Athletic Trainer-Reported Prevalence of Mental Health, Substance Use, and Barriers to Health in Secondary Schools

Context: Where a person lives can have a significant effect on health. Limited access to health care, food insecurity, lack of affordable housing, and violence increase a person's likelihood of poor health. Athletic trainers (ATs) can contribute to identifying and improving the determinants of health that affect student-athletes. Objectives: (1) What were the current perceptions ATs had about the health behaviors (specifically mental health and substance use) of high school student-athletes? (2) What were the barriers that ATs experienced when providing health services to high school student-athletes? (3) How did the developed environment affect the health behaviors and barriers that ATs observed? Design: Qualitative study. Setting: Online survey. Patients or Other Participants: Certified National Athletic Trainers' Association members employed in the secondary school setting. Main Outcome Measure(s): Demographics of ATs were collected, and the ATs' perceptions of the health of student athletes across developed environments, prevalence of mental health issues, tobacco and substance use, barriers to health care services, and housing and food insecurities among student-athletes were surveyed. Descriptive statistics for the outcome measures were reported. Results: A total of 7600 electronic surveys were distributed to the ATs and 911 responded (females = 62%, average age = 36 years, average experience = 12.5 years). The school setting was identified by 82.5% as public and the environment as suburban by 43.7%, rural by 30.1%, and urban by 26.1%. Participants perceived a high average prevalence of mental health concerns (32%),e-cigarette use (31.7%), and marijuana use (26.9%) among student-athletes. Significant perceived barriers to health included limited access to transportation, poverty, and housing and food insecurities. Conclusions: This study highlights the health disparities and barriers ATs observed when addressing the health care needs of student-athletes. Understanding the determinants of health in order to identify the causes of health disparities may better prepare ATs to manage the health needs of underserved student-athletes.