Survey of sport participation and sport injury in Calgary and area high schools.

OBJECTIVE: To examine (1) sport participation and (2) sport injury in adolescents. DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective survey design. In total, 2873 adolescents were recruited from a random sample of classes from 24 Calgary and area high schools. Each subject completed an in-class questionnaire in March 2004. MAIN OUTCOME MEASUREMENTS: Overall and sport-specific participation rates (number of sport participants/number of students completing survey). Overall and sport-specific injury rates (number of injuries/number of participants). RESULTS: In the previous 1 year, 94% of students participated in sport. The top 5 sports by participation for males were basketball, hockey, football, snowboarding, and soccer, and for females, basketball, dance, volleyball, snowboarding, and soccer. The injury rate including only injuries requiring medical attention was 40.2 injuries/100 adolescents/y (95% CI, 38.4-42.1), presenting to a hospital emergency department was 8.1 injuries/100 adolescents/y (95% CI, 7.1-9.2), resulting in time loss from sport was 49.9 injuries/100 adolescents/y (95% CI, 48-51.8), and resulting in loss of consciousness was 9.3 injuries/100 adolescents/y (95% CI, 8.3-10.5). The greatest proportion of injuries occurred in basketball, hockey, soccer, and snowboarding. The top 5 body parts injured were the ankle, knee, head, back, and wrist. The top 5 injury types were sprain, contusion, concussion, fracture, and muscle strain. A previous injury was associated with 49% of the injuries and direct contact with 45% of injuries. CONCLUSIONS: Rates of participation in sport and sport injury are high in adolescents. Future research should focus on prevention strategies in sports with high participation and injury rates to maximize population health impact.     

Is body mass index a risk factor for sport injury in adolescents?

ObjectivesTo investigate the relationship between sport injury and body mass index in adolescents (12–19 years).DesignSecondary analysis of data collected in junior and senior high school surveys in Alberta, Canada.MethodsParticipants (n = 4339) included students from 59 schools. All sport injury was defined as injury reported in the past one year. Medically treated injury, as any more serious sport related injury reported in the last year that required medical attention. Overweight, obese, and healthy was defined using international cut points, as the exposure.ResultsMultivariate logistic regression analysis controlling for clustering by school, and adjusting for potential risk factors was used. There was a 34% increased risk for all sport injury in obese adolescents compared to healthy adolescents [odds ratio (OR) = 1.34 (95% CI: 1.02–1.80)]. There was increased risk for all sport injury and medically treated injury with hours of participation, where the highest group had a 4-fold increase in risk (OR = 4.17, 95%CI: 2.77–6.30 and OR = 3.80, 95%CI: 2.54–5.69, respectively). There was also increased risk for both all sport injury and medically treated injury in Caucasians compared to non-Caucasians [OR = 1.45 (95%CI: 1.15–1.82), OR = 1.94 (95%CI: 1.59–2.37), respectively], as well as for club/team play compared to less elite play [OR = 1.87 (95%CI: 1.43–2.44) and OR = 2.12 (95%CI: 1.57–2.87), respectively].ConclusionsThe risk of sustaining a sport injury in obese adolescents was greater compared to those of healthy weight. There is also a greater risk with increasing hours of play, in Caucasian adolescents, and those that play at a higher sporting level.     

Participation in sports clubs is a strong predictor of injury hospitalization: a prospective cohort study

