Perceived challenges and barriers for females working in the heat.

Given rising temperatures, globally, heat exposures and catastrophic heat illnesses are a major concern in laborer and industrial sectors. The purpose of this study was to evaluate the perceptions of females laboring in the heat regarding challenges and barriers encountered in their respective industries while working in the heat. A consensual qualitative research (CQR) design was employed to gain information related to participant occupational and job characteristics, feelings while working in the heat, adjustments made by employers when they work in the heat, and their experience working in the heat specific to their identified sex. Females were eligible to participate if they were currently employed in an environment that required them to work in the heat. Twelve females participated in a single, 45-60 min one-on-one semi-structured interview. Participants reported working in the manufacturing, agriculture, tourism, and railroad industries. Upon completion of data analysis, one primary theme was identified: heat stress mitigation strategies, which were further broken down into two subthemes of formal strategies provided by the employer and informal strategies driven by the employees. Participants indicated there was a lack of heat stress prevention strategies implemented by their employers, which resulted in employees creating their own strategies to protect themselves and their coworkers from heat stress. Results indicated there are limited heat stress prevention strategies that are provided in industries that include females working in the heat. Unique considerations should be made to protect this population from the dangers of heat stress and must go beyond workers protecting themselves.

Geographic Disparity in Distance to Trauma Care in Secondary Schools across the United States.

CONTEXT: Geographic disparities exist in trauma care (i.e., "trauma center desert") within the United States. An athletic trainer (AT) on-site at secondary schools (SSs) may help enhance collaboration with emergency medical systems and potentially lead to better outcomes following catastrophic injuries. However, access to AT services relative to the location of Level I or II (i.e., tertiary) trauma centers remain unknown. OBJECTIVE: To visualize and describe SSs distance to trauma centers and compare access to AT services across the United States. DESIGN: Cross-sectional study. SETTING: Public and private secondary schools with interscholastic athletics program in the United States. PATIENTS OR OTHER PARTICIPANTS: Survey data obtained through the Athletic Training Locations and Services (ATLAS) project database between September 2019 and April 2023. MAIN OUTCOME MEASURE(S): The minimum distance from each SS to tertiary trauma centers was calculated on Tableau Desktop by geocoding with longitude and latitude. The status and level of AT employment were obtained from ATLAS project database. The odds and percentage of access to AT services were examined by distance ranges. RESULTS: A total of 18,244 SSs were included in the analyses. Seventy-five percent of SSs (n=13,613) were located within 50 miles from tertiary trauma center. The odds of access to AT services were 2.74 [CI: 2.56-2.93] times greater in SSs located within 50 miles from tertiary trauma center (P<0.001). Additionally, SSs located > 60 miles from tertiary trauma center have decreased access to AT services (R2= 0.9192). CONCLUSION: This study highlights geographic disparity in distance to trauma care for SSs in the United States. SSs located > 60 miles from trauma centers were at reduced odds of access to AT services. Identification of geographic trends of AT services relative to the location of tertiary trauma centers is a critical first step to prevent fatal consequences of catastrophic injuries.

Athletic Trainers' Psychosocial Experiences During the COVID-19 Pandemic: A Qualitative Research Study.

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.

Work-Family Conflict and Family Role Performance Among Collegiate Athletic Trainers.

