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Risky health behaviors of female intercollegiate varsity athletes and their nonathlete peers were compared. Five hundred seventy-one female university students (109 athletes and 462 nonathlete peers) at two midwestern universities completed a self-administered, anonymous questionnaire during team meetings or class sessions. Each athlete was matched with two nonathlete controls of similar age, ethnicity, and class year to test for dichotomous outcome variables. A human immunodeficiency virus (HIV) risk scale was developed to identify factors associated with increased HIV risk for all of the female participants. Measures of alcohol and other drug use were associated with HIV risk. The athletes were found to engage in significantly fewer risk-taking behaviors than the nonathletes and to be at less risk for HIV. High levels of risk behaviors generally indicated the need for increased efforts to change risky behaviors in all college women.

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OBJECTIVE: Winconsin high school wrestlers were surveyed 1 year before (90W) and 2 years after (93W) a new program was implemented to restrict weight loss for competition. The Wisconsin wrestling minimal weight program (WMWP) included a minimal weight limit determined from percent body fat and a nutrition education program. DESIGN: A retrospective survey of wrestlers was conducted, with schools stratified to reflect school size and quality of the wrestling program. PARTICIPANTS: Respondents surveyed in 1990 included 713 wrestlers from 45 schools; 368 wrestlers from 29 of the same schools responded to an identical survey in 1993. MAIN OUTCOME MEASURES: Measures of weight-cutting practices, weight-loss methods, bulimic behaviors, and nutritional knowledge. RESULTS: The most weight lost (MWL), the weight lost to certify (WLC), the weekly weight cycled (WWC), the longest fast (LF), and the frequency of cutting weight (FCW) all decreased significantly (chi 2, p < 0.05) among 93W wrestlers compared with 90W wrestlers. The results for the 90W group are as follows: MWL, 3.2 kg +/- 2.6; WLC, 2.8 kg +/- 2.8; WWC, 1.9 kg +/- 1.5; LF, 20.5 hours +/- 17.2; FCW, 6.2 +/- 6.4. The results for the 93W group are as follows: MWL, 2.6 kg +/- 2.6; WLC, 2.4 kg +/- 2.9; WWC, 1.6 kg +/- 1.4; LF, 16.5 hours +/- 15.6; FCW, 4.7 +/- 6.7. Weight-loss methods, including restricting food or fluids and use of rubber suits, declined significantly (chi 2, p < 0.05). Wrestlers exhibiting more than one of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R)-related bulimic behaviors decreased by 11% (chi 2, p < 0.05), but those exhibiting all five (1.6%) remained the same. CONCLUSIONS: The results suggest that the WMWP appeared to reduce unhealthy weight-loss behaviors among high school wrestlers. Other states should be encouraged to institute similar programs as recommended by the American Medical Association and the American College of Sports Medicine.

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An athlete may think that if a small amount of a chemical helps his or her performance, more will work better. The most appealing supplements are those that claim to help build muscle, improve endurance, and reduce body fat. Widespread acceptance of herbal of "natural" alternatives to mainstream medicine (especially nutritional supplements) is increasing, and the market is largely unregulated. The authors summarize the facts and fiction surrounding the use of popular products that may be found at the pharmacy and health food store that are being used in the locker rooms of high schools, colleges, and gyms in the U.S. They urge clinicians to stress the value of a well balanced diet to their active adolescent patients and not to encourage supplement use.

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Determining the mechanism of injury is often helpful in making the diagnosis during the evaluation of the acutely injured knee. A few injuries require immediate orthopedic referral such as fractures, evidence of more than one sprained ligament, or neurovascular compromise. Most patients with acute knee injuries can be treated initially with crutches, ice, and analgesics. The key to rapid recovery of most injuries is a diligent rehabilitation program.

