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Journal Article


Scarneo-Miller SE, Distefano LJ, Mazerolle SM, Register-Mihalik JK, Stearns RL, Casa DJ. J. Athl. Train. 2019; ePub(ePub): ePub.


Department of Kinesiology, University of Connecticut, Storrs.


(Copyright © 2019, National Athletic Trainers' Association (USA))






CONTEXT: Secondary schools (SSs) inconsistently adopt emergency action plans (EAPs) for athletics.

OBJECTIVE: To describe the social determinants, barriers, and facilitators influencing EAP adoption in SSs in the United States.

DESIGN: Cross-sectional study. SETTING: Secondary schools. PARTICIPANTS: A national sample of athletic trainers (ATs; n = 9642) and athletic directors (ADs; n = 9687) were invited to participate in a Web-based questionnaire. A total of 1273 (13.2%) ATs and 702 (9.2%) ADs responded to the survey. MAIN OUTCOME MEASURE(S): The questionnaire addressed self-reported barriers to and facilitators and current social determinants (eg, locale, funding classification [eg, public or private SS]) of EAP adoption. The responses of ATs and ADs were analyzed separately. Barriers, facilitators, and social determinants were evaluated using descriptive statistics. Contingency (2 × 2) tables were used to calculate the odds ratios (ORs) of adopting an EAP and the presence of each social determinant.

RESULTS: Compared with ATs at rural schools, ATs at suburban schools displayed greater odds of having an EAP (χ2 = 5.63, P =.01, OR = 1.63 [95% confidence interval = 1.08, 2.44]). According to the ADs' responses, a larger SS enrollment (≥500) led to greater odds of adopting an EAP (OR = 2.02 [95% confidence interval = 1.41, 2.89]). Perceived barriers to implementation were a lack of knowledge about how to implement an EAP and financial limitations. Facilitators were having access to health care personnel, state mandates, and support from a person in an authoritative position.

CONCLUSIONS: Certain social determinants (eg, school enrollment) may affect EAP adoption, but not every proposed determinant significantly affected adoption. Perceived barriers to EAP adoption suggest that ATs and ADs need to be educated so they can provide further information on the low cost of EAP adoption. Further, ADs described state mandates as facilitators to improve EAP adoption; therefore, efforts to educate state leaders about the need for mandated policies may be warranted.

Language: en


catastrophic injuries; public health; socioecological framework


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