Background Football (soccer) is endorsed as a health-promoting physical activity worldwide. When football programs are introduced as part of general health promotion programs, equal access and limitation of pre-participation disparities with regard to injury risk are important. The aim of this study was to explore if disparity with regard to parents’ educational level, player body mass index (BMI), and self-reported health are determinants of football injury in community-based football programs, separately or in interaction with age or gender. Methodology/Principal Findings Four community football clubs with 1230 youth players agreed to participate in the cross-sectional study during the 2006 season. The study constructs (parents’ educational level, player BMI, and self-reported health) were operationalized into questionnaire items. The 1-year prevalence of football injury was defined as the primary outcome measure. Data were collected via a postal survey and analyzed using a series of hierarchical statistical computations investigating associations with the primary outcome measure and interactions between the study variables. The survey was returned by 827 (67.2%) youth players. The 1-year injury prevalence increased with age. For youths with parents with higher formal education, boys reported more injuries and girls reported fewer injuries than expected; for youths with lower educated parents there was a tendency towards the opposite pattern. Youths reporting injuries had higher standardized BMI compared with youths not reporting injuries. Children not reporting full health were slightly overrepresented among those reporting injuries and underrepresented for those reporting no injury. Conclusion Pre-participation disparities in terms of parents’ educational level, through interaction with gender, BMI, and self-reported general health are associated with increased injury risk in community-based youth football. When introduced as a general health promotion, football associations should adjust community-based youth programs to accommodate children and adolescents with increased pre-participation injury risk.
References
[1]
Dvorák J (2009) Give Hippocrates a jersey: promoting health through football/sport. Br J Sports Med 43(5): 317–322.
[2]
Krustrup P, Aagaard P, Nybo L, Petersen J, Mohr M, et al. (2010) Recreational football as a health promoting activity: a topical review. Scand J Med Sci Sports Suppl 1: 1–13.
[3]
FIFA website. Available: http://www.fifa.com/worldfootball/bigcou？nt/. Accessed: 2012 July 29.
[4]
Lundy T (2010) A paradigm to guide health promotion into the 21st century: the integral idea whose time has come. Glob Health Promot 17(3): 44–53.
[5]
Froholdt A, Olsen OE, Bahr R (2009) Low risk of injuries among children playing organized soccer: a prospective cohort study. Am J Sports Med 37(6): 1155–1160.
[6]
Timpka T, Risto O, Bj？rmsj？ M (2007) Boys soccer league injuries: a community-based study of time-loss from sports participation and long-term sequelae. Eur J Public Health 18(1): 19–24.
[7]
McNoe BM, Chalmers DJ (2010) Injury in community-level soccer: development of an injury surveillance system. Am J Sports Med 38(12): 2542–2551.
[8]
Bazelmans C, Coppieters Y, Godin I, Parent F, Berghmans L, et al. (2004) Is obesity associated with injuries among young people? Eur J Epidemiol 19(11): 1037–1042.
[9]
Zonfrillo MR, Seiden JA, House EM, Shapiro ED, Dubrow R, et al. (2008) The association of overweight and ankle injuries in children. Ambul Pediatr 8(1): 66–69.
[10]
Knowles SB (2010) Is there an injury epidemic in girls’ sports? Br J Sports Med 44: 38–44.
[11]
Brownell MD, Derksen SA, Jutte DP, Roos NP, Ekuma O, et al. (2010) Socio-economic inequities in children's injury rates: has the gradient changed over time? Can J Public Health 101 (suppl 3): S28–S31.
[12]
Pickett W, Molcho M, Simpson K, Janssen I, Kuntsche E, et al. (2005) Cross national study of injury and social determinants in adolescents. Inj Prev 11(4): 213–218.
[13]
Nixon H (1993) Accepting the risks of pain and injury in sports: mediated cultural influences on playing hurt. Sociology Sports J 10: 183–196.
