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.

Pediatric Health Care Provider Awareness, Perceptions, and Utility of Sport Specialization Recommendations.

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.

Does Increased Physical Activity Explain the Psychosocial Benefits of Sport Participation During COVID-19?

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

Secondary School Athletic Trainers' Navigation of Patient Socioeconomic Status Challenges in Care: A Qualitative Study.

Secondary school ATs (SSATs) are uniquely positioned healthcare providers at an optimal public health intersection where they can provide equitable healthcare to low socioeconomic status (SES) adolescents. SSATs face similar challenges to physicians in treating low SES patients, but their strategies may be different compared to other medical professions. However, the consequences of low SES population healthcare delivery by SSATs have not been explored. SSATs were asked to share what challenges, if any, they encounter with providing care for their low SES patients and what strategies they find most effective to overcome these challenges. Data were collected via semi-structured interviews and reflective field notes and analyzed using a four-step, interpretative phenomenological analysis (IPA) guided theme development. Data saturation was met, and the sample size aligned with other IPA studies. Trustworthiness was established with research triangulation and Yardley's four principles. Three interrelated themes emerged: (a) mechanisms for identifying SES, (b) the impact of SES on care, and (c) navigating SES challenges. SSATs described many strategies that were gained through their clinical experiences to overcome healthcare barriers. SSATs have the potential to decrease health disparities through their role as a liaison and advocates for their low SES patients.

Consensus Definition of Sport Specialization in Youth Athletes Using a Delphi Approach.

CONTEXT: A single, widely accepted definition of sport specialization does not currently exist. A consensus definition is necessary to guide youth sport stakeholders on topics associated with sport specialization. OBJECTIVE: To develop a consensus definition of youth sport specialization and identify elements that support the construct of specialization. DESIGN: Delphi study. SETTING: Directed surveys. PATIENTS OR OTHER PARTICIPANTS: A consensus panel of 17 experts was created to provide a broad multidisciplinary perspective on sport specialization in youth athletes. DATA COLLECTION AND ANALYSIS: The final definition was developed per an iterative process that involved 4 rounds of review. A comprehensive review of the literature and expert input supported our initial proposed umbrella definition that included 6 additional elements. The study team reviewed the results after each round, and changes were made to the definition based on panel feedback. MAIN OUTCOME MEASURE(S): Panel members were provided with the definition and 6 elements and then asked to rate each specific to importance, relevance, and clarity using a 4-point Likert scale. RESULTS: In 4 Delphi consensus rounds, 17 experts reviewed the umbrella definition and 6 elements before consensus was reached. The umbrella definition and 3 of the initial 6 elements achieved greater than 80% agreement for importance, relevance, and clarity after the fourth round of review. The remaining 3 components did not reach greater than 80% agreement, even after iterative edits, and were removed. The process resulted in a final consensus definition: Sport specialization is intentional and focused participation in a single sport for a majority of the year that restricts opportunities for engagement in other sports and activities. CONCLUSIONS: A consensus-based conceptual definition for sport specialization was developed using a Delphi method. This definition has important implications for clinicians and sports medicine professionals who support youth athletes.

The Health Of Us Adolescent Athletes During Covid-19 Related School Closures And Sport Cancellations.

CONTEXT: In the spring of 2020, US schools closed to in-person teaching and sports were cancelled to control the transmission of COVID-19. It is critical to understand the mental and physical health of adolescent athletes during this time. OBJECTIVE: Describe the health of athletes during COVID-19 related school closures and sport cancellations. DESIGN: Cross sectional. SETTING: A national sample recruited via social media. PATIENTS OR OTHER PARTICIPANTS: 13,002 US adolescent athletes (age=16.3+1.2 yrs., female=53.1%) completed an anonymous online survey. MAIN OUTCOME MEASURE(S): Demographic information included: sex, grade, sports played and zip code. Assessments included the: General Anxiety Disorder-7 Item (GAD-7) for anxiety, Patient Health Questionnaire-9 Item (PHQ-9) for depression, the Pediatric Functional Activity Brief Scale (PFABS) for physical activity, and the Pediatric Quality of Life Inventory 4.0 (PedsQL) for quality of life. Mental health, physical activity and quality of life variables were compared between sex, grade, sports played and poverty level using means and 95%CI from the survey weighted ANOVA. RESULTS: Females reported a higher prevalence of moderate to severe anxiety symptoms (females=43.7% vs. males=28.2%). The PFABS score (mean [95%CI] was highest (best) for grade 9 (14.5 [14.0,15.0]) and lowest for grade 11 (10.9 [10.5,11.3]. The prevalence of depression symptoms was highest in team sport (74.1%) and lowest for individual sport participants (64.9%). The total PedsQL score was lowest (worst) for athletes from counties with the highest poverty levels (high=74.5[73.7,75.3], middle=78.9[78.0,79.8], low=78.3 [77.4,79.1]). CONCLUSIONS: The health of US adolescents during the COVID-19 related school closures and sport cancellations varied to differing degrees depending on sex, grade level, type of sport participation and level of poverty. Health policy experts should consider these findings when creating and implementing policies to improve the health of adolescents in the US in the future.

