Factors Influencing Athletic Training Services in California Secondary Schools: A 5-Year Update.

Context: California is the only state that does not regulate the athletic training profession, allowing unqualified personnel to be hired and call themselves athletic trainers (ATs). The benefits of employing a certified AT in the secondary school setting are numerous, but efforts to push regulation legislation continue to fail in California.

Objective: To describe the availability of certified ATs in California secondary schools and explore factors influencing AT employment.

Design: Cross-sectional study.

Setting: Online survey.

Patients or other participants: Participants from 1538 California secondary schools.

Main outcome measure(s): Officials from member schools completed the 2022-2023 California Interscholastic Federation Participation Census. Participants provided information specific to enrollment, sport participation, access to automated external defibrillators, and whether the school had ATs on staff. The AT's certification status was independently verified. Enrollment data specific to ethnicity, race, and percentage of students eligible for free meals were obtained through the California Department of Education Statistics.

Results: More than half (51.6%) of California secondary schools did not employ a certified AT, and 8.3% employed unqualified personnel as ATs. Nearly half (43%) of student-athlete participants were enrolled at schools with no certified AT. Schools that employed certified ATs had a lower proportion of students eligible to receive free and reduced-price meals. The average percentage of Hispanic or Latino students was greater in schools with no certified AT and schools that employed unqualified personnel as ATs than schools that employed certified ATs.

Conclusions: Data indicate that, in a 5-year period, access to athletic training services in California secondary schools has not improved. Large gaps in access to athletic training services and clear socioeconomic and racial and ethnic disparities exist. Efforts to educate stakeholders on the importance of athletic training regulation in California should continue.