The Association between the Social Vulnerability Index and Access to California High School Athletic Trainers

Abstract

Context: Social determinants of health are known to affect overall access to youth sports, however, it is not fully understood how multiple social determinants of health may impact access to school-based athletic training services.

Objective: To determine the relationship between Social Vulnerability Index (SVI) scores on access to high school-based athletic trainers in California.

Design: Retrospective, cross-sectional study.

Setting: Online survey.

Patients or other participants: California Interscholastic Federation (CIF) high school respondents of the 2022-23 Participation Census.

Main outcome measures: Association between Social Vulnerability Index scores and access to school-based athletic trainer services.

Methods: This study uses data from CIF high school respondents of the 2022-23 Participation Census. School addresses were used to extract SVI scores from the U.S. Census Bureau. Separate multivariable logistic regressions and generalized linear mixed effects models assessed the relationships between access to school-based athletic training services and SVI scores at the census and county levels.

Results: There were 1,598 respondent schools (65% public, 24% private, and 11% charter). 49% of schools reported having an athletic trainer, of which 41% were certified. Adjusted analyses revealed that increased vulnerability in household characteristics was associated with lower odds of access to athletic trainers and certified athletic trainers at both county (OR: 0.89 (95% CI: 0.80, 0.99); p = .04) and census tract levels (OR: 0.93 (95% CI: 0.89, 0.97); p = .002). Increased vulnerability in socioeconomic status was associated with lower odds of having an certified athletic trainer at the census tract level (OR: 0.94 (95% CI: 0.89, 0.98); p = .006), but not the county level (p = .16).

Conclusions: Increased vulnerability in household characteristics is associated with decreased odds of access to high school-based athletic training services.

Keywords: Health care access; Health inequities; School-based athletic trainer; Social determinants of health; Youth sports.