Jump-landing mechanics after anterior cruciate ligament reconstruction: a landing error scoring system study.

CONTEXT: The Landing Error Scoring System (LESS) is a clinical evaluation of jump-landing mechanics and may provide useful information in assisting with return-to-sport decisions in patients after anterior cruciate ligament reconstruction (ACLR). However, it is currently unknown how patients with ACLR perform on the LESS compared with healthy controls. OBJECTIVE: To determine if the total LESS score differed between individuals with ACLR and healthy controls and to determine the types of errors that differ between groups. DESIGN: Cross-sectional study. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 27 individuals with unilateral ACLR (age = 19.8 ± 1.8 years, height = 170 ± 5.5 cm, mass = 68.8 ± 11.9 kg) and 27 controls (age = 20.5 ± 1.7 years, height = 169 ± 8.4 cm, mass = 66.6 ± 9.0 kg) with no history of ACLR. INTERVENTION(S): Each participant completed 3 trials of a standardized jump-landing task. MAIN OUTCOME MEASURE(S): Each jump landing was assessed for specific postures using standardized LESS criteria by a blinded evaluator. Individual LESS items were summed to create a total LESS score. The dominant limb was assessed in the control group, and the reconstructed limb was assessed in the ACLR group. RESULTS: The ACLR group had higher LESS scores compared with controls (ACLR: 6.7 ± 2.1 errors, control: 5.6 ± 1.5 errors, P = .04). Additionally, the ACLR group was more likely to err when landing with lateral trunk flexion (Fisher exact test, P = .002). CONCLUSIONS: Individuals with ACLR had worse landing mechanics as measured by the LESS. Lateral trunk deviation may be related to quadriceps avoidance in the reconstructed limb or poor trunk neuromuscular control. The LESS is useful for evaluating landing errors in patients with ACLR and may help to identify areas of focus during rehabilitation and before return to sport.

Effect of limiting ankle-dorsiflexion range of motion on lower extremity kinematics and muscle-activation patterns during a squat.

CONTEXT: Limitations in gastrocnemius/soleus flexibility that restrict ankle dorsiflexion during dynamic tasks have been reported in individuals with patellofemoral pain (PFP) and are theorized to play a role in its development. OBJECTIVE: To determine the effect of restricted ankle-dorsiflexion range of motion (ROM) on lower extremity kinematics and muscle activity (EMG) during a squat. The authors hypothesized that restricted ankle-dorsiflexion ROM would alter knee kinematics and lower extremity EMG during a squat. DESIGN: Cross-sectional. PARTICIPANTS: 30 healthy, recreationally active individuals without a history of lower extremity injury. INTERVENTIONS: Each participant performed 7 trials of a double-leg squat under 2 conditions: a no-wedge condition (NW) with the foot flat on the floor and a wedge condition (W) with a 12° forefoot angle to simulate reduced plantar-flexor flexibility. MAIN OUTCOME MEASURES: 3-dimensional hip and knee kinematics, medial knee displacement (MKD), and ankle-dorsiflexion angle. EMG of vastus medialis oblique (VMO), vastus lateralis (VL), lateral gastrocnemius (LG), and soleus (SOL). One-way repeated-measures ANOVAs were performed to determine differences between the W and NW conditions. RESULTS: Compared with the NW condition, the wedge produced decreased peak knee flexion (P < .001, effect size [ES] = 0.81) and knee-flexion excursion (P < .001, ES = 0.82) while producing increased peak ankle dorsiflexion (P = .006, ES = 0.31), ankle-dorsiflexion excursion (P < .001, ES = 0.31), peak knee-valgus angle (P = .02, ES = 0.21), and MKD (P < .001, ES = 2.92). During the W condition, VL (P = 0.002, ES = 0.33) and VMO (P = .049, ES = 0.20) activity decreased while soleus activity increased (P = .03, ES = 0.64) compared with the NW condition. No changes were seen in hip kinematics (P > .05). CONCLUSIONS: Altering ankle-dorsiflexion starting position during a double-leg squat resulted in increased knee valgus and MKD, as well as decreased quadriceps activation and increased soleus activation. These changes are similar to those seen in people with PFP.