A prospective cohort study was used to quantify risk factors for sports concussions. Analysis was based on a stratified cluster sample of North Carolina high school athletes followed during 1996-1999. Clustering was by school and sport, and the sample included 15,802 athletes with 1-8 seasons of follow-up per athlete. Concussion rates were estimated for 12 sports, and risk factors were quantified using generalized Poisson regression. Concussion rates ranged from 9.36 (95% confidence interval: 1.93, 16.80) per 100,000 athlete-exposures in cheerleading to 33.09 (95% confidence interval: 24.74, 41.44) per 100,000 athlete-exposures in football, where "athlete-exposure" is one athlete participating in one practice or game. The overall rate of concussion was 17.15 (95% confidence interval: 13.30, 21.00) per 100,000 athlete-exposures. Cheerleading was the only sport for which the practice rate was greater than the game rate. Almost two thirds of cheerleading concussions involved two-level pyramids. Concussion rates were elevated for athletes with a history of concussion, and they increased with the increasing level of body contact permitted in the sport. After adjustment for sport, body mass index, and year in school, history of concussion(s) remained a moderately strong risk factor for concussion (rate ratio = 2.28, 95% confidence interval: 1.24, 4.19). The fact that concussion history is an important predictor of concussion incidence, even in this young population, underscores the importance of primary prevention efforts, timely identification, and careful clinical management of these injuries.

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Sports-related injuries are an issue of concern in high school sports athletes. A prospective cohort study of injury risk factors was conducted from 1996 to 1999 among varsity high school athletes in 12 sports in 100 North Carolina high schools. Data were collected by trained school personnel. Unadjusted and adjusted incidence rates and rate ratios were estimated using Poisson regression models. The overall rate of injury was 2.08 per 1,000 athlete-exposures (95% confidence interval (CI): 1.79, 2.41). At 3.54 per 1,000 athlete-exposures (95% CI: 2.87, 4.37), football had the highest rate of injury of all sports. The adjusted rate ratio for athletes with a history of injury, compared with those without a prior injury, was 1.94 (95% CI: 1.69, 2.22). The injury rate rose with each year of playing experience (rate ratio=1.06, 95% CI: 1.01, 1.12). In a subanalysis restricted to gender-comparable sports, boys had a higher rate of injury than did girls (rate ratio=1.33, 95% CI: 0.99, 1.79). All other factors did not appear to be independent predictors of the injury rate. The influence of prior injury suggests that proper rehabilitation and primary prevention of the initial injury are important strategies for injury control.

ObjectiveTo test the efficacy of a weight loss intervention designed to appeal to men.Design and methodsA randomized trial tested the efficacy of the REFIT (Rethinking Eating and FITness) weight loss program compared to a waitlist control. The six-month intervention was delivered via two face-to-face sessions followed by Internet contacts. REFIT encouraged participants to create calorie deficits by making six 100-calorie changes to their eating daily while increasing physical activity and the program encouraged customization through selection of specific diet strategies evaluated each week.ResultsParticipants (N=107, 44.2 years, 31.4 kg/m2, 76.6% white) were randomized into the study and 90.6% provided data at six months. REFIT participants lost -5.0 kg (95% CI: -6.1, -3.9) at three months, which was maintained through six months (-5.3 kg, 95% CI: -6.5, -4.2); this was greater than the control group (p<0.001; 6-month: -0.6, 95% CI: -1.8, 0.5). More REFIT participants (49%) achieved a 5% weight loss than control participants (19%; OR 9.4; 95% CI: 3.2, 27.4). An average of 11.2 (±2.7) of 13 of the online intervention contacts were completed.ConclusionsThe novel REFIT intervention produced clinically significant weight losses. This approach holds promise as an alternative to traditional behavioral therapy for men.

Teens are exposed to multiple hazards, use dangerous equipment despite federal prohibitions, and work long hours during the school week. They also lack consistent training and adult supervision on the job. It is important for adolescent medicine practitioners to become involved in prevention efforts through both anticipatory guidance and policy advocacy.

Objective: To estimate the economic cost of injuries in a population of US high school varsity athletes. Design and Setting: The North Carolina High School Athletic Injury Study, conducted from 1996 to 1999, was a prospective cohort study of injury incidence and severity. A two-stage cluster sampling technique was used to select athletic teams from 100 high schools in North Carolina. An injury cost model was used to estimate the economic cost of injury. Participants: Varsity athletes from 12 sports: football, girls' and boy's soccer, girls' and boys' track, girls' and boy's basketball, baseball, softball, wrestling, volleyball, and cheerleading. Main outcome measures: Descriptive data were collected at the time of injury. Three types of costs were estimated: medical, human capital (medical costs plus loss of future earnings), and comprehensive (human capital costs plus lost quality of life). Results: The annual statewide estimates were $9.9 million in medical costs, $44.7 million in human capital costs, and $144.6 million in comprehensive costs. The mean medical cost was $709 per injury (95% CI $542 to $927), $2223 per injury (95% CI $1709 to $2893) in human capital costs, and $10 432 per injury (95% CI $8062 to $13 449) in comprehensive costs. Sport and competition division were significant predictors of injury costs. Conclusions: Injuries among high school athletes represent a significant economic cost to society. Further research should estimate costs in additional populations to begin to develop cost-effective sports injury prevention programs.

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