)=1.03 [95% CI=0.49-2.2], p=0.93) or between non-contact and contact sports (IRR=0.53 [0.23-1.3], p=0.14), although the difference between outdoor and indoor sports approached statistical significance (IRR=0.52 [0.26-1.1], p=0.07). 84% of schools required face masks while playing. For those sports with >50 participating schools, there were no significant associations between COVID-19 incidence and face mask use in cross country (IRR=0.71 [0.2-2.2], p=0.52), football (IRR=1.6 [0.6-5.1], p=0.404), boys soccer (IRR=2.3 [0.5-17], p=0.31), or girls volleyball (IRR=1.4 [0.3-6.6], p=0.64).ConclusionsIncidence of reported COVID-19 among athletes was related to background county incidence and most cases were attributed to household and community contact. Although not statistically significant, reported COVID-19 incidence may be lower in outdoor sports. Face mask use did not have a significant benefit, which may be due to relatively low rates of COVID-19 and the small number of schools that did not report using face masks.

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The Association of COVID-19 Incidence with Sport and Face Mask Use in United States High School Athletes

Journal of Athletic Training ◽

10.4085/1062-6050-281-21 ◽

2021 ◽

Author(s):

Andrew M. Watson ◽

Kristin Haraldsdottir ◽

Kevin Biese ◽

Leslie Goodavish ◽

Bethany Stevens ◽

...

Keyword(s):

United States ◽

High School ◽

Incidence Rate ◽

Close Contact ◽

Statistical Significance ◽

Face Mask ◽

High School Athletes ◽

Contact Sports ◽

Individual Sports ◽

Indoor Sports

Context: The relationships between different sports, face mask use and COVID-19 risk among high school athletes remains unknown. Objective: The purpose of this study was to evaluate the influence of sport characteristics and face mask use on COVID-19 incidence among high school athletes. Design: Descriptive Epidemiology Study Setting: United States High School Athletic Departments Participants: Athletic Directors Interventions: None Main Outcome Measures: Surveys were completed regarding sport re-initiation, COVID-19 cases, and risk reduction procedures in fall 2020. Separate mixed effects Poisson regression models were developed to evaluate the associations between reported COVID-19 incidence and 1) sport characteristics (contact/non-contact, individual/team, indoor/outdoor) and 2) face mask use while playing (yes/no). Results: 991 schools had restarted fall sports, representing 152,484 athletes on 5,854 teams. 2,565 cases of COVID-19 were reported, representing a case rate of 1,682 cases per 100,000 athletes and an incidence rate of 24.6 cases per 100,000 player-days. COVID-19 incidence was lower among outdoor versus indoor sports (incidence rate ratio [IRR]=0.54, 95% CI=0.49–0.60, p<0.001) and non-contact versus contact sports (IRR=0.78 [0.70–0.87], p<0.001), but not team versus individual sports (IRR=0.96 [0.84–1.1], p=0.49). Face mask use was associated with a decreased incidence in girls' volleyball (IRR=0.53 [0.37–0.73], p<0.001), boys' basketball (IRR=0.53 [0.33–0.83], p=0.008) and girls' basketball (IRR=0.36 [0.19–0.63], p<0.001), and approached statistical significance in football (IRR=0.79 [0.59–1.04], p=0.10) and cheer/dance (IRR=0.75 [0.53–1.03], p=0.081). Conclusions: In this nationwide survey of high school athletes, lower COVID-19 incidence was independently associated with participation in outdoor versus indoor and non-contact versus contact sports, but not team versus individual sports. Face mask use was associated with decreased COVID-19 incidence among indoor sports, and may be protective among outdoor sports with prolonged close contact between participants.

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The Association of COVID-19 Incidence with Sport and Face Mask Use in United States High School Athletes

10.1101/2021.01.19.21250116 ◽

2021 ◽

Author(s):

Andrew M. Watson ◽

Kristin Haraldsdottir ◽

Kevin Biese ◽

Leslie Goodavish ◽

Bethany Stevens ◽

...

