Differences in Access to Athletic Trainers in Public Secondary Schools Based on Socioeconomic Status

Abstract

Context: Significant health care disparities exist in the United States based on socioeconomic status (SES) but the role SES has on secondary school athletes' access to athletic training services has not been examined on a national scale. Objective: To identify differences in access to athletic training services in public secondary schools based on school-SES. Design: Cross-Sectional Study Setting: Database secondary analysis. Patients or Other Participants: Data for 3,482 public high schools. Main Outcome Measures: Data were gathered from the Athletic Training Location and Services (ATLAS) database, United States Census Bureau, and National Center for Education Statistics (NCES). We included schools from 5 states with the highest, middle, and lowest poverty percentages (15 states total) and collected county median household income (MHI), percentage of students eligible for free and reduced lunch, race/ethnicity demographics, and access to athletic training services (full-time AT, part-time AT only, no AT) for each school. Data were summarized in standard deviations, means, medians, interquartile ranges (IQR), frequencies and proportions, one-way ANOVAs, and Kruskal-Wallis tests. Results: There were significant differences in school-SES between schools with full-time, part-time only, and no athletic training services. Schools with greater access to athletic training services had fewer students eligible for free and reduced lunch (full-time: 41.1%±22.3, part-time only: 45.8%±24.3, no AT: 52.9%±24.9, p<0.001). Similarly, county MHI was higher in schools with increased access to athletic training services (full-time: Median [IQR], $56,026 [$49,085–$64,557], part-time only: Median [IQR], $52,719 [$45,355–$62105], and no AT: Median [IQR], $49,584 [$41,094–$57,688], p<0.001). Conclusions: SES disparities were present in access to athletic training services in a national sample of public secondary schools. Access to athletic trainers positively influences student-athlete's health care across several measures. Pilot programs or government funds have been used previously to fund athletic training services and should be considered to ensure equitable access regardless of school-SES.

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

“…The presence of an employed AT on-site is negatively impacted by the median household income and percentage of free-reduced lunch students of school [ 12 ]. Barter et al identified significant differences in public secondary school SES and AT services, with secondary schools of lower SES having less access to ATs and the care they provide [ 13 ]. Similarly, Robison et al identified that in schools that employ an AT, schools in disadvantaged SES communities reported lower rates of contact frequencies for injury-related care, such as fewer AT room visit days/injury, fewer AT services/injury, and fewer AT services/AT room visit days [ 14 ].…”

“…Without an AT preceptor as a contact at a low SES school, it would make it difficult to provide clinical education that exposed AT students to the SDOH. This shows the need for ATP to integrate these concepts of the SDOH into their education programs through clinical case studies, patient simulations, understanding of health statistics, local community programs, legislations, health literacy and language barrier resources [ 13 , 32 , 43 ].…”

“…Barter et al demonstrated that there are socioeconomic disparities in access to ATs in the public secondary school setting [ 13 ]. Similarly, Robison et al found that schools of lower SES had fewer contact frequencies for injury-related care, yet, equal rates of therapeutic exercise, neuromuscular control, and manual therapy were achieved [ 14 ].…”

Effects of Athletic Trainer Direct Employment on the Management of Sports-Related Injuries in High School Athletes

“…High schools that lack adequate AT services are more likely to see the following in their athletes: increased musculoskeletal injuries, lower rates of concussion recognition, lower rates of emergency action plans, and a higher cost of care for patients covered by Medicaid. Of the high schools that do have access to AT service, 57% are employed through external universities or medical groups, and based on a report by Barter et al, 45.8%±24.3 these ATs are employed part-time [17]. The wide range of availability may contribute to missed identification of injuries, prevention, and treatment opportunities.…”

Disparities in Sports Medicine Health Care Access in Illinois High Schools: Access to Team Physicians, Athletic Trainers, and Automated External Defibrillators

“…Although Illinois state law requires all school athletic facilities to have at least one AED, a single AED is usually inadequate. Previous studies have identified socioeconomic disparities in access to an AT (10)(11)(12), as well as racial and socioeconomic disparities in access to AEDs (13).…”