Context: The Athletic Training Locations and Services (ATLAS) Annual Report suggested that athletic trainer (AT) employment status differed based on geographic locale. However, the influence of geographic locale and school size on AT employment is unknown. Objective: To determine if differences existed in the odds of having AT services by locale for public and private schools and by student enrollment for public schools. Design: Cross-sectional study. Setting: Public and private secondary schools with athletics programs. Patients or Other Participants: Data from 20 078 US public and private secondary schools were obtained. Main Outcome Measures(s): Data were collected by the ATLAS Project. Athletic trainer employment status, locale (city, suburban, town, or rural) for public and private schools, and school size category (large, moderate, medium, or small) only for public schools were obtained. The employment status of ATs was examined for each category using odds ratios. Logistic regression analysis produced a prediction model. Results: Of the 19 918 public and private schools with available AT employment status and locale, suburban schools had the highest access to AT services (80.1%) with increased odds compared with rural schools (odds ratio = 3.55 [95% CI = 3.28, 3.85]). Of 15 850 public schools with known AT employment status and student enrollment, large schools had the highest rate of AT services (92.1%) with nearly 18.5 times greater odds (odds ratio = 18.49 [95% CI = 16.20, 21.08]) versus small schools. The logistic model demonstrated that the odds of access to an AT increased by 2.883 times as the school size went up by 1 category. Conclusions: Nationally, suburban schools and large public schools had the greatest access to AT services compared with schools that were in more remote areas and with lower student enrollment. These findings elucidate the geographic locales and student enrollment levels with the highest prevalence of AT services.
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