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OBJECTIVES: To (a) determine the prevalence of alcohol and other drug use, and health risk behaviors among a general university population; and (b) compare health risk-taking behaviors between genders, and varsity athletes and their non-athlete peers. DESIGN: Descriptive survey of multiple health risk behaviors, including physical, mental health, alcohol and other drug, and sexual risk taking. SETTING: Two large midwestern universities. PARTICIPANTS: A convenience sample of 86% of 1,210 eligible students (271 athletes and 775 nonathlete peers) completed a self-administered, anonymous questionnaire during team meetings or class sessions. INTERVENTION: None. MAIN OUTCOME MEASURES: Differences between gender and athlete status were assessed using Cochran-Mantel-Haenszel statistics for the following variables, determined by questionnaire responses: physical risk, mental health, alcohol and other drug use, and sexual behaviors. RESULTS: Common risk behaviors in the entire collegiate sample included riding in a car with a driver who was under the influence of alcohol, driving and swimming under the influence of alcohol, binge drinking, and low rate of condom use for all types of sexual intercourse. Risk-taking behaviors varied by gender, with men showing more risk behaviors than women, except for suicide and sexual behaviors. Male athletes had a higher prevalence of risk behaviors than their male nonathlete counterparts, in contrast to female athletes, who had fewer risk behaviors than their female nonathlete counterparts. CONCLUSION: In contrast to previous studies, results of the present study show, when results are stratified by gender, that not all athletes engage more frequently than nonathletes in high risk behaviors. Results suggest that educational and early intervention strategies to decrease risk may need to be tailored according to gender and athletic status.

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Despite a growing body of evidence admonishing the behavior, weight cutting (rapid weight reduction) remains prevalent among wrestlers. Weight cutting has significant adverse consequences that may affect competitive performance, physical health, and normal growth and development. To enhance the education experience and reduce the health risks for the participants, the ACSM recommends measures to educate coaches and wrestlers toward sound nutrition and weight control behaviors, to curtail "weight cutting," and to enact rules that limit weight loss.

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OBJECTIVES: To assess how sports medicine is taught within pediatric residency programs and to determine the level of comfort that pediatric graduates have in managing common sports injuries. INTERVENTION: Investigator-prepared cross-sectional survey. METHOD: A survey questionnaire was mailed to 203 pediatric chief residents of pediatric residency programs in the United States. MEASUREMENTS/MAIN RESULTS: Seventy-three percent of the questionnaires were returned. Most pediatric chief residents (73%) reported that their program provided lectures on pediatric sports medicine topics. Lecture time devoted to sports medicine topics was reported to be less than 6 hours for many residency programs (83%). Instruction on the medical criteria for exclusion from sports was provided to 64% of the chief residents. Of those residents who completed the survey, 55% reported that clinical sports medicine training was available in their programs. Rotations in adolescent medicine (28%), pediatric orthopedics (26%), and ambulatory pediatrics (9%) provided the bulk of clinical training. Clinical exposure to sports medicine was reported to be less than 5 hours in a large number of programs (43%). Most of the chief residents reported that they would refer six of eight pediatric sports injuries for diagnosis and management. CONCLUSIONS: The pediatric chief residents who completed the survey received limited didactic instruction or clinical training in sports medicine. Because pediatricians are primary care physicians for many children and adolescents who participate in sports, pediatric residency directors should consider integrating sports medicine instruction into their programs.

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In the context of sport, an ergogenic aid can be broadly defined as a technique or substance used for the purpose of enhancing performance. Ergogenic aids have been classified as nutritional, pharmacologic, physiologic, or psychologic and range from use of accepted techniques such as carbohydrate loading to illegal and unsafe approaches such as anabolic-androgenic steroid use. The efficacy of many of these techniques is controversial, whereas the deleterious side effects are clear. The purpose of this article is to review the epidemiology, administration, efficacy, pharmacology, and side effects of commonly used ergogenic aids. Physical therapists should be able to recognize the signs of ergogenic aid abuse in individuals under their care, and they should be aware of the side effects of these aids. Moreover, the physical therapist can serve as a resource for those individuals seeking information on the risks and benefits of ergogenic aids.

