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 impact on health. Limited access to health care, food insecurity, lack of affordable housing, and violence increases a person's likelihood for poor health. Athletic trainers can have an impact on identifying and improving the determinants of health that affect student-athletes. Objective To understand 1) What are the current perceptions athletic trainers have about the health behaviors (specifically mental health and substance use) of high school student-athletes? 2) What are the barriers that athletic trainers experience when providing health services to high school student-athletes? 3) How does the developed environment effect the health behaviors and barriers that athletic trainers observe? Design Survey Setting: Online Participants: Certified National Athletic Training Association Members employed in the secondary school setting Main Outcome Measure(s): Demographics of athletic trainers, athletic trainers' perceptions on 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. Descriptive statistics for the outcome measures are reported. Results 7,600 electronic surveys were distributed to athletic trainers, with 910 respondents. Respondents were 61% female; average age was 36 years old; and an average of 12.5 years of experience. 82% of athletic trainers identified their school setting as public, 43.7% of respondents identified their school as suburban, 30.1% rural, and 26.2% urban. Athletic trainers perceived a high average prevalence of mental health issues (32%), e-cigarette use (31.7%), and marijuana use (26.9%) in student athletes. There were significant perceived barriers to health including access to transportation, poverty, housing and food insecurities. Conclusions This study highlights health disparities and barriers athletic trainers observe when addressing health care needs of student-athletes. Understanding determinants of health to identify causes of health disparities may better prepare athletic trainers to manage the health needs of underserved student-athletes.