Disparities in Youth Sports and Barriers to Participation

Amateur Athletic Union (AAU) Accessibility: An Area Deprivation Index (ADI) Analysis of National Basketball Association (NBA) Players' Profiles

PURPOSE OF REVIEW

Youth sports are increasingly shifting towards a "pay to play" model which has introduced financial barriers to participation. The Amateur Athletic Union (AAU) is the main organization for club basketball, serving as a platform where young athletes can compete beyond the recreational level. Outside the realm of athletes who have access to state-of-the-art facilities and top-tier coaching, the pathway to playing basketball at the next level may be predominantly available to those who can afford the considerable costs of AAU participation. The objective of this study is to determine the accessibility of AAU teams of active National Basketball Association (NBA) players through use of the Area Deprivation Index (ADI).

RECENT FINDINGS

We identified 114 AAU teams with physical addresses for 250 (50%) currently active domestic NBA players. The State ADI of the high schools as well as national and state ADIs of prior AAU teams of active NBA players were significantly skewed toward lower ADI rankings (higher socioeconomic status) (p < 0.05). The mean distance between high school location and AAU location was 170 miles. Prior AAU teams of currently active NBA players are more frequently located in areas of higher socioeconomic status with nearly 50% being within the top 3rd lower state decile as measured by the area deprivation index. Similarly, we found the high schools these players attended, as a proxy for areas they grew up in, were also more frequently located in areas of higher socioeconomic status.

Navigating uncertainty: exploring parents' knowledge of concussion management and neuropsychological baseline testing

Introduction

Parents play an important role in preventing and managing sport-related concussions among youth sport participants. Research indicates that parents understand the severity and consequences associated with the injury but gaps exist in their knowledge of its management. Neuropsychological baseline testing (NBT) is a modality that has gained interest in youth sport to purportedly better manage concussion injuries. Little is known about parents' perspectives on the use of NBT in the management process.

Methods

The present qualitative study used Protection Motivation Theory as a guiding framework and employed focus groups (N = 2) with parents (N = 11) to gain insight into parents' perceptions and experiences with concussion management, specifically focusing on NBT.

Results

Inductive Content Analysis developed a core theme of navigating uncertainty. Participants expressed uncertainty about the nature of concussion and its management process, where concussion was not always easy to identify, youth were not always reliable reporters, and there was no prescribed or proscribed path for recovery. Personal experience and concussion management policy provided participants with a degree of certainty in managing concussions. Participants gave NBT mixed reviews in potentially promoting greater certainty but also held reservations about its usefulness in concussion management.

Discussion

We discuss findings relative to existing knowledge and theory in youth sport concussion and identify implications for practice.

Secondary School Athletic Trainers' Perceptions of the Influence of Social Determinants of Health and Socioeconomic Status on Clinical Management Decisions

CONTEXT

Evidence suggests that lower socioeconomic status (SES) and negative social determinants of health (SDOH) contribute to health care disparities. Due to their accessibility in the high school setting, secondary school athletic trainers (SSATs) may encounter patients who are historically underserved in health care, such as patients with low SES. However, a significant gap in knowledge exists regarding how SDOH and SES may influence SSATs' clinical management decisions.

OBJECTIVES

To describe SSATs' perceptions of how patient SDOH and SES influence clinical management decisions and to identify barriers to athletic health care.

DESIGN

Cross-sectional study.

SETTING

Online survey.

PARTICIPANTS OR OTHER PARTICIPANTS

National Athletic Trainers' Association SSATs (6.7% response rate).

MAIN OUTCOME MEASURE(S)

Secondary school athletic trainers were asked about their perceptions of patient SDOH and SES (content validity index = 0.83 for relevancy). The levels of relevance and agreement were answered on a 4-point Likert scale. Data were summarized using means and SDs, frequencies and proportions (%), and median scores.

RESULTS

A total of 380 SSATs participated (mean years of experience = 14.9 ± 11.7 years). When providing care, most (71.3%) SSATs believed their patients' health or health care access to be the most relevant of the 5 SDOH, whereas the other 4 SDOH were less than 60% relevant. Most SSATs agreed or strongly agreed that patient SES affected both referral (67.4%) and the reliance on conservative treatment before referral (71.2%). Secondary school athletic trainers identified patient or guardian compliance (70.2%) and type of health insurance (61.5%) as barriers to providing care to patients with low SES.