CONTEXT: Work-life balance continues to be a focal point of athletic training research, particularly due to the job challenges and demands of health care providers. Despite a large body of literature, much is still unexplored, especially in the area of family role performance (FRP). OBJECTIVE: To examine the relationships between work-family conflict (WFC), FRP, and various demographic variables among athletic trainers employed in the collegiate setting. DESIGN: Cross-sectional online survey. SETTING: Collegiate setting. PATIENTS OR OTHER PARTICIPANTS: A total of 586 collegiate athletic trainers (females = 374, males = 210, sex variant or nonconforming = 1, preferred not to answer = 1). MAIN OUTCOME MEASURE(S): Data were collected through an online survey (Qualtrics) in which participants responded to demographic questions and previously validated WFC and FRP scales. Demographic data were reported and analyzed for descriptive information and frequencies. Mann-Whitney U tests were performed to identify differences among groups. RESULTS: Participants' mean scores were 28.19 ± 6.01 and 45.86 ± 11.55 for the FRP and WFC scales, respectively. Mann-Whitney U tests revealed differences between men and women for WFC scores (U = 344 667, P = .021). The FRP score was moderately negatively correlated with the WFC total score (rs[584] = -0.497, P < .001) and predicted the WFC score (b = 72.02, t582 = -13.30, P = .001). The Mann-Whitney U test demonstrated that married athletic trainers (47.20 ± 11.92) had higher WFC scores than those who were not married (43.48 ± 11.78; U = 19847.00, P = .003). Mann-Whitney U analysis (U = 32 096.00, P = .001) also revealed a difference between collegiate athletic trainers with children (48.16 ± 12.44) and those without children (44.68 ± 10.90). CONCLUSIONS: Collegiate athletic trainers experienced more WFC with marriage and having children. We propose that the time required to raise a family and build relationships may cause WFC due to time incongruencies. Athletic trainers want to be able to spend time with their families; however, when such time is highly limited, then WFC increases.

Youth Athletes' Parents' Perceptions and Knowledge of the Athletic Training Profession.

CONTEXT: Parents have unique roles in advocating for their child's health and safety. Such advocacy can improve student-athletes' access to athletic trainers (ATs), yet few researchers have investigated the perceptions of student-athletes' parents regarding athletic training. OBJECTIVE: To explore parents' perceptions of athletic training and evaluate their knowledge regarding the AT's role. DESIGN: Concurrent mixed-methods study. SETTING: Web-based questionnaire. PATIENTS OR OTHER PARTICIPANTS: Parents affiliated with USA Football representing 36 states (n = 316: men = 53.5%, women = 46.1%; average age = 45.6 ± 6.2 years [age provided = 291]) were included. MAIN OUTCOME MEASURE(S): An online questionnaire was developed and distributed via Qualtrics. The questionnaire contained demographic questions, quantitative items assessing perceived value and knowledge of athletic training, and open-ended questions to provide opportunities for expansion. Descriptive statistics were calculated for the demographic data. Quantitative measures were presented as count and percentage responses. Open-ended responses were analyzed using the general inductive approach, and overall perceptions were supported with participant quotes. RESULTS: Of 10 763 parents, 390 completed the questionnaire (3.6% response rate, 74.8% completion rate). Of the 390, 316 had a child in high school. Approximately 67% (n = 213) of respondents considered an AT a trusted source of medical information and "extremely valuable" to student-athletes' health and safety. The questionnaire response injury prevention was frequently recognized (n = 307, 97.2%) as a skill ATs perform, followed by first aid/wound care (91.8%) and therapeutic interventions (82.3%). Parents highlighted the AT's role in immediate care and attributed peace of mind and feelings of comfort to having a health care professional readily available for their children. CONCLUSIONS: When asked directly and when discussing their effect on student-athlete health and safety, parents valued ATs. Though various qualifications of ATs were recognized, parents emphasized the importance of having someone immediately available to provide care if and when needed. Educational efforts should focus on ATs as the most qualified health care professionals to provide comprehensive medical care to student-athletes in both urgent and nonurgent situations.

Secondary School Athletic Coaches' Perceptions and Knowledge of the Athletic Training Profession.