Keyword(s):

United States ◽

High School ◽

Incidence Rate ◽

Athletic Directors ◽

Face Mask ◽

High School Athletes ◽

Contact Sports ◽

High School Athletic ◽

Individual Sports ◽

Indoor Sports

ABSTRACTPurposeTo evaluate the influence of sport characteristics and face mask use on COVID-19 incidence among high school athletes.MethodsSurveys were distributed to high school athletic directors throughout the United States regarding sport re-initiation, COVID-19 cases, and risk reduction procedures in fall 2020.Separate mixed effects Poisson regression models were developed to evaluate the associations between reported COVID-19 incidence and 1) sport characteristics (contact/non-contact, individual/team, indoor/outdoor) and 2) face mask use while playing (yes/no).Results991 schools had restarted fall sports, representing 152,484 athletes on 5,854 teams. 2,565 cases of COVID-19 were reported, representing a case rate of 1,682 cases per 100,000 athletes and an incidence rate of 24.6 cases per 100,000 player-days. COVID-19 incidence was lower among outdoor versus indoor sports (incidence rate ratio [IRR]=0.54, 95% CI=0.49-0.60, p<0.001) and non-contact versus contact sports (IRR=0.78 [0.70-0.87], p<0.001), but not team versus individual sports (IRR=0.96 [0.84-1.1], p=0.49). Face mask use was associated with a decreased incidence in girls’ volleyball (IRR=0.53 [0.37-0.73], p<0.001), boys’ basketball (IRR=0.53 [0.33-0.83], p=0.008) and girls’ basketball (IRR=0.36 [0.19-0.63], p<0.001), and approached statistical significance in football (IRR=0.79 [0.59-1.04], p=0.10) and cheer/dance (IRR=0.75 [0.53-1.03], p=0.081).ConclusionsIn this nationwide survey of US high school athletic directors representing 152,484 athletes, lower COVID-19 incidence was independently associated with participation in outdoor versus indoor and non-contact versus contact sports, but not team versus individual sports. Face mask use was associated with decreased COVID-19 incidence among indoor sports, and may be protective among outdoor sports with prolonged close contact between participants.

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Perceived coach-created environment directly predicts high school athletes’ physical activity during sport

International Journal of Sports Science & Coaching ◽

10.1177/1747954120959733 ◽

2020 ◽

pp. 174795412095973

Author(s):

Tsz Lun (Alan) Chu ◽

Xiaoxia Zhang ◽

Joonyoung Lee ◽

Tao Zhang

Keyword(s):

Physical Activity ◽

High School ◽

Indirect Effects ◽

Sport Participation ◽

Longitudinal Design ◽

Vigorous Physical Activity ◽

Need Satisfaction ◽

Direct Effects ◽

High School Athletes ◽

Need Frustration

Sport participation is an important means for adolescents to achieve moderate-to-vigorous physical activity (MVPA), yet most high school students including athletes do not achieve the 60-minute daily MVPA guideline. As psychosocial factors influence athlete engagement and physical activity during sport, the perceived environment created by coaches could play a role in this influence. Guided by self-determination and achievement goal theories, this four-month prospective study examined the direct and indirect effects of perceived coach-created environment on high school athletes’ MVPA and sedentary behavior (SB) during sport. During the third to fourth week of a sport season, 225 high school athletes ( Mage = 15.24 years) completed a survey assessing perceptions of coach-created empowering and disempowering climates as well as psychological need satisfaction and frustration. Four months later, their MVPA and SB percentage times (%) during sport were measured using accelerometers. Path analyses partially supported our hypothesis, indicating significant direct effects of a perceived empowering climate on need satisfaction (β = .41) and need frustration (β = –.29), and direct effects of a perceived disempowering climate on need frustration (β = .38) and MVPA% (β = –.28). No significant indirect effects on MVPA% or SB% were found. Findings support and provide new insights into the important role of disempowering beyond empowering climates in predicting high school athletes’ PA. Specifically, when coaches display ego-involving and controlling behaviors, high school athletes may disengage during sport and achieve less overall MVPA. Further examination of these relationships using a longitudinal design across more diverse samples is warranted.

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A Prospective Study on the Effect of Sport Specialization on Lower Extremity Injury Rates in High School Athletes

The American Journal of Sports Medicine ◽

10.1177/0363546517710213 ◽

2017 ◽

Vol 45 (12) ◽

pp. 2706-2712 ◽

Cited By ~ 65

Author(s):

Timothy A. McGuine ◽

Eric G. Post ◽

Scott J. Hetzel ◽

M. Alison Brooks ◽

Stephanie Trigsted ◽

...