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Injuries to a skeletally immature athlete are common, but most of the injuries do not have long-term implications. There is no risk-free sport, and children tend to select the sports they wish to participate in based on their own desire, peer pressure, and their own talent regardless of the injury rate. Both acute and overuse injuries may occur. Open physes and apophyses represent unique structures that may be injured in this population. Prompt and proper identification of many of these injuries may allow the young athlete a relatively timely return to sports competition or recreation. Pediatricians and other primary care providers can make an active commitment to youth sports by learning more about these common sports-related injuries and becoming team physicians or joining local sports medicine advisory councils.

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Considerable energy and money are being spent on drug screening nationally, both in the workplace and the athletic arena. Many legal questions remain unanswered because there are so many different kinds of drug screening programs, and many of the issues have not been tested in court. Unfortunately, there is not a "gold standard" for screening for AOD in student-athletes or in any other setting. The efficacy and detrimental effects of drug screening on student athletes has not been examined in any scientific fashion, and further longitudinal studies are needed to determine efficacy.

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Three collegiate athletes tested positive for morphine after a championship competition; however, all three denied narcotic use. The medical team was stumped until the coach suggested a food source. Reviewing the literature and recreating the scenario helped identify the cause.

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OBJECTIVE: To determine the sensitivity and specificity of the 2-minute, 12-step, orthopedic screening examination. DESIGN: Prospective, single-blind study. SETTING: National Collegiate Athletic Association Division 1 athletics program. PARTICIPANTS: Two hundred fifty-nine male and female varsity athletes. INTERVENTIONS: The athletes were screened by five primary care physicians who were "blind" to each patient's history. The athletes were then evaluated by a team of orthopedic surgeons who had knowledge of each patient's history. Significant injuries were injuries that would limit participation, predispose to injury, or need further evaluation or rehabilitation. MAIN RESULTS: A total of 120 significant injuries were identified by compiling the results of the history and both physical examinations. Of the significant injuries, 91.6% were detected by history alone. Fourteen of the significant injuries were missed by the detailed orthopedic examination, but they were detected by the screening examination. The overall sensitivity of the screening examination compared with the results of all three methods was 50.8%, with a specificity of 97.5%, positive predictive value of 40.9%, and negative predictive value of 98.3%. Almost half of the false-positive screening findings were shoulder asymmetries. CONCLUSIONS: Even in mass screenings, the screening orthopedic examination should be used only in conjunction with an orthopedic history. Some modifications may improve the sensitivity of the screening examination.

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Wrestlers are known for their extreme weight-cutting practices including fasting, food and fluid restriction, and dehydration. Using a stratified statewide survey, this investigation elucidated weight loss practices, nutritional knowledge, and bulimic behaviors among 713 high school wrestlers in Wisconsin. Results showed that 1.7% of the wrestlers answered questions consistent with all five criteria for bulimia nervosa, a rate higher than expected for adolescent males. An additional 43% exhibited weight-cutting practices similar to those of the wrestlers who met all bulimia nervosa criteria. The average wrestler lost 3.2 kg to compete, cycled 1.8 kg weekly, and fasted 20 hours prior to weigh-in. More extreme behaviors occurred among the 45% who met two or more bulimia nervosa criteria on their questionnaire; 19% frequently fasted, 25% restricted fluids, 34% used rubber suits, and 8% vomited. These results are comparable with data published over the past 20 years. Efforts to curtail these behaviors through regulations restricting weight loss coupled with sound nutritional information are warranted. Physicians and health professionals should be alert to potential eating disorders within this population.

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When a physician disqualifies an athlete based on theoretical deleterious effects, he is doing so based on the perception that the risk of participation is sufficient to override the athlete's desire to participate (4). If sports participation is very important to the athlete, the sports physician should determine what interventions might reduce the risk of participation. Rather than look for reasons for disqualification, the team physician should look for ways for the athlete to participate more safely and reduce the risk of injury. (If the risk of participation is too high, the athlete should be disqualified.) In this case an aggressive shoulder rehabilitation program and prompt follow-up of his asthma and anemia would have been helpful to this athlete's participation in football. In general, team physicians should weigh all the potential risks and benefits in each case and involve the athlete and the family when these difficult playability issues arise. The team physician should be mindful of potential conflicts of interests and should be careful to avoid imposing his or her own values on the athlete. In this case, the disqualification of this athlete based on obesity was not in his best interest. Whether the potential conflicts in decision making played a role in the decision in this case will never be known. Weighing the facts as presented, I believe the athlete's interests would have been better served by allowing him to play after completing a shoulder rehabilitation program.