The aim of this prospective cohort study was to investigate the nature and risk factors of injuries leading to hospitalization. A cohort of 57 407 Finns aged 14–18 years was followed in the Hospital Discharge Register for an average of 10.6 years, totaling 608 990 person-years. We identified 5889 respondents (10.3%) with injury hospitalization. The most common anatomical location was the knee and shin (23.9%), followed by the head and neck (17.8%), and the ankle and foot (16.7%). Fractures (30.4%) and distortions (25.4%) were the most common injury types. The strongest risk factor for injury hospitalization was frequent participation in sports clubs [hazard ratio (HR) in males 1.8; 95% confidence interval (CI): 1.7–2.0 and in females 2.3; 95% CI: 1.9–2.7], followed by recurring drunkenness (HR 1.6; 95% CI: 1.4–2.7 in males and 1.4; 95% CI: 1.2–1.6 in females) and daily smoking (HR 1.4; 95% CI: 1.3–1.5 in males and 1.43 95% CI: 1.2–1.5 in females). The association between injuries and sports clubs participation remained after adjusting for sociodemographic background, health, and health behaviors. Health behavior in adolescence, particularly sports club activity, predicted injury hospitalization. Preventive interventions directed toward adolescents who participate in sports clubs may decrease injury occurrence.     

Parachute ankle brace and extrinsic injury risk factors during parachuting

INTRODUCTION: This study examined the injury prevention effectiveness of the parachute ankle brace (PAB) while controlling for known extrinsic risk factors. METHODS: Injuries among airborne students who wore the PAB during parachute descents were compared with injuries among those who did not. Injury risk factors from administrative records included wind speed, combat loads, and time of day (day/night). Injuries were collected in the drop zone. RESULTS: A total of 596 injuries occurred in 102,784 parachute descents. In univariate analysis, students not wearing the PAB (Controls) were 2.00 [95% confidence interval (95% CI) = 1.32-3.02] times more likely to experience an ankle sprain, 1.83 (95% CI = 1.04-3.24) times more likely to experience an ankle fracture, and 1.92 (95% CI = 1.38-2.67) times more likely to experience an ankle injury of any type. PAB wearers and Controls had a similar incidence of lower body injuries exclusive of the ankle [risk ratio (Control/PAB) = 0.92, 95% CI = 0.65-1.30]. After accounting for known extrinsic injury risk factors, Controls were 1.90 (95% CI = 1.24-2.90) times more likely than PAB wearers to experience an ankle sprain, 1.47 (95% CI = 0.82- 2.63) times more likely to experience an ankle fracture, and 1.75 (95% CI = 1.25-2.48) times more likely to experience an ankle injury of any type. The incidence of parachute entanglements that persisted until the jumpers reached the ground were similar among PAB wearers and Controls IRR (Control/PAB) = 1.17, 95% CI = 0.61-2.29]. CONCLUSION: After controlling for known injury risk factors, the PAB protected against ankle injuries, and especially ankle sprains, while not influencing parachute entanglements or lower body injuries exclusive of the ankle.     

Longitudinal influence of musculo‐skeletal injuries and extra physical education on physical fitness in schoolchildren

The aims of this study were to investigate if (A) injuries and (B) increased physical education (PE) influenced the development of physical fitness in schoolchildren. Simultaneously, to investigate if a possible PE effect was modified by sport participation outside school hours. This was a longitudinal controlled school‐based study. Six schools with 270 min of PE (extra PE) and four schools with 90 min of PE were followed up for 2.5 years. In total, 1054 children were included for analysis (normal PE = 443, extra PE = 611). Development in fitness was analyzed using composite z‐scores from six fitness tests measured four times. Information of injury and sport was derived from weekly automated mobile phone text messages surveying the presence of musculo‐skeletal pain and organized sport participation. Injury and extra PE both influenced the development of physical fitness. Injury decreased development of physical fitness with ?1.01 composite z‐score units (95% CI: ?1.57; ?0.45). Extra PE increased physical fitness development with 0.80 (95% CI: 0.49; 1.10) composite z‐score units. The influence of injury was not dependent on extra PE. No modifying effect was found by mean weekly sport participation outside school hours. In conclusion, extra PE had a positive effect, whereas injuries had a negative effect on physical fitness development in schoolchildren.     

