Differences in Access to Athletic Trainers in Public Secondary Schools Based on Socioeconomic Status.

Barter E, Post E, Games K, Eberman L, Rivera M. J Athl Train. 2021 Oct 8. doi: 10.4085/1062-6050-0240.21. Epub ahead of print. PMID: 34623428.
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Take-Home Message

Public secondary schools with lower socioeconomic status have less access to athletic trainers.


Athletics in secondary schools is a popular activity, yet access to healthcare for these students differs widely. Consistent access to certified athletic trainers improves injury reporting, decreases emergency department visits, and improves access to preventative care and injury management. Therefore, we need to understand the barriers to access to athletic training services.

Study Goal

Barter and colleagues completed a cross-sectional database study to identify differences in access to athletic training services in public secondary schools based on socioeconomic status.


The researchers gathered information from the Athletic Training Location and Services database, the U.S. Census Bureau, and the National Center for Education Statistics. They focused on data from 5 states with the highest, middle, and lowest poverty percentages (15 states), which included 3,482 public secondary schools. The authors gathered data on county median household income, percentage of students eligible for free/reduced lunch, race/ethnicity, and access to certified athletic trainers (full-time, part-time, or no access).


Overall, 73% of public secondary schools had access to an athletic trainer (full-time or part-time). A school was likely to have less access to athletic training services if they were located in a county with a lower median household income or had more students eligible for free/reduced lunch.


Overall, the data from this study suggest that public secondary schools in a community with lower socioeconomic status have less access to athletic training services. This may be attributable to these schools being in areas with a smaller tax base, which leads to schools having less money to employ athletic trainers. A broad qualitative survey of athletic directors reported that many would prefer to employ athletic trainers. However, they lacked the authority to hire an athletic trainer because of budgetary concerns of superintendents/school boards. The authors of that study noted that public school systems are reeling from national budget cuts and cannot hire athletic trainers when other school staff are being laid off. However, the sports medicine community needs to reframe this discussion to highlight how improving access to athletic training services may reduce overall costs to the community by implementing preventative services and reducing other healthcare costs.

Clinical Implications

The authors suggest that clinicians need to understand the social factors impacting the health of their patients. Furthermore, these results should encourage the athletic training community to engage in lobbying efforts, media campaigns, and stakeholder education to advocate for equitable access to healthcare.

Questions for Discussion

How do you feel your responsibilities as a clinician are impacted by the financial resources in your geographical area? What other factors outside of socioeconomic status do you think would positively or negatively impact access to athletic training services?

Written by: Kyle Harris
Reviewed by: Jeffrey Driban

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