CONTEXT: Coaches play a role in streamlining care, especially by directing student-athletes in need of further medical attention to the athletic trainer (AT). The AT-coach relationship holds great potential for incorporating collaborative care, and yet, little is known about coaches' perceptions and knowledge of ATs. OBJECTIVE: To investigate coaches' perceptions of athletic training and their knowledge regarding the roles and responsibilities of ATs in secondary schools. DESIGN: Concurrent mixed-methods study. SETTING: Cross-sectional online questionnaire. PATIENTS OR OTHER PARTICIPANTS: Secondary school athletic coaches from 10 sports with the highest participation rates during the 2017-2018 season (n = 1097). Most respondents were male (n = 795, 72.4%), and their average age was 44.7 ± 11.4 years. MAIN OUTCOME MEASURE(S): Participants completed a web-based questionnaire containing demographics and quantitative measures assessing their perceived value and knowledge of ATs, as well as open-ended questions. Descriptive statistics summarized the demographic data. Counts and percentage responses for quantitative measures were reported. Open-ended responses were analyzed using the general inductive approach. RESULTS: Approximately 93% of respondents considered an AT a trusted source of medical information and a key member of the sports medicine team. Most respondents selected injury prevention (98.9%), first aid and wound care (97%), therapeutic interventions (89.9%), and emergency care (85.8%) as skills ATs are qualified to perform. Forty-six percent of respondents were willing to coach without an AT employed. Coaches trusted ATs as part of the "athletic team" and as gatekeepers, referring student-athletes for advanced care when warranted. Regarding the AT role, coaches emphasized the treatment of minor injuries and the idea of "coverage versus care." CONCLUSIONS: Secondary school coaches valued the athletic training profession and were knowledgeable regarding various roles and responsibilities ATs frequently perform. However, they may view ATs as luxuries instead of necessities, as evidenced by the fact that just under half of responding coaches were willing to coach without an AT employed at the school.

Work-Family Conflict and Family Role Performance Among Collegiate Athletic Trainers.

CONTEXT: Work-life balance continues to be a focal point of athletic training research, particularly due to the job challenges and demands of healthcare providers. Despite a large body of literature, much is still unexplored, especially in the area of family role performance. OBJECTIVE: Examine the relationship between work-family conflict (WFC), family role performance (FRP) and various demographic variables among athletic trainers employed in the collegiate setting. DESIGN: Cross-sectional online survey. SETTING: Collegiate setting. PATIENTS OR OTHER PARTICIPANTS: 586 collegiate athletic trainers (females=374, males=210, gender variant/non-conforming=1, preferred not to answer=1). MAIN OUTCOME MEASURE(S): Data were collected through an online survey (Qualtrics) where participants responded to demographic questions and previously validated WFC and FRP scales. Demographic data were reported and analyzed for descriptives and frequencies. Mann-Whitney U tests were performed to identify differences among groups. RESULTS: Participants mean scores were 28.19±6.01 and 45.86±11.55 for the FRP and WFC scales respectively. Mann Whitney-U tests revealed statistically different differences between men and women for WFC scores (U=344667, p=.021). Family role performance was moderately negatively correlated with WFC total score (rs[584] = -.497, p<.001) and predicted WFC scores (b=72.02, t582=-13.30, p=.001). Mann Whitney-U test demonstrated married athletic trainers (47.20±11.92) had statistically significantly higher WFC scores (U=19847.00, p=.003) than those who were not married (43.48±11.78). Mann Whitney U analysis (U=32096.00 p=.001) also found a significant difference between college athletic trainers with children (48.16±12.44) and those without children (44.68±10.90). CONCLUSIONS: Collegiate athletic trainers experience more WFC with marriage and having children. These findings indicate that time required to raise a family and build relationships may cause WFC due to time incongruencies. Athletic trainers want to engage in their family roles, when this is limited WFC increases.

Collegiate Athletic Trainers' Experiences Implementing Return-to-Sport Policies and Procedures During COVID-19: A Qualitative Research Study.

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.

Work-Addiction Risk in Athletic Trainers and Its Relationship to Work-Family Conflict and Burnout.