Risk factors for groin injuries in hockey

PURPOSE: The objective of this cohort study was to determine the level of off-season sport specific activity, peak isometric adductor torque, and hip abduction flexibility that are predictive of groin or abdominal strain injury in the National Hockey League (NHL). METHODS: The subjects were 1292 consenting NHL players. Estimated relative risks of injury are reported using the following exposures: 1) level of sport specific training in the off-season, 2) peak isometric adductor torque, 3) total hip abduction flexibility, 4) previous injury, 5) years of NHL experience, and 6) skate blade hollow measurement. Estimates of probability of injury are predicted for various levels of exposures on the basis of logistic regression analysis. RESULTS: During training camp, players who reported less than 18 sessions sport specific training in the off-season were at greater than three times the risk of injury than those who did not (relative risk (RR); 3.38 95% confidence interval (CI), 1.45-7.92). Players who reported previous history of this injury were at more than two times the risk of injury than those who did not (RR, 2.88; 95% CI, 1.33-6.26). Veterans were at greater than five times the risk of injury than rookies (RR, 5.69; 95% CI, 2.05-15.85). Peak isometric adductor torque, total abduction flexibility, and skate blade hollow measurement were not predictive of injury. There is evidence of a dose-response gradient as predicted probability of injury decreases with increasing levels of sport specific training. In the regular season, sport specific training was not as strong a risk factor (RR, 2.32; 95% CI, 1.0-5.39). CONCLUSION: Low levels of off-season sport specific training and previous injury are clearly risks for groin injury at an elite level of hockey. Future research is required to investigate prevention strategies for this injury in hockey.     

Factors associated with adolescents' physical inactivity in Xi'an City, China

PURPOSE: To explore the sociodemographic and environmental factors at community, school, and household levels associated with physical inactivity. METHODS: In a cross-sectional study in 2004, physical activity level was assessed using a validated questionnaire in 1787 students. Physical inactivity was defined as less than 150 min.wk of moderate activity (4-6 METs) or less than 60 min.wk of vigorous activity (> 6 METs). Sociodemographic and environmental information was recorded on self-administered questionnaires. Hierarchical multiple logistic models were developed based on a conceptual framework of factors related to physical activity. RESULTS: Overall, girls were twice as likely to be inactive. Adolescents aged 14 yr were 30% less likely to be inactive compared with those younger than 13 yr (95% CI: 0.5-0.9). Paternal education was inversely associated with inactivity (OR: 0.6, 95% CI: 0.4-0.9). Adolescents living in neighborhoods without sidewalks were 1.3 times more likely to be inactive (95% CI: 1.0-1.6). At the school level, lack of extracurricular exercise (OR: 1.3, 95% CI: 1.1-1.6) and fewer sports meetings (OR: 2.0, 95% CI: 1.4-2.9) were associated with physical inactivity. Difficult access to community recreational facilities (moderate OR: 1.4, 95% CI: 1.0-1.9; difficult OR: 1.7, 95% CI: 1.2-2.4) and concerns about safety in the neighborhood (OR: 2.1, 95% CI: 1.1-4.1) were associated with inactivity. There were some differences associated with physical inactivity between boys and girls. CONCLUSION: Strategies to promote physical activity in Chinese adolescents should integrate associated factors at household, school, and community levels and address the important gender differences in factors associated with physical inactivity in youth.     

A prevention strategy to reduce the incidence of injury in high school basketball: a cluster randomized controlled trial.