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Physical exercise is traditionally considered beneficial in the treatment of IDDM. Attainment and maintenance of ideal body weight, improvement in self-image, and decreases in hypertension and lipid-related cardiovascular risk factors can all be achieved by the diabetic patient who exercises. Although the value of exercise in improving long-term glycemic control remains controversial, athletic participation by individuals with IDDM is encouraged to achieve the same health benefits enjoyed by exercising nondiabetic individuals. Knowledge of the metabolic responses to exercise in IDDM patients is required for appropriate guidance and management. Careful monitoring and adjustment of insulin doses and nutrition plans can then make possible the safe and successful participation of IDDM patients in virtually any athletic activity.

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Participation in youth sports is relatively safe. Injuries become more frequent as the child gets older, bigger, and achieves higher skill levels. At the high school and collegiate levels, football has the highest injury rate followed by wrestling and gymnastics. There is no risk-free sport, and children tend to select the sports they wish to participate in without considering injury rates. Pediatricians should take an active role in injury prevention when covering sporting events as team physicians and as spectators.

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We evaluated 12 skeletally immature patients with acute, intrasubstance tears of the anterior cruciate ligament (ACL) and open physes for meniscal pathology. Arthrograms were completed in 10 of 12 patients, and subsequent arthroscopy confirmed 8 meniscal tears (4 medial, 4 lateral) in 6 patients. Four patients with repairable menisci underwent arthroscopic meniscal repair and stabilization. Eight patients received quadriceps and hamstrings rehabilitation and returned to sports with a brace. After return to sports, all braced patients developed instability with multiple episodes of "giving way." Average time from initial injury to first episode of instability was 7 months. Seven patients sustained further meniscal damage an average of 15 months (range 7-27 months) after initial injury. We conclude that meniscal pathology is commonly associated with ACL tears in skeletally immature patients and we recommend arthrography or arthroscopy to evaluate patients with suspected ACL tears. Brace management did not prevent instability or new meniscal tears.

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Anabolic steroids are capable of increasing strength and muscle bulk in certain individuals when combined with a proper diet and an intense training program. Any steroid that is anabolic is also androgenic. Anabolic steroids are fraught with numerous side effects, a few of which are potentially life threatening, and some of which are permanent. Most of the side effects are mild and reversible. Use of anabolic steroids in sports is as much a moral issue as a medical one. Drug testing has not been a very successful means to eradicate abuse in the sporting arena. Education alone is probably not the answer to stopping anabolic steroid abuse but is an essential first step in combating this problem. Use of anabolic steroids in athletes is a form of cheating, and use will likely continue, especially if the rewards for success in sports remain so high. Physicians should avoid condemning individuals who choose to use anabolic steroids and encourage discussion of use with their health providers.

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Tap water scald burns are an important topic of injury prevention in pediatricians' offices. Consecutive pediatric clinic clients, randomized to two groups, received an informational pamphlet, a one-minute discussion about tap water safety, and a baseline questionnaire. The first group also received a liquid-crystal thermometer for testing maximum hot tap water temperature. One month later in a follow-up telephone interview (n = 503), the impact of the added thermometer on knowledge regarding scalding, temperature testing, and thermostat lowering was assessed. Approximately 80% of each group read the pamphlet. Reading the pamphlet was associated with greater temperature testing in the thermometer (T) group but not in the pamphlet only (P) group. Temperatures were checked by 46.4% of the T group but by only 23.0% of the P group (P less than .001). In the households in which the reported water temperature exceeded 54.4 degrees C (130 degrees F) and the water heater was accessible, 77.3% reported lowering the setting, independent of receiving the thermometer. The reliability of self-reported water temperature was assessed after 1 year by home visits. The use of relevant facilitating devices, such as a liquid-crystal thermometer, in-office anticipatory guidance efforts may increase behavioral compliance.

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