摘要：Objectives. We sought to describe the use of discretionary protective equipment among high school athletes and to examine social and behavioral determinants contributing to equipment usage. Methods. We analyzed data from a 3-year (1996–1999), stratified, 2-stage cluster sample of athletes engaged in 12 organized sports in 100 North Carolina high schools (n=19728 athlete-seasons) (an athlete-season represents an individual student who participates in a particular sport in a particular season). We used generalized logistic regression to model the association of social and behavioral determinants and demographic variables with discretionary protective equipment use. Results. About one third of high school athletes self-reported using lower extremity discretionary protective equipment. Girls, seniors, those who played limited-contact sports, and those who played multiple sports reported higher usage. Small school size, low player/coach ratio, high proportion of team usage, and history of previous lower extremity injury were important predictors of usage. Coaches’ experience, qualifications, and training, however, were not predictive of usage. Conclusions. Intervention efforts to promote use of discretionary protective equipment need to target school-level factors and should consider both team requirements and the role of peers in setting and reinforcing norms. Use of protective equipment has been recognized as a common injury prevention strategy. 1 – 6 Because the number of high-school students participating in organized sports has increased each year, rising to approximately 7 million in 2003, 7 sports injuries have become more widespread and pose an increasingly serious threat to the health and well-being of young people. 8 In particular, although sports and recreational activities are widely promoted as parts of healthy lifestyles, the physical and psychological benefits gained from participating in sports may be diminished if participants are injured. 9 – 12 Although an extensive body of literature addresses various types of protective equipment and its role in protecting specific body parts from injuries, 5 , 6 , 13 – 21 the patterns and determinants of use of discretionary (non-mandatory) protective equipment by high school athletes are poorly understood. An understanding of the determinants of voluntary use of protective equipment is crucial to developing intervention programs and policies to increase protective equipment use and thereby prevent sports injury. A social and behavioral science perspective suggests that behavior is influenced by the social context in which the individual lives. Social cognitive theory, in particular, defines human behavior as a triadic, dynamic, and reciprocal interaction of personal factors, behavior, and environmental influences. 22 , 23 In this context, the decisions of high school athletes to use discretionary protective equipment are influenced not only by individual determinants but also by the physical and social environment. 22 , 23 No existing conceptual model in the injury literature describes the determinants leading to use of discretionary protective equipment by high school athletes to prevent sports injury; therefore, we used social cognitive theory as a guide to understand the determinants of discretionary protective equipment use. We proposed the model shown in Figure 1 ▶ on the basis of injury prevention literature, 14 , 17 , 21 health behavior models, 22 – 24 and developmental theory. 25 This model posits that injury risk and severity are influenced by the use of discretionary protective equipment, which, in turn, is determined by aspects of the physical and social environment, observational learning through team member’s modeling equipment use, and the athlete’s behavioral capability. This model is supported by research which shows that: (1) health-protective behaviors are associated with smaller school size. Students in smaller schools are more attached to schools, have closer relationships with teachers, and have more parental involvement. Consequently, they are more likely to engage in health promoting behaviors. 26 – 29 (2) A coach’s experience, qualification, and training creates a social environment that encourages equipment use. 30 – 32 In addition, athletes in a team with lower player/coach ratio would receive higher quality instructional and emotional support. 33 , 34 (3) Modeling of equipment by team members leads to more use. 35 , 36 (4) Skills and knowledge deficits are associated with injury experience. 14 , 37 Support for the conceptual model shown in Figure 1 ▶ would suggest that to reduce injury risk and severity, changes in use of discretionary protective equipment by high school athletes, like the learning of other complex behaviors, would ultimately be best accomplished through modifying behavioral determinants at intrapersonal, interpersonal, and environmental levels. Open in a separate window FIGURE 1— A conceptual model illustrating the determinants leading to high school athletes’ use of discretionary protective equipment to prevent sports injury. *Experience, qualifications, and training. In this study, we describe the use of discretionary protective equipment among high school athletes and examine how social and behavioral determinants, consistent with social cognitive theory, influence equipment use by high school athletes. In particular, we examined how school size; coach experience, qualifications, and training; player/coach ratio; teammate usage of protective equipment; and a history of prior injury affect use by athletes of lower-extremity discretionary protective equipment (e.g., kneepads, shin guards, knee braces, and ankle braces).