OBJECTIVE: To examine the effectiveness of a sport-specific balance training program in reducing injury in adolescent basketball. DESIGN: Cluster randomized controlled trial. SETTING: Twenty-five high schools in Calgary and surrounding area. SUBJECTS: Nine hundred and twenty high school basketball players (ages 12-18). INTERVENTION: Subjects were randomly allocated by school to the control (n = 426) and training group (n = 494). Both groups were taught a standardized warm-up program. The training group was also taught an additional warm-up component and a home-based balance training program using a wobble board. MAIN OUTCOME MEASURES: All injuries occurring during basketball that required medical attention and/or caused a player to be removed from that current session and/or miss a subsequent session were then recorded and assessed by a team therapist who was blinded to training group allocation. RESULTS: A basketball-specific balance training program was protective of acute-onset injuries in high school basketball [RR = 0.71 (95% CI; 0.5-0.99)]. The protective effect found with respect to all injury [RR = 0.8 (95% CI; 0.57-1.11)], lower-extremity injury [RR = 0.83 (95% CI; 0.57-1.19)], and ankle sprain injury [RR = 0.71 (95% CI; 0.45-1.13)] were not statistically significant. Self-reported compliance to the intended home-based training program was poor (298/494 or 60.3%). CONCLUSIONS: A basketball-specific balance training program was effective in reducing acute-onset injuries in high school basketball. There was also a clinically relevant trend found with respect to the reduction of all, lower-extremity, and ankle sprain injury. Future research should include further development of neuromuscular prevention strategies in addition to further evaluation of methods to increase compliance to an injury-prevention training program in adolescents.     

Risk factors for acute and overuse sport injuries in Swedish children 11 to 15 years old: What about resistance training with weights?

To determine the 1‐year self‐reported incidence of overuse and traumatic sport injuries and risk factors for injuries in children participating in a summer sports camp representing seven different sports. 4363 children, 11 to 15 years old participating in a summer camp in seven different sports answered a questionnaire. Injury in this cross‐sectional study was defined as a sport‐related trauma or overload leading to pain and dysfunction preventing the person from participation in training or competition for at least 1 week. A number of risk factors for injury were investigated such as sex, age, number of hours spent on training in general, and on resistance training with weights. Nearly half [49%, 95% confidence interval (CI) 48–51%] of the participants had been injured as a result of participation in a sport during the preceding year, significantly more boys than girls (53%, 95% CI 50–55% vs 46%, 95% CI 43–48%; P < 0.001). Three factors contributed to increased incidence of sport injuries: age, sex, and resistance training with weights. Time spent on resistance training with weights was significantly associated with sport injuries in a logistic regression analysis. In children age 11 to 15 years, the risk of having a sport‐related injury increased with age and occurred more often in boys than in girls. Weight training was the only modifiable risk factor that contributed to a significant increase in the incidence of sport injuries.     

Community size and sport participation across 22 countries

The objective of this study was to examine, across 22 countries, the association between community size and individual sport, team sport, and exercise participation. Hierarchal non‐linear Bernoulli modeling is used to examine the association between community size (100 000–10 000; <10 000) and (a) individual sport, (b) team sport, and (c) exercise participation. After controlling for country‐level clustering and demographic variables, those residing a community with between 100 000 and 10 000 residents are more likely to participate in individual sport [odds ratio (OR) = 1.14; 95% confidence interval (CI) = 1.05–1.23] while residing in a community with less than 10 000 residents is unrelated (OR = 1.06; 95% CI = 0.96–1.19). Those residing in communities with between 100 000 and 10 000 residents were more likely to participate in team sport (OR = 1.21; 95% CI = 1.01–1.45) while residing in a community with less than 10 000 residents is unrelated (OR = 1.02; 95% CI = 0.88–1.18). Residing in a community with between 100 000 and 10 000 residents is unrelated to exercise participation (OR = 0.97; 95% CI = 0.89–1.7), while residing in a community with less than 10 000 residents is negatively related to exercise participation (OR = 0.86; 95% CI = 0.79–0.93). These findings provide novel evidence that communities between 100 000 and 10 000 residents are related to increased sport participation, particularly team sport participation.     