CONCLUSIONS

Secondary school athletic trainers perceived health or health care access as the most relevant social determinant when providing care to patients with low SES. When SSATs further considered the SES of patients, they identified all SDOH as barriers that they were ill equipped to navigate as they delivered care and engaged in patient referral.

Sociodemographic influences on youth sport participation and physical activity among children living within concentrated Hispanic/Latino rural communities

Introduction

Lack of physical activity (PA) among children living in rural communities is a documented public health problem. Although studies have examined community conditions defined by a rural-urban dichotomy, few have investigated rural community conditions with a concentration of Hispanic/Latino people. This cross-sectional study examined sociodemographic characteristics associated with youth sport (YS) participation and daily PA among children living within concentrated Hispanic/Latino rural U.S. Midwest communities.

Methods

During spring 2022, 97% of 3rd-6th grade children (n = 281, aged approximately 8-12 years) attending school in rural Midwestern communities (n = 2) with >50% concentration of Hispanic students participated in the Wellscapes Project, a community randomized trial. Participants completed the Youth Activity Profile and supplemental National Survey of Children's Health questions assessing PA behaviors and YS participation. Caregivers of a subsample of children (n = 215; males, n = 93; females, n = 122) consented to pair their child's survey results with school enrollment records (e.g., free/reduced lunch status and race and ethnicity). Mixed models with community as a random effect examined main and interaction effects of grade, sex, ethnoracial status, and family income on YS participation and these sociodemographic characteristics and YS participation on daily moderate-to-vigorous PA (MVPA).

Results

Approximately half of children participated in YS. Non-Hispanic White children (n = 82) were over five times more likely to participate in YS than Hispanic peers (n = 133) (OR = 5.54, 95% CI = 2.64-11.61, p < 0.001). YS participants accumulated 8.3 ± 2.3 more minutes of daily MVPA than non-participants (p < 0.001). Sixth graders, females, and Hispanic children reported lower daily MVPA than comparison groups (p < 0.05). Significant interaction effects on daily MVPA between grade and ethnoracial status (F(3, 204) = 3.04, p = 0.030) were also found.

Discussion

Disparities in sport participation and PA outcomes based on sociodemographic characteristics exist among children living in ethnoracially diverse rural communities. Strategies to promote YS participation, including community structural changes, may help reduce PA disparities. The research provides valuable insights for policymakers, public health professionals, and community members to address YS participation barriers, not limited to cost, while considering other PA-promotion efforts to improve child population health.

Baseball Injury Prevention Through a Community Outreach Initiative

Sports-related craniofacial injuries account for 10% to 42% of facial fractures in the US pediatric population, with the incidence of injury peaking at ages 6 to 7 and 12 to 14. The National Survey of Children's Health reported ~5.6 million children between the ages of 6 and 17 participated in baseball in 2021. National Electronic Injury Surveillance System reported 861,456 injuries resulting from baseball and 511,117 injuries resulting from softball in 2021, with ~500,000 of those injuries being to the face/head/neck. While participation in baseball and other youth sports has tremendous physical and mental health benefits, facial and other athletic injuries are concerning beyond the pain and disability caused by the incident itself. Severe injury can result in lost time from school as well as other social activities. Players and their families often experience financial strain as a result of physical trauma as well. The use of protective equipment has decreased the incidence of emergency department visits due to baseball-related trauma, especially mouthguards. However, adherence to using mouthguards is relatively low in baseball, with over 80% of players reporting not being told by a coach to wear mouthpieces. Youth from low-income areas often lack financial means to provide protective equipment and health insurance in the case of injury. The authors, along with the University of Miami Miller School of Medicine Division of Plastic and Reconstructive Surgery and Miami Marlins RBI Program, created an outreach program by which over 400 mouthguards were given to players and caretakers at inner-city baseball and softball programs. Two community outreach events took place in South Florida. One event was held at a University of Miami Men's Baseball Game, and another was held on the opening day of the Miami Marlins RBI Program youth baseball league. In addition to handing out protective equipment and informational pamphlets, a question and answers session was held to discuss injury prevention. In conclusion, our community safety initiative created an interactive dialogue and message to hundreds of youth baseball players about the importance of protective gear to prevent injuries.

