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 in 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 3482 public high schools.

Main outcome measure(s): Data were gathered from the Athletic Training Locations and Services (ATLAS) database, US Census Bureau, and National Center for Education Statistics. We included schools from 5 states with the highest, middle, and lowest poverty percentages (15 states total) and collected county median household income, percentage of students eligible for free or reduced-price lunch, race and ethnicity demographics, and access to athletic training services (full-time athletic trainer [AT], part-time AT only, no AT) for each school. Data were summarized in means, SDs, medians, interquartile ranges (IQRs), frequencies and proportions, 1-way analyses of variance, and Kruskal-Wallis tests.

Results: Differences were present 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 or reduced-price lunch (full time: 41.1% ± 22.3%, part time only: 45.8% ± 24.3%, no AT: 52.9% ± 24.9; P < .001). Similarly, county median household income was higher in schools with increased access to athletic training services (full time median [IQR]: $56 026 [$49 085-$64 557], part time only: $52 719 [$45 355-$62 105], and no AT: $49 584 [$41 094-$57 688]; P < .001).

Conclusions: Disparities in SES were seen in access to athletic training services among a national sample of public secondary schools. Access to ATs positively influences student-athletes' 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.

Keywords: athletic health care; health care access; social determinants of health.

Figure 1

Comparison of school county median household income by school athletic trainer (AT) employment status. Each circle represents data from an individual school, with outliers presented as solid black circles. Presented as a notched box plot, with the box representing the interquartile range (IQR), line indicating the median, notch displaying the 95% CI of the median, whiskers representing the range within 1.5 × IQR of the upper or lower quartile, and individual data points for each school.

Figure 2

Comparison of proportion of students eligible for free or reduced-priced lunch based on athletic training services in secondary school settings. Each circle represents data from an individual school. Presented as a notched box plot, with the box representing the interquartile range (IQR), line indicating the median, notch displaying the 95% CI of the median, whiskers representing the range within 1.5 × IQR of the upper or lower quartile, and individual data points for each school. The mean and SD are presented above each box.