Parental,socio and cultural factors associated with adolescents' sports participation in four Danish municipalities

Despite the well‐documented health effects of physical activity, few studies focus on the correlates of leisure‐time sports and exercise participation. The present study examined correlations between adolescent sports participation and demographic factors, socioeconomic status (SES) and sociocultural factors. A school‐based cross‐sectional cluster sample including 6356 Danish fifth‐ and ninth‐grade adolescents from four municipalities were included. Age (younger) and gender (boy) were associated with adolescents' sports participation. Girls were half as likely [odds ratio (OR) 0.49 95% confidence interval (CI): 0.44–0.55] to participate in sports than boys. Adolescents were more likely to participate in sports if they perceived their parents as active in exercise or sports. Adolescents with one or two unemployed parents were 0.75 (95% CI: 0.62–0.89) and 0.75 (95% CI: 0.56–1.00), respectively, less likely to participate in sports than adolescents with two employed parents. In a gender‐stratified analysis, parents' occupational status was only a predictor of sports participation in girls. Differences between municipalities in adolescents' sports participation remained significant when controlled for individual factors such as gender, age, parents' background or parents' physical activity. The association between sociocultural and SES was stronger for girls than boys. In conclusion, demographics, SES and sociocultural factors were the best determinants of adolescent sport participation.     

Single season re-injury risk after concussion and lower extremity injury among male,collision sport,high school athletes

ObjectivesResearch suggests that a recent concussion increases subsequent lower extremity injury risk; however, data in high school athletes is limited. This study evaluates the association between concussion and subsequent injury risk among male, collision sport, high school athletes over a single season.DesignRetrospective cohort study.MethodsData were obtained from 2005/06–2014/15 in the High School Reporting Information Online database. A two stage, multi-method matching process was used to identify athletes who suffered multiple injuries over a single athletic season. Demographics and injury characteristics were compared with Chi square and Student's t-tests. Multiple Cox Proportional Hazards regression analysis was used to test whether index injury type was associated with hazard of subsequent injury following return to play from index injury.ResultsOverall 1364 HS athletes sustained 2 injuries over a single athletic season (subsequent injury within 45 days of the index injury). Index injuries included 686 (50.2%) lower extremity injuries, 417 (30.6%) upper extremity injuries, and 261 (19.1%) concussions. Hazard of subsequent concussion was increased in the index concussion group relative to the index lower extremity injury group [hazard ratio (HR): 1.60, 95% CI: 1.15–2.23, p = 0.0052]. Hazard of a subsequent lower extremity injury was not significantly different for the index lower extremity injury group relative to the index concussion group [HR: 1.27, 95% CI: 0.98–1.65, p = 0.0728].ConclusionsHistory of recent concussion or recent lower extremity injury are both risk factors for subsequent lower extremity injury in male, collision sport, high school athletes.     

First-time inversion ankle ligament trauma: the effects of sex, level of competition, and sport on the incidence of injury

BACKGROUND: Inversion ankle trauma is disabling, yet little is known regarding the incidence rate of first-time ankle sprains and how it is influenced by factors including sex, level of competition, and sport. HYPOTHESIS: The incidence rates of first-time ankle ligament sprains are influenced by sex, level of competition (high school vs college), and type of sports participation (basketball, soccer, lacrosse, and field hockey). STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Between 1999 and 2003, high school and college athletes were evaluated before participation in their sports. Subjects were included in the study if they had not experienced a prior ankle or lower extremity injury and were then followed during participation in soccer, basketball, lacrosse, or field hockey to document their days of exposure to sport and injuries sustained. The relative risk associated with sex, level of competition, and sport was estimated by Cox regression. RESULTS: A total of 901 athletes had 50 680 person-days of exposure to sports, and 43 (4.8%) had an inversion injury that produced an ankle ligament sprain. Overall, the injury incidence rate was 0.85 sprains per 1000 person-days of exposure to sport. There were 0.68 and 0.97 ankle sprains per 1000 person-days of exposure to sport for the men and women, respectively. Although the risk of suffering an ankle sprain was higher for women than for men (relative risk, 1.51), the difference was not statistically significant (P = .21) and was owing to the increased risk in female basketball athletes compared to male basketball athletes (relative risk, 4.11; P = .045). Risk of injury was similar for the high school athletes in comparison to the college athletes (relative risk, 1.16). For the men, there was no difference in the risk of suffering an ankle sprain between the sports of basketball, soccer, and lacrosse, whereas for the women, the risk of suffering an ankle sprain was significantly greater during participation in basketball compared to lacrosse. CONCLUSION: In this study of first-time ankle sprains, for most sports, the incidence rate of inversion injury is less than 1 per 1000 days of exposure to sport, a value lower than previously reported. Among female athletes, ankle injury is associated with type of sport. Risk is highest for female basketball athletes, who are at significantly greater risk than male basketball athletes and female lacrosse athletes. The risk of first-time ankle injury is similar for high school and college-level athletes.     