Overuse Injuries, Overtraining, and Burnout in Young Athletes

Sports participation can have tremendous physical and mental health benefits for children. Properly implemented progressive training programs can yield a broad range of beneficial physiologic adaptations, but imbalances of training load and recovery can have important negative consequences. Overuse injuries, for example, can result from repetitive stress without sufficient recovery that leads to accumulated musculoskeletal damage. In addition, extended periods of increased training loads that exceed the intervening recovery can have systemic consequences such as overtraining syndrome, which results in decreased performance, increased injury and illness risk, and derangement of endocrine, neurologic, cardiovascular, and psychological systems. Burnout represents one of the primary reasons for attrition in youth sports. Broadly defined as physical or mental exhaustion and a reduced sense of accomplishment that leads to devaluation of sport, burnout represents a direct threat to the goal of lifelong physical activity and the wide-ranging health benefits that it provides. This clinical report is intended to provide pediatricians with information regarding the risk factors, diagnosis, management, and prevention of these conditions to assist in the identification of at-risk children, the treatment of young athletes, and the guidance of families in the promotion of safe and healthy sport participation.

Higher Levels of Income and Education are Associated with More Specialized Sport Participation Behaviors: Results from a Representative Sample of Youth Sport Parents from the United States

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.

Physical Activity Engagement: Perspectives From Adolescents With Comorbid Asthma and Overweight/Obesity and Their Caregivers

OBJECTIVE

Most adolescents do not meet physical activity (PA) guidelines, and engagement rates are even lower among adolescents with asthma and overweight/obesity (OW/OB). Understanding barriers and facilitators to PA engagement that are unique to youth with comorbid asthma and OW/OB is important for PA promotion. The current qualitative study identified caregiver- and adolescent-reported factors contributing to PA among adolescents with comorbid asthma and OW/OB across the four domains of the Pediatric Self-Management Model: individual, family, community, and health care system.

METHODS

Participants were 20 adolescents (Mage = 16.01; 55% male) with asthma and OW/OB and their caregiver (90% mothers). Caregivers and adolescents participated in separate semistructured interviews about influences, processes, and behaviors related to adolescent PA engagement. Interviews were analyzed using thematic analysis.

RESULTS

Factors contributing to PA varied across four domains. The individual domain included influences (e.g., weight status, psychological and physical challenges, asthma triggers and symptoms) and behaviors (e.g., taking asthma medications, self-monitoring). At the family level, influences included support, lack of modeling, and independence; processes included prompts and praise; and behaviors included engaging in shared PA and providing resources. Community-level influences included surrounding and settings, social support, and cornonavirus disease-2019-related changes, while behaviors included engaging in PA with others and extracurricular activities.

CONCLUSIONS

Influences, processes, and behaviors across multiple domains interact to impact adolescent PA engagement, highlighting factors that may be potential leverage points in prevention and intervention efforts to promote adolescent PA.

Youth Sport Participation Experiences From the Perspective of Hispanic/Latinx Parents and Their Children

Hispanic/Latinx communities remain an underserved population in terms of health and physical activity opportunities. The rise of sport specialization can jeopardize these opportunities. Understanding the appeal and welcomeness that minoritized populations feel toward sport and sport specialization culture can play an important role in health promotion and breaking down barriers that widen the gap on physical activity levels in Hispanic/Latinx communities. To date, these studies have not qualitatively investigated Hispanic/Latinx youth sport dyads (parent and child) and how sport specialization perceptions have affected their sport participation experiences. We used a qualitative interpretative phenomenological analysis to explore experiences of Hispanic/Latinx high school athletes. We engaged in semistructured interviews with 12 parent-child dyads. The following 3 interrelated themes emerged: (a) expectations of youth sport participation, (b) meeting expectations of youth sport participation, (c) and (mis)alignment of cultures. Dyads describe a negative youth sport experience when both cultures do not align because of the rise in sport specialization and pay-to-play culture. Findings indicate that dyads understand what is necessary to participate in organized sport and do this by methods that are rooted in their Hispanic/Latinx culture.

