• Sarah B Knowles, Stephen W Marshall, Michael J Bowling, Dana Loomis, Robert Millikan, Jinzhen Yang, and Frederick O Mueller.
• Department of Epidemiology, School of Public Health, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. knowless@pamfri.org
• Epidemiology. 2009 Mar 1; 20 (2): 302-10.

BackgroundFootball is the most popular interscholastic high school sport in the United States. Prior research has described a higher rate of injury among high school football players than in other sports, but few studies have examined potential predictors while controlling for other risk factors.MethodsUsing a 2-stage cluster sampling technique, we conducted a prospective cohort study from 1996 to 1999 among varsity athletes from 12 sports in 100 North Carolina high schools. A total of 3323 football players participated. Injury exposure and risk factor data were collected by trained school personnel. Incidence rates, rate ratios, and odds ratios (ORs) were estimated using Poisson and logistic regression.ResultsThere were 1064 injured athletes and 1238 injuries; 106 injuries resulted in greater than 3 weeks lost from participation. The overall incidence rate was 3.54 per 1000 athlete-exposures (95% confidence interval [CI] = 3.31-3.78). The rate of game injury was 9 times that of practice injury (OR = 9.2; 95% CI = 6.6-11). Athletes with a prior injury had twice the injury rate of those without (1.9; 1.5-2.4). Among those injured, having a coach with more experience, qualifications, and training was associated with half the odds of severe injury (0.49; 0.27-0.92).ConclusionsPrior injury, additional years of playing experience, and older age were predictors of injury incidence after controlling for multiple risk factors. A high level of coaching skills did not reduce the injury rate, but was protective against severe injury.

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