Keyword(s):

High School ◽

Lower Extremity ◽

Sport Participation ◽

Large Population ◽

Lower Extremity Injury ◽

High School Athletes ◽

Adolescent Athletes ◽

School Year ◽

Increased Risk ◽

Interscholastic Athletes

Background: Sport specialization is associated with an increased risk of musculoskeletal lower extremity injuries (LEIs) in adolescent athletes presenting in clinical settings. However, sport specialization and the incidence of LEIs have not been investigated prospectively in a large population of adolescent athletes. Purpose: To determine if sport specialization was associated with an increased risk of LEIs in high school athletes. Study Design: Cohort study; Level of evidence, 2. Methods: Participants (interscholastic athletes in grades 9-12) were recruited from 29 Wisconsin high schools during the 2015-2016 school year. Participants completed a questionnaire identifying their sport participation and history of LEIs. Sport specialization of low, moderate, or high was determined using a previously published 3-point scale. Athletic trainers reported all LEIs that occurred during the school year. Analyses included group proportions, odds ratios (ORs) and 95% CIs, and days lost due to injury (median and interquartile range [IQR]). Multivariate Cox proportional hazard ratios (HRs) with 95% CIs were calculated to investigate the association between the incidence of LEIs and sport specialization level. Results: A total of 1544 participants (50.5% female; mean age, 16.1 ± 1.1 years) enrolled in the study, competed in 2843 athletic seasons, and participated in 167,349 athlete-exposures. Sport specialization was classified as low (59.5%), moderate (27.1%), or high (13.4%). Two hundred thirty-five participants (15.2%) sustained a total of 276 LEIs that caused them to miss a median of 7.0 days (IQR, 2.0-22.8). Injuries occurred most often to the ankle (34.4%), knee (25.0%), and upper leg (12.7%) and included ligament sprains (40.9%), muscle/tendon strains (25.4%), and tendinitis/tenosynovitis (19.6%). The incidence of LEIs for moderate participants was higher than for low participants (HR, 1.51 [95% CI, 1.04-2.20]; P = .03). The incidence of LEIs for high participants was higher than for low participants (HR, 1.85 [95% CI, 1.12-3.06]; P = .02). Conclusion: Athletes with moderate or high sport specialization were more likely to sustain an LEI than athletes with low specialization. Sports medicine providers need to educate coaches, parents, and interscholastic athletes regarding the increased risk of LEIs for athletes who specialize in a single sport.

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Association of Competition Volume, Club Sports, and Sport Specialization With Sex and Lower Extremity Injury History in High School Athletes

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738117714160 ◽

2017 ◽

Vol 9 (6) ◽

pp. 518-523 ◽

Cited By ~ 49

Author(s):

Eric G. Post ◽

David R. Bell ◽

Stephanie M. Trigsted ◽

Adam Y. Pfaller ◽

Scott J. Hetzel ◽

...

Keyword(s):

High School ◽

Lower Extremity ◽

Sport Participation ◽

Lower Extremity Injury ◽

Extremity Injury ◽

High School Athletes ◽

Level Of Evidence ◽

Increased Risk ◽

History Of ◽

Club Sport

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%, χ2 = 84.7, P < 0.001), participate on a club team (61.2% vs 37.2%, χ2 = 88.3, P < 0.001), and be highly specialized (16.4% vs 10.4%, χ2 = 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.

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A Comparison of Team Sport Volume Surveyed Between High School and Club Sport Coaches

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119836484 ◽

2019 ◽

Vol 7 (4) ◽

pp. 232596711983648

Author(s):

Eric G. Post ◽

Daniel A. Schaefer ◽

Kevin M. Biese ◽

Andrew M. Watson ◽

Timothy A. McGuine ◽

...

Keyword(s):

High School ◽

Large Scale ◽

Sport Participation ◽

Cross Sectional Study ◽

High School Athletes ◽

Online Questionnaire ◽

Cross Sectional ◽

High School Coaches ◽

Sport Team ◽

Club Sport

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.