A randomized trial of preexercise stretching for prevention of lower-limb injury

PURPOSE: This study investigated the effect of muscle stretching during warm-up on the risk of exercise-related injury. METHODS: 1538 male army recruits were randomly allocated to stretch or control groups. During the ensuing 12 wk of training, both groups performed active warm-up exercises before physical training sessions. In addition, the stretch group performed one 20-s static stretch under supervision for each of six major leg muscle groups during every warm-up. The control group did not stretch. RESULTS: 333 lower-limb injuries were recorded during the training period, including 214 soft-tissue injuries. There were 158 injuries in the stretch group and 175 in the control group. There was no significant effect of preexercise stretching on all-injuries risk (hazard ratio [HR] = 0.95, 95% CI 0.77-1.18), soft-tissue injury risk (HR = 0.83, 95% CI 0.63-1.09), or bone injury risk (HR = 1.22, 95% CI 0.86-1.76). Fitness (20-m progressive shuttle run test score), age, and enlistment date all significantly predicted injury risk (P < 0.01 for each), but height, weight, and body mass index did not. CONCLUSION: A typical muscle stretching protocol performed during preexercise warm-ups does not produce clinically meaningful reductions in risk of exercise-related injury in army recruits. Fitness may be an important, modifiable risk factor.     

Height, weight, and BMI predict intra-articular injuries observed during ACL reconstruction: evaluation of 456 cases from a prospective ACL database.

OBJECTIVE: To identify demographic and anthropometric risk factors for intra-articular (IA) injuries observed during ACL reconstruction. We hypothesize that significant associations exist among height, weight, and body mass index (BMI) with IA injuries when ACL tear occurs. DESIGN: This observational study of a prospective multi-investigator ACL database used logistic and Poisson regression analysis to assess independent predictors of IA injuries. SETTING: Vanderbilt Sports Medicine and affiliated tertiary care center. PATIENTS: Patients undergoing unilateral ACL reconstruction without prior injury to either knee were identified from a detailed prospective ACL reconstruction database. Four hundred fifty-six patients met inclusion/exclusion criteria. INTERVENTIONS: Per inclusion criteria, all patients underwent unilateral ACL reconstruction after assessment of injury profile. MAIN OUTCOME MEASUREMENTS: The ACL database was initiated in 1990 to identify demographic, anthropometric, and mechanistic variables associated with intra-articular injury. RESULTS: Height best predicted tibial and patellar damage. BMI better predicted medial femoral condyle lesions, whereas weight better predicted lateral and patellofemoral injury. BMI and weight equally predicted injury to menisci and medial tibial plateau. Through different outcomes, age (odd ratio [OR], 1.49; 95% CI, 1.02-2.16), height (OR, 2.66; 95% CI, 1.52-4.65), weight (OR, 1.02; 95% CI, 1.01-1.04), and BMI (OR, 1.24; 95% CI, 1.004-1.53) were all significant predictors of intra-articular injury. CONCLUSIONS: This is the first report using multivariable analysis of age, height, weight, and BMI to evaluate associations with IA injuries after ACL rupture observed during ACL reconstruction. We hypothesize that athletes possibly could reduce risk of certain IA pathologies with maintenance of lower body weight and BMI and thus potentially improve long-term functional outcomes after ACL reconstruction.     