CONTEXT: Individual factors can affect numerous work-life interface outcomes, including work-family conflict and burnout. Recently, the concept of work addiction has been investigated as an individual factor that could affect numerous outcomes. Despite the large body of literature investigating work-family conflict and burnout in athletic training, little is known about the incidence of work addiction or its potential effect on these outcomes. OBJECTIVE: To gather descriptive data on the work-addiction risk and examine the effect work addiction may have on work-life interface outcomes in athletic training. DESIGN: Cross-sectional study. SETTING: Online web-based survey. PATIENTS OR OTHER PARTICIPANTS: Athletic trainers (ATs) employed in all work settings were recruited to participate via social media and email distribution lists. Data from 226 (n = 65, 28.8% males; n = 161, 71.2% females) ATs, currently employed in more than 13 work settings, were included in data analysis. MAIN OUTCOME MEASURE(S): The online questionnaire consisted of 4 main sections: demographic questions, work-family conflict scale, Copenhagen Burnout Inventory, and the Work Addiction Risk Test. We calculated Mann-Whitney U and Kruskal-Wallis tests to determine if group differences existed. Simple linear regressions were used to assess if work-addiction risk scores predicted burnout and work-family conflict. RESULTS: The ATs experienced moderate levels of personal (55.0 ± 19.1) and work-related (50.0 ± 16.0) burnout and were at medium risk for work addiction (58.3 ± 11.2). No demographic differences were observed in burnout or work-family conflict scores, but these scores differed based on the work-addiction risk. Women were more at risk for compulsive tendencies than were men. Work-addiction risk scores predicted both burnout and work-family conflict, but only a relatively small percentage of the variability was explained. CONCLUSIONS: Those ATs at higher risk for work addiction reported higher levels of burnout. Because of the medium risk for work addiction among ATs, work-addiction mitigation strategies should be implemented by individuals and organizations.

Parental Perspectives of Work-Family Conflict and Guilt in Collegiate Athletic Trainers: A Descriptive Qualitative Design.

CONTEXT: Work-family guilt has been reported among athletic trainers (ATs) working in the intercollegiate setting; however, it has yet to be fully explored from a descriptive, in-depth perspective. OBJECTIVE: To better understand the experiences of work-family conflict and guilt of intercollegiate ATs who are parents. DESIGN: Descriptive qualitative study. SETTING: Intercollegiate athletics. PATIENTS OR OTHER PARTICIPANTS: Twelve collegiate ATs (females = 6, males = 6) participated in the study. All 12 were married (12 ± 7 years) with an average 2 ± 1 children (range = 1-4). The ATs reported working 51 ± 9 hours per week and spending 11 ± 7 hours per week on household duties or chores. DATA COLLECTION AND ANALYSIS: One-on-one interviews were conducted with all participants. An inductive descriptive coding process was used to analyze the data after saturation was met. Peer review and researcher triangulation were completed. RESULTS: Conflict and guilt were discussed as unavoidable given the equally demanding roles of AT and parent. The resulting guilt was bidirectional, as each role is equally important to the AT. The management theme was specifically defined by 3 subthemes: creating a separation between work and parenting roles, the benefits of having a supportive workplace, and the importance of having coworkers and supervisors with shared life experiences. CONCLUSIONS: The ATs experienced work-family conflict and feelings of guilt from their parental responsibilities. The guilt described by the ATs was bidirectional, as they placed high value on both their parenting and athletic training roles. Guilt was balanced and managed by reducing the spillover from the parental role into work or work into time at home. By separating roles and having supportive workplace environments, including coworkers and supervisors who had similar life experiences, ATs felt they were better able to meet work and home demands.

Age, Sex, and Years of Experience: Examining Burnout Among Secondary School Athletic Trainers.