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Developmental Differences in Burnout Among High School Athletes in the United States: A Gendered Perspective

Journal of Clinical Sport Psychology ◽

10.1123/jcsp.2021-0017 ◽

2021 ◽

pp. 1-13

Author(s):

Tsz Lun (Alan) Chu ◽

Bailey Sommerfeld ◽

Tao Zhang

Keyword(s):

High School ◽

Sport Participation ◽

The United States ◽

Developmental Differences ◽

Developmental Model ◽

Analysis Of Covariance ◽

Future Research ◽

High School Athletes ◽

Athlete Burnout ◽

And Gender

Building on recent research examining athlete burnout trajectories, this study implemented the developmental model of sport participation to compare emotional and physical exhaustion, reduced sense of accomplishment, and sport devaluation between age groups (specializing [aged 13–15 years] vs. investment [aged 16–18 years]) and gender (boys vs. girls) among U.S. high school athletes. Participants were 367 high school athletes (M = 15.53; 212 males; 186 specializing) across various individual and team sports who completed a survey assessing their demographic information, sport backgrounds, and burnout perceptions. A 2 × 2 multivariate analysis of covariance, controlling for training hours, showed greater emotional and physical exhaustion and sport devaluation in the investment than the specializing group, but no developmental differences in reduced sense of accomplishment. Contrary to our hypothesis, no gender or interaction effects were found. Findings inform interventions and future research that address the role of developmental stages and gender in athlete burnout.

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Sport Specialization Characteristics Between Rural and Suburban High School Athletes

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117751386 ◽

2018 ◽

Vol 6 (1) ◽

pp. 232596711775138 ◽

Cited By ~ 7

Author(s):

David R. Bell ◽

Eric G. Post ◽

Stephanie M. Trigsted ◽

Daniel A. Schaefer ◽

Timothy A. McGuine ◽

...

Keyword(s):

High School ◽

High School Students ◽

High Schools ◽

Sport Participation ◽

Suburban Schools ◽

High School Athletes ◽

School Students ◽

Rural High Schools ◽

Study Enrollment ◽

Younger Age

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 (χ2 = 52.5, P < .001), participate in more competitions (χ2 = 16.5, P < .001), play in a league outside of school (χ2 = 18.4, P < .001), and train in their primary sport for >8 months per year (χ2 = 27.8, P < .001) and >16 hours per week (χ2 = 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.

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Knowledge of Concussion and Reporting Behaviors in High School Athletes With or Without Access to an Athletic Trainer

Journal of Athletic Training ◽

10.4085/1062-6050-52.1.07 ◽

2017 ◽

Vol 52 (3) ◽

pp. 228-235 ◽

Cited By ~ 39

Author(s):

Jessica Wallace ◽

Tracey Covassin ◽

Sally Nogle ◽

Daniel Gould ◽

Jeffrey Kovan

Keyword(s):

High School ◽

Sport Participation ◽

Signs And Symptoms ◽

Cross Sectional Study ◽

Medical Professional ◽

Athletic Trainer ◽

High School Athletes ◽

Cross Sectional ◽

Reporting Behaviors ◽

Concussion Knowledge

Context: Increased sport participation and sport-related concussion incidence has led to an emphasis on having an appropriate medical professional available to high school athletes. The medical professional best suited to provide medical care to high school athletes is a certified athletic trainer (AT). Access to an AT may influence the reporting of sport-related concussion in the high school athletic population; however, little is known about how the presence of an AT affects concussion knowledge, prevention, and recognition. Objective: To evaluate knowledge of concussion and reporting behaviors in high school athletes who did or did not have access to an AT. Design: Cross-sectional study. Setting: Survey. Patients or Other Participants: A total of 438 athletes with access to an AT and 277 without access to an AT. Intervention(s): A validated knowledge-of-concussion survey consisting of 83 items addressing concussion history, concussion knowledge, scenario questions, signs and symptoms of a concussion, and reasons why an athlete would not report a concussion. The independent variable was access to an AT. Main Outcome Measure(s): We examined the proportion of athletes who correctly identified knowledge of concussion, signs and symptoms of concussion, and reasons why high school student-athletes would not disclose a potential concussive injury by access to an AT. Frequency statistics, χ2 tests, independent t tests, and linear regression were conducted to analyze the data. Results: The underreporting of concussion among high school athletes was 55%. Athletes with access to an AT had more knowledge of concussion than did athletes without such access (P ≤ .001). Chi-square tests did not demonstrate a significant relationship between AT access and a higher percentage reporting concussions. Conclusions: High school athletes with access to an AT had more concussion knowledge, but they did not report suspected concussions to an authority figure more frequently than athletes without access to an AT.

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