Risk factors for dive injury: a survey study

Scuba diving is a world sport, but it is not medically regulated. Study objectives sought to identify risk behaviors, preexisting medical conditions, compliance to dive guidelines, and injury patterns of recreational scuba divers. An Internet-based survey examined risk behaviors and diver safety practices. Responses from 682 of 770 (88.6%) divers revealed that 80.6% were certified; 51.7% of certified divers reported diving injuries versus 75.0% for noncertified divers (RR = 1.31; 95% CI: 1.16-1.48; P < 0.001); suspected decompression symptoms were witnessed by 52.6% of divers; 32.7% of certified divers reported medical problems including hypertension, asthma, diabetes, and epilepsy. No significant differences were observed in injuries among the certified divers based on dive frequency (P = 1.000), medical conditions (P = 0.750), smoking (P = 0.545), alcohol (P = 0.649), or illicit substances use (P = 0.230). Among certified divers, there was a positive association with fewer diving injuries but not with diving frequency, preexisting medical condition(s), smoking, alcohol, or illicit substance use.     

Psychobiology and behavioral strategies. Physical activity, sport participation, and suicidal behavior: U.S. high school students

PURPOSE: To evaluate the associations of physical activity and sports team participation with suicidal behavior among U.S. high school students. METHODS: Data were from the 2003 Youth Risk Behavior Survey (N = 10,530 respondents). Exposure variables included physical activity (inactive, insufficient, moderately intensive, regular vigorously intensive, and frequent vigorously intensive) and sports team participation. Outcome variables were suicide ideation (seriously considering and/or planning suicide) and suicide attempts. Hierarchical logistic regressions were run, controlling for age, race, smoking, alcohol use, drug use, geographic region, unhealthy weight-control practices, and body mass index/weight perceptions. RESULTS: Compared with inactive students or sports team nonparticipants, the odds of suicide ideation were lower among boys reporting frequent vigorous-intensity physical activity (adjusted odds ratio (AOR) = 0.48; 95% confidence interval (CI) = 0.29, 0.79) and sports team participation, respectively (AOR = 0.65; 95% CI = 0.48, 0.86). The odds of suicide attempts were also lower among frequently vigorously active boys (AOR = 0.44; 95% CI = 0.21, 0.96) and sports team participants (AOR = 0.61; 95% CI = 0.40, 0.93). The odds of suicide attempts were lower for regular vigorously active girls compared with inactive girls (AOR = 0.67; 95% CI = 0.45, 0.99) and sports team participants compared with nonparticipants (AOR = 0.73; 95% CI = 0.57, 0.94). Associations with one exposure variable generally weakened when adjustment was made for the other exposure variable, or for feeling sad and hopeless. CONCLUSIONS: The association of physical activity and sports team participation with suicide ideation and suicide attempts varied by sex. Further research is needed to clarify these different associations.     

Incidence and risk factors for injury in non-elite netball

This paper identifies the risk and protective factors for injury in non-elite netball. Three-hundred and sixty-eight non-elite netballers completed a baseline questionnaire at the commencement of the 1997 preseason. Participants were telephoned each month during the 1997 and 1998 playing seasons to provide details of their exposure at training and games and any injury experiences in the previous 4 weeks. The incidence of injury in this study was 14 injuries per 1000 player hours. The risk factors for injury were identified as: not warming up before a game (IRR 1.11, 95% CI 1.00-1.23) and not being open to new ideas (IRR 1.04, 95% CI 1.00-1.07). Training for 4 or more hours per week (IRR 0.66, 95% CI 0.45-0.98) and not sustaining an injury in the previous 12 months (IRR 0.58, 95% CI 0.43-0.79) were found to be protective against injury. The risk and protective factors for injury identified in this study can be used as the basis for the development of evidence-based injury prevention strategies that seek to reduce the risk of injury in sport. Injury prevention strategies should focus on the development of effective training programs that include netball-specific skills, activities and movements. Further investigation into the mechanisms associated with the risk and protective factors identified would provide further understanding of why these factors increase or decrease the risk of injury.