CONTEXT: Burnout is occurring in the athletic training profession. Although data on burnout are growing, the secondary school employment setting is often overlooked in research. With the employment of athletic trainers in the secondary school setting growing rapidly, a better understanding of burnout is warranted, as it has been linked to attrition. OBJECTIVE: To better understand burnout among secondary school athletic trainers using the Copenhagen Burnout Inventory (CBI), with a particular focus on differences between men and women. DESIGN: Cross-sectional survey. SETTING: Secondary school athletic trainers. PATIENTS OR OTHER PARTICIPANTS: Athletic trainers who work in the secondary school setting were recruited via email to participate in the online survey. A total of 572 (373 women, 195 men, and 4 unreported) responses were included after we filtered out incomplete responses. MAIN OUTCOME MEASURE(S): Participants were asked to complete an online survey, which consisted of demographic and workplace questions along with 3 scales (ie, Perceived Stress Scale, CBI, and Work-Family Conflict Scale). Nonparametric analysis was used to investigate the differences in scale scores between groups. RESULTS: Participants reported a mean score of 40.1 (± 16.28) on the CBI scale. Women's scores were higher on the personal burnout subscale (t570 = 24.501, P ≤ .001), work-related burnout subscale (t570 = 11.347, P ≤ .001), and total CBI (t570 = 9.423, P = .002). Participants who were ≤30 years of age scored higher on the personal burnout subscale (t515 = 5.53, P = .019), work-related subscale (t515 = 7.812, P = .005), and total CBI (t515 = 4.194, P = .041). Those with ≤3 years of experience scored higher on the personal burnout subscale (t570 = 11.213, P ≤ .001), work-related burnout subscale (t570 = 6.557, P = .010), and total CBI (t570 = 4.722, P = .030). CONCLUSIONS: Low levels of burnout are being reported among secondary school athletic trainers. Female athletic trainers experienced greater levels of burnout, as well as personal and work-related burnout. Early-career athletic trainers also reported higher levels of burnout, suggesting the need for more support during this time.

The Athletic Identity of Collegiate Athletic Trainers: A Descriptive Study.

CONTEXT: Empirical and anecdotal evidence suggests that many athletic trainers (ATs) are former athletes and selected the profession because of its affiliation with sport. Qualitative research has indicated that collegiate ATs may have a strong athletic identity, but the concept of athletic identity has not been quantified in this population. OBJECTIVE: To quantitatively assess the athletic identity of collegiate ATs and determine if group differences exist. DESIGN: Cross-sectional observational study. SETTING: Collegiate clinical setting. PATIENTS OR OTHER PARTICIPANTS: A total of 255 (n = 93 men [36%], n = 162 women [63%]; n = 2 did not indicate sex [1%]) ATs employed in the collegiate setting. MAIN OUTCOME MEASURE(S): Data were collected via a web-based survey platform that was designed to measure athletic identity. Demographic information was analyzed for frequency and distribution. Mann-Whitney U tests and Kruskal-Wallis tests were calculated to determine if group differences existed. RESULTS: The large majority of respondents (90%) self-identified as having participated in organized sport and yet scored moderately on the Athletic Identity Measurement Scale (22.9 ± 7.9). No sex differences were present in overall athletic identity (P = .446), but women had higher levels of negative affectivity (P = .045) than men. Testing also revealed group differences based on current employment setting for social identity (P = .020), with scores for those in National Collegiate Athletic Association (NCAA) Division I less than those in Division II, Division III, and the National Association of Intercollegiate Athletics. Exclusivity in NCAA Division III was lower (P = .030) than that in NCAA Division II and National Association of Intercollegiate Athletics ATs. CONCLUSIONS: Components of athletic identity appeared to vary based on the employment setting of collegiate ATs and may be related to the number of hours worked in the summer. The moderate athletic identity scores of collegiate ATs were comparable with those of former athletes who selected career paths outside of sport. This may indicate adaptive career decision processes.

Athletic Trainers' Use of Support Systems for Balancing Roles as an Athletic Trainer and Parent.

CONTEXT: Work-life balance is a topic of interest in the athletic training profession. Particularly for parents, managing work and home roles can be challenging. Social support has been identified as a resource for improving athletic trainers' balance and quality of life and warrants further investigation. OBJECTIVE: To explore the sources and perceptions of social support among athletic trainers with children. DESIGN: Qualitative study. SETTING: Collegiate and secondary school settings. PATIENTS OR OTHER PARTICIPANTS: Thirty-two athletic trainers who worked in the collegiate (12) or secondary school (20) setting participated. All individuals (19 females, 13 males) were parents, and they ranged in age from 25 to 72 years, with 2 to 52 years of experience as athletic trainers. DATA COLLECTION AND ANALYSIS: Participants were recruited from a larger cross-sectional survey. A semistructured interview was developed by the research team and reviewed by a peer expert in the field. Respondents completed the interview protocol, which contained questions in numerous areas related to work-life balance. Data analyses were guided by the research questions related to social support and used a phenomenologic approach. We researchers immersed ourselves in the data and engaged in a coding process. Researcher triangulation and peer review were used to establish credibility. RESULTS: Our participants found social support in their work and home lives. Support was described by source (eg, supervisors, coworkers, spouses, family, friends) and type (eg, emotional, tangible, network). Respondents perceived that support stemmed from understanding, flexibility, sharing responsibilities, and shared life experiences, which aided them in balancing their roles. CONCLUSIONS: Athletic trainers valued social support and used different types of support to help create work-life balance. Support in the workplace, at home, and from the profession is necessary for athletic trainers who are parents, as it provides a means to help balance roles and responsibilities.

