Use of discretionary protective equipment and lower extremity injury in high school athletes

Youth sports injury is increasing due to the fact that half of children aged 5--18 years participate in organized sports today. Although use of protective equipment is an important injury prevention strategy, little is known about the patterns and determinants of high school athletes' use of discretionary (non-mandatory) protective equipment. Few studies have examined high school athletes' use of protective equipment in relation to their injury risk and injury severity.; Study aims were to: (1) describe high school athletes' discretionary protective equipment usage; (2) understand the social and behavioral determinants of high school athletes' use of discretionary protective equipment; and (3) determine whether high school athletes' use of discretionary protective equipment affects their lower extremity injury risk and injury severity.; Longitudinal data from a three-year (1996 to 1999), multi-stage study of athletes from 12 organized sports in 100 North Carolina high schools (n = 19,728 athlete-seasons) were analyzed in SUDAAN. Logistic regression was used to model the probability of discretionary protective equipment use with the social and behavioral determinants and to predict lower extremity injury severity. Poisson regression was used to examine the relationship between discretionary protective equipment use and lower extremity injury risk.; About one-third of high school athletes reported using lower extremity discretionary protective equipment. Females, seniors, and those who played limited contact sports or multiple sports reported higher usage of protective equipment. Social and behavioral variables including small school size, higher proportion of team usage, and prior injury history were important predictors of usage. Coaches' experience, qualifications and training, however, were not predictive of usage.; Use of lower extremity discretionary protective equipment was associated with a reduced lower extremity injury risk and injury severity. In particular, kneepad use was associated with a reduced knee injury risk. Unexpectedly, brace use was associated with an increased risk of both knee and ankle injuries.; Well-controlled, prospective epidemiological studies are needed to investigate why kneepad use is associated with a reduced injury risk, and why brace use is not. Further, theory informed interventions targeting schools, coaches and athletes should examine how best to promote use of effective protective equipment in preventing sports injuries.