[14]
Fuller CW, Junge A, Dvorak J (2012) Risk management: FIFA’s approach for protecting the health of football players. Br J Sports Med 46: 11–17.
[15]
von Elm E, Altman DG, Egger M, Pocock SJ, G？tzsche PC, et al. (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370(9596): 1453–1457.
[16]
Fuller CW, Ekstrand J, Junge A, Andersen TE, Bahr R, et al. (2006) Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Br J Sports Med 40(3): 193–201.
[17]
Davis-Kean PE (2005) The influence of parent education and family income on child achievement: the indirect role of parental expectations and the home environment. J Fam Psychol 19(2): 294–304.
[18]
Rothman KJ (2002) Measuring interactions. In: Epidemiology: An Introduction. New York, NY: Oxford University Press. 168–180.
[19]
de Mutsert R, de Jager DJ, Jager KJ, Zoccali C, Dekker FW (2011) Interaction on an additive scale. Nephron Clin Pract 119(2): 154–157.
[20]
de Mutsert R, Jager KJ, Zoccali C, Dekker FW (2009) The effect of joint exposures: examining the presence of interaction. Kidney Int 75(7): 677–681.
[21]
Karlberg J, Lou ZC, Albertsson-Wikland K (2001) Body mass index reference values (mean and SD) for Swedish children. Acta Paediatr 90(12): 1427–1434.
[22]
West C, Zimmerman DH (1987) Doing gender. Gender and Society 1: 125–151.
[23]
Goffman E (1977) The arrangement between the sexes. Theory and Society 4: 301–331.
[24]
McHugh MP (2010) Oversized young athletes: a weighty concern. Br J Sports Med 44(1): 45–49.
[25]
Faude O, Kerper O, Multhaupt M, Winter C, Beziel K, et al.. (2010) Football to tackle overweight in children. Scand J Med Sci Sports (Suppl 1): 103–110.
[26]
Carter CW, Micheli LJ (2011) Training the child athlete: physical fitness, health and injury. Br J Sports Med 45(11): 880–885.
[27]
Pelliccia A, Maron BJ (1995) Pre-participation cardiovascular evaluation of the competitive athlete: perspectives from the 30-year Italian experience. Am J Cardiol 75: 827–829.
[28]
Thompson PD (2009) Preparticipation screening of competitive athletes: seeking simple solutions to a complex problem. Circulation 119: 1072–1074.
[29]
Jones EG, Fields KB, Callaway DJ (1999) Should a history section be included on the National Youth Sports Program pre-participation physical examination? J Natl Med Assoc 91(1): 27–32.
[30]
Bulik CM, Wade TD, Heath AC, Martin NG, Stunkard AJ, et al. (2001) Relating body mass index to figural stimuli: population-based normative data for Caucasians. Int J Obes Relat Metab Disord. 25(10): 1517–24.
[31]
Villanueva EV (2001) The validity of self-reported weight in US adults: a population based cross-sectional study. BMC Public Health (1): 11.
[32]
S？derman K, Adolphson J, Lorentzon R, Alfredson H (2001) Injuries in adolescent female players in European football: a prospective study over one outdoor soccer season. Scand J Med Sci Sports 11(5): 299–304.
[33]
Kakavelakis KN, Vlazakis S, Vlahakis I, Charissis G (2003) Soccer injuries in childhood. Scand J Med Sci Sports 13(3): 175–178.
[34]
Peterson L, Junge A, Chomiak J, Graf-Baumann T, Dvorak J (2000) Incidence of football injuries and complaints in different age groups and skill-level groups. Am J Sports Med 28(5 suppl): 51–57.
[35]
Emery CA, Meeuwisse WH, Hartmann SE (2005) Evaluation of risk factors for injury in adolescent soccer implementation and validation of an injury surveillance system. Am J Sports Med 33(12): 1882–1891.
[36]
Ahlbom A, Alfredsson L (2005) Interaction: a word with two meanings creates confusion Eur J Epidemiol. 20(7): 563–564.