Collegiate Athletic Trainers' Experiences With Work-Family Conflict and Work-Family Guilt Based Upon Organizational Factors.

CONTEXT: The collegiate athletic setting has been described as having high workloads and working demands. The extensive time commitment required of athletic trainers working in this setting has been identified as a precursor to work-family conflict (WFC) and work-family guilt (WFG). Although individualized, experiences in the work-life interface can largely be affected by organizational factors (ie, elements specific to the workplace). Staff size and patient load may influence the athletic trainer's feelings of WFC and WFG, yet these factors have not been directly studied. OBJECTIVE: To examine organizational factors and experiences of WFC and WFG among collegiate athletic trainers. DESIGN: Cross-sectional study. SETTING: Collegiate setting. PATIENTS OR OTHER PARTICIPANT(S): A total of 615 (females = 391, gender variant or nonconforming = 1, males = 222, preferred not to answer = 1) athletic trainers responded to an online survey. The average age of participants was 33 ± 9 years, and they were Board of Certification certified for 10 ± 8 years. A total of 352 participants (57.2%) worked in National Collegiate Athletic Association Division I, 99 in Division II (16.1%), and 164 in Division III (26.7%). MAIN OUTCOME MEASURE(S): Participants responded to demographic and workplace characteristic questions (organizational infrastructure, staff size, and number of varsity-level athletic teams). They completed WFC and WFG scales that have been previously validated and used in the athletic trainer population. RESULTS: Work-family conflict and WFG were universally experienced among our participants, with WFC scores predicting WFG scores. Participants reported more time-based conflict than strain- or behavior-based conflict. No differences in WFC and WFG scores were found among organizational infrastructures. Weak positive correlations were present between staff size and WFC scores and WFG scores. The number of athletic teams was not associated with WFC or WFG scores. CONCLUSIONS: Organizational factors are an important component of the work-life interface. From an organizational perspective, focusing on improving work-life balance for the athletic trainer can help mitigate experiences with WFC and WFG.

State-Level Implementation of Health and Safety Policies to Prevent Sudden Death and Catastrophic Injuries Within High Schools: An Update.

BACKGROUND: Mandated sports safety policies that incorporate evidence-based best practices have been shown to mitigate the risk of mortality and morbidity in sports. In 2017, a review of the state-level implementation of health and safety policies within high schools was released. PURPOSE: To provide an update on the assessment of the implementation of health and safety policies pertaining to the leading causes of death and catastrophic injuries in sports within high school athletics in the United States. STUDY DESIGN: Cross-sectional study. METHODS: A rubric composed of 5 equally weighted sections for sudden cardiac arrest, traumatic head injuries, exertional heatstroke, appropriate health care coverage, and emergency preparedness was utilized to assess an individual state's policies. State high school athletic/activities association (SHSAA) policies, enacted legislation, and Department of Education policies were extensively reviewed for all 50 states and the District of Columbia between academic year (AY) 2016-2017 (AY16/17) and 2019-2020 (AY19/20). To meet the specific rubric criteria and be awarded credit, policies needed to be mandated by all SHSAA member schools. Weighted scores were tabulated to calculate an aggregate score with a minimum of 0 and a maximum of 100. RESULTS: A total of 38 states had increased their rubric scores since AY16/17, with a mean increase of 5.57 ± 6.41 points. In AY19/20, scores ranged from 30.80 to 85.00 points compared with 23.00 to 78.75 points in AY16/17. Policies related to exertional heatstroke had the greatest change in scores (AY16/17 mean, 6.62 points; AY19/20 mean, 8.90 points; Δ = 2.28 points [11.40%]), followed by emergency preparedness (AY16/17 mean, 8.41 points; AY19/20 mean, 10.29 points; Δ = 1.88 points [9.40%]). CONCLUSION: A longitudinal review of state high school sports safety policies showed progress since AY16/17. A wide range in scores indicates that continued advocacy for the development and implementation of policies at the high school level is warranted.