The association of families' socioeconomic and demographic characteristics with parents' perceived barriers to returning to youth sport following the COVID-19 pandemic

Developmentally appropriate sport contexts have the potential to positively influence young people's physiological, psychological, and social outcomes. However, little is known about how families returned to sport in the wake of COVID-19-related restrictions or how socioeconomic and demographic factors influenced parents' perceptions of barriers to returning. A nationally representative sample (N = 6183) of American youth sport parents completed a questionnaire in which they provided demographic information and answered questions related to the barriers they perceived in returning to sport, such as the risk of their child getting sick. Structural equation modeling was used to examine the relationships among a range of socioeconomic and demographic factors and these barriers to returning. Results suggest that parents from racially minoritized and urban neighborhoods held higher levels of concern over health-related and practical barriers to returning to sport. Findings highlight the importance of designing available, equitable, and appropriate youth sport contexts.

Association of Insurance Status With Treatment Delays for Pediatric and Adolescent Patients Undergoing Surgery for Patellar Instability

Background:

Health care disparities have been highlighted in pediatric sports medicine, but the association between insurance status and delayed care for patients undergoing surgery for patellar instability has not been defined.

Purpose:

To determine whether there is an association between insurance status and delays in care in pediatric and adolescent patients undergoing surgery for patellar instability.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

This was a retrospective case series at a safety-net tertiary referral center of pediatric and adolescent patients undergoing surgical treatment for patellar instability. Insurance status was classified as public or private. We calculated the times from injury to clinical evaluation, injury to magnetic resonance imaging (MRI), injury to surgery, clinical evaluation to MRI, and clinical evaluation to surgery. Comparisons were made between insurance groups.

Results:

Included were 78 patients (38 public, 40 private insurance) who underwent surgery for patellar instability. The public insurance group was older (P = .019), with a lower proportion of White patients (15.8% vs 52.5%; P = .0005), higher proportion with Hispanic ethnicity (55.3% vs 15.0%; P = .0001), and higher proportion of Spanish-speaking patients (21.1% vs 2.5%; P = .007). Publicly insured patients had longer times from initial injury to clinical evaluation (466 vs 77 days; P = .002), MRI (466 vs 82 days; P = .003), and surgery (695 vs 153 days; P = .0003), as well as a longer time from clinical evaluation to surgery (226 vs 73 days; P = .002). Multivariable models confirmed insurance status as an independent predictor in each of the identified delays.

Conclusion:

Significant delays were seen for pediatric and adolescent patients with patellar instability and public insurance (approximately 6 times longer to clinical evaluation, more than 5.5 times longer to obtain MRI, and 4.5 times longer to surgery) relative to injured patients with private insurance. Even after adjusting for delays to clinical evaluation, publicly insured patients had a delay from clinic to surgery that was triple that of privately insured patients.

The Gap in Community Sports: Utilization of Sports Facilities in South Korea

Anyone can participate in sports, but not everyone has the opportunity to do so. The purpose of this study was to identify the factors causing inequality in sports participation based on the causes of the disparity in sports facility utilization in South Korea. Based on ecosystem theory, factors affecting the use of sports facilities were identified. For the causal relationship analysis of each factor, a hierarchical regression analysis was performed using the SPSS (version 26.0) package (IBM, Armonk, NY, USA). The characteristics of individual, family, and community levels show the different impacts based on study models with hierarchical structures. The results of this study illustrated that family characteristics did not influence the facilities’ utilization rate. However, individual and community characteristics did influence the sports facilities’ utilization rate. Although these results were derived from the case of South Korea, they are comparable data focusing on country-specific characteristics and community indicators. It is expected that sports participation can be strengthened by bridging the gap in sports facilities’ utilization.

The COVID-19 Pandemic Upended Youth Sports

The American Academy of Pediatrics estimates that approximately 35 to 45 million young people age 6 to 18 years participate in some type of athletics every year. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic interrupted youth sports and left many children unable to train in-person with teammates and coaches. Given the large impact sports and physical activity have on the lives of children and adolescents, the effect that coronavirus disease 2019 restrictions have had on the psychological and physical well-being of young athletes is significant. The youth sports community has worked hard to find creative ways to safely bring children and adolescents back to the fields and courts with rules and regulations in place. Youth practices and competitions are potential spreader events for SARS-CoV-2, especially given the challenge of identifying young athletes and other participants with asymptomatic active viral infection. With the implementation of rapid result testing programs and the US Food and Drug Administration approval of a highly effective vaccine in adolescents and, most recently, in younger children, youth sports are once again becoming a place for young athletes to train, socialize, and learn invaluable lessons in teamwork and leadership. [Pediatr Ann. 2021;50(11):e450-e453.].