Secondary School Administrators' Knowledge and Perceptions of the Athletic Training Profession, Part II: Specific Considerations for Principals.

CONTEXT: Secondary school administrators fulfill many leadership roles, including creating and implementing policies to help ensure the safety of athletic programs. However, few researchers have examined principals' awareness and perceptions of the athletic trainer's (AT's) role. OBJECTIVE: To explore secondary school principals' knowledge of the roles and responsibilities of ATs and perceptions of athletic training. DESIGN: Concurrent mixed-methods study. SETTING: Cross-sectional online questionnaire. PATIENTS OR OTHER PARTICIPANTS: Principals (n = 686; age = 48.1 ± 7.8 years, time in position = 7.1 ± 5.8 years) represented public secondary schools across the United States. MAIN OUTCOME MEASURE(S): The web-based questionnaire was composed of demographics, various quantitative items assessing knowledge and perceived value of ATs, and open-ended questions. Descriptive statistics summarized demographic data. Select quantitative measures are reported as count responses and overall percentages. Responses to open-ended questions were analyzed inductively. RESULTS: We obtained a 5% response rate (686 of 13 517). Approximately 93% (n = 637) of responding principals considered an AT to be a trusted source of medical information. The most frequently selected skills they believed ATs were qualified to perform were injury prevention (99.1%), first aid/wound care (96.5%), and therapeutic intervention (91.4%). Sixty-three percent (n = 430) of participants considered an AT to be extremely valuable to student-athlete health and safety. Our results indicated that secondary school principals had a vague understanding of AT "training" and appreciated the immediacy of care ATs could provide. They also appeared to use decentralized hiring practices. CONCLUSIONS: Secondary school principals identified ATs as a trusted source of medical information and recognized the role ATs played in the immediate care of athletic-related injuries. However, principals had a limited understanding of the qualifications and educational requirements of ATs. Future professional advocacy efforts targeting this stakeholder group should highlight all medical services an AT provides and emphasize the AT's value in schools that sponsor athletics programs.

Work-Family Guilt: The Perspective of Secondary School Athletic Trainers With Children.

CONTEXT: The literature in athletic training has consistently demonstrated evidence of work-family-life conflict and the potential consequences of that conflict among athletic trainers (ATs) employed in the clinical setting. Parental responsibilities have been suggested to increase the conflict among work, family, and life. The emotions that occur because of this conflict have received little attention and warrant further study. OBJECTIVE: To investigate perceptions and antecedents of work-family guilt (WFG) among secondary school ATs with children. DESIGN: Phenomenological qualitative study. SETTING: Secondary schools. PATIENTS OR OTHER PARTICIPANTS: Twenty (13 women, 7 men) ATs with children (range = 1-3) employed in the secondary school setting. All but 3 were married (n = 17) at the time of the study. Their average age was 37 ± 11 years, and they were certified as ATs for 14 ± 11 years. DATA COLLECTION AND ANALYSIS: Participants completed one-on-one semistructured phone interviews. Multiple-analyst triangulation and peer review were used to establish data credibility. RESULTS: General inductive analysis revealed that men and women participants experienced feelings of WFG despite having supportive work environments. The guilt for both sexes stemmed from work interfering with family and an altruistic mindset. Women indicated they felt pressure from their husbands that contributed to feelings of guilt. CONCLUSIONS: Secondary school ATs experienced WFG. Trying to balance parental and athletic training duties can cause an emotional response, and ATs' giving and caring nature may be